【摘要】 目的乳腺癌具有明显的激素依赖性,包括雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)都可以促进乳腺癌的生长发展。本研究初步探讨乳腺癌免疫组化分子分型与新辅助化疗(neoadjuvant chemotherapy,NAC)疗效相关性。方法 2014-06-01-2016-06-30连续收治齐河县人民医院原发性乳腺癌患者168例作为研究对象。均给予NAC,观察该组患者治疗后的近期疗效,同时采用免疫组化法对化疗前后患者乳腺癌组织中ER、PR、增殖细胞核抗原(Ki-67)及人类表皮生长因子受体2(human epidermal growth factor receptor-2,HER2)表达水平变化情况进行测量,探究乳腺癌分子分型与NAC疗效相关性。结果 NAC后临床有效率为80.9%(136/168),其中完全缓解(complete response,CR)为3.0%(5/168),部分缓解(partial response,PR)为78.0%(131/168)。临床无效率为19.0%(32/168),其中疾病稳定(stable disease,SD)为17.9%(30/168),疾病进展(progressive disease,PD)为1.2%(2/168)。分子分型后发现,Luminal A型有效率为60.0%(24/40),Luminal B型HER2阴性有效率为95.2%(40/42),Luminal B型HER2阳性有效率为90.0%(44/49),三阴型有效率为76.2%(16/21),HER2过表达型有效率为75.0%(12/16),Luminal B型临床有效率明显高于其他分子分型,差异有统计学意义,P<0.01。NAC前后ER改变率为14.3%(24/168)。PR改变率为19.6%(33/168)。HER2改变率为3.0%(5/168)。Ki-67总的改变率为26.2%(44/168)。但NAC前后ER、PR、HER2和Ki-67改变差异无统计学意义,P>0.05。结论 NAC的有效率与ER、PR、HER2相关但差异无统计学意义,而与Ki-67的增殖指数呈正相关。NAC可以改变ER、PR和HER2和Ki-67的状态,但改变趋势不明确,ER、PR、HER2和Ki-67的改变与NAC疗效无相关性。更多还原

【Abstract】 OBJECTIVE Breast cancer has obvious hormone dependence.Estrogen receptor(ER),progesterone receptor(PR)and androgen receptor can promote the development of breast cancer.This study was to investigate and analyze the relationship of immunohistochemical molecular typing of breast cancer and neoadjuvant chemotherapy efficacy.METHODS From June 16,2014 to June 30,2016,168 consecutive patients with primary breast cancer from Shandong were enrolled in this study and patients were given NAC treatment to observe the short-term efficacy after treatment.By using immunohistochemistry,ER,PR,proliferating cell nuclear antigen(Ki-67)and human epidermal growth factor receptor 2(human epidermal growth factor receptor-2,HER2)expression levels in patients with breast cancer before and after treatment were measured to explore the molecular relationship between breast cancer and neoadjuvant chemotherapy efficacy.RESULTS The clinical effective rate after NAC was 80.9%(136/168).The CR was 3.0%(5/168)and PR was78.0%(131/168).The clinical inefficacy was 19.0%(32/168),of which SD was 17.9%(30/168)and PD was 1.2%(2/168).After molecular typing,it was found that the effective rate of Luminal A was 60.0%(24/40),the positive rate of Luminal B HER2 was 95.0%(40/42),the positive rate of Luminal B HER2 was 90.0%(44/49),the effective rate of triple negative was 76.2%(16/21),and the effective rate of HER2 overexpression was 75.0%(12/16).The clinical efficacy of Luminal B was significantly higher than that of other molecular types.The difference was statistically significant(P<0.01).The change rate of ER before and after NAC was 14.3%(24/168).The rate of change of PR was 19.6%(33/168).The rate of change of HER2 was 3.0%(5/168).The overall rate of change of Ki-67 was 26.2%(44/168).However,the changes of ER,PR,HER2 and Ki-67 before and after NAC were not statistically significant(P>0.05).CONCLUSIONS There is no significant correlation between the effective rate of NAC and ER,PR,HER2,but a positive correlation with the proliferation index of Ki-67(P<0.05).NAC can change the status of ER,PR,HER2 and Ki-67,but the change trend is not clear.The changes of ER,PR,HER2 and Ki-67 have no correlation with the efficacy of NAC.更多还原