乳腺癌新辅助化疗前后ER、PR、HER-2、EGFR、CK5/6的表达及预测化疗效果的意义

目的：观察乳腺癌新辅助化疗（neoadjuvant chemotherapy,NAC）前后雌激素受体（ER）,孕激素受体（PR）、人类表皮生长因子受体2（HER-2）、细胞角蛋白5/6（CK5/6）、表皮生长因子受体（EGFR）表达及对化疗疗效的预测价值.方法：收集82例确诊为乳腺浸润性导管癌的病例,临床Ⅱa～Ⅲb期,取NAC前后乳腺癌灶组织,应用免疫组织化学（IHC） Envision二步法检测ER、PR、HER-2、EGFR及CK5/6的表达水平,并将指标表达情况与化疗效果进行对比,评价其对化疗效果的预测价值.结果：7例患者化疗后达病理完全缓解（pCR）不能进行IHC检测,其余75例患者在NAC前后ER、PR、HER-2、EGFR、CK5/6的表达变化差异无统计学意义,完全缓解（CR）8例,部分缓解（PR）61例,客观有效率（CR＋ PR）84.1％ （69/82）,疾病稳定（SD）7例,无疾病进展（PD）病例;ER（＋）组与ER（-）组、PR（＋）组与PR（-）组化疗疗效差异具有统计学意义（P＜0.05）,但HER-2（＋）组与（-）组、EGFR（＋）组与EGFR（-）组、CK5/6（＋）组与CK5/6（-）组的化疗有效率差异均无统计学意义（P＞0.05）.结论：NAC前后ER、PR、HER-2、EGFR及CK5/6表达变化对乳腺癌化疗效果判断的参考意义不大,NAC前ER、PR阳性的乳腺癌病人对化疗更敏感,二者可作为预测化疗疗效的指标.

Expression of ER,PR, HER-2, EGFR and CK5/6 in Breast Cancer Tissue before and after Neoadjuvant Chemotherapy and Its Significance in Predicting Chemotherapeutic Effects

Objective：To observe the expression of estrogen receptor （ER）,progesterone receptor （PR）,human epidermal growth factor receptor 2 （HER-2）,cytokeratin 5/6 （CK5/6）,epidermal growth factor receptor （EGFR） before and after neoadjuvant chemotherapy （NAC） in breast cancer tissue,to understand the possible value of the molecular targets in predicting chemotherapeutic effects.Methods：Eighty-two patients with breast infiltrating ductal carcinoma,clinical stage Ⅱ a ～ Ⅲ b,were selected.Immunohistochemistry was employed to detect the expression levels of ER,PR,HER-2,EGFR and CK5/6 in breast cancer tissues before and after neoadjuvant chemotherapy.The test results were compared with chemotherapeutic effects.Results：Immunohistochemical detection could not be carried out in 7 cases who obtained pathological complete response （pCR） after chemotherapy.No significant difference was found in ER,PR,HER-2,EGFR and CK5/6 expression levels of the other 75 cases before and after NAC.There were 8 complete remission （CR） cases,60 partial remission （PD） cases and 7 cases stable （SD） cases,and there was no case with progressive disease （PD）.The objective effective rate （CR ＋ PR） was 84.1％ （69/82）.The differences of chemotherapeutic effects were statistically significant between ER （＋） and ER （-） group as well as between） R （＋） and PR （-） group （P ＜ 0.05）,but there was no significant difference in chemotherapeutic effects between Her-2 （＋） and Her-2 （-） group,between EGFR （＋） and EGFR （-） group as well as between the CK5/6 （＋） and the CK5/6 （-） group （P ＞0.05）.Conclusions：The expression changes of ER,PR,HER-2,EGFR and CK5/6 has little meaning in predicting chemotherapeutic effects of breast cancer; Breast cancer patients who express ER and PR positively are more sensitive to chemotherapy,both of them may be molecular indicators for forecasting the chemotherapeutic effects.