表皮生长因子受体、p53、Ki-67在三阴性乳腺癌中的表达及其意义

目的 探讨表皮生长因子受体（EGFR）、p53、Ki-67在三阴性乳腺癌（TNBC）中的表达及其意义.方法 回顾性分析53例TNBC和128例非三阴性乳腺癌（NTNBC）临床病理特征,并应用免疫组织化学方法检测EGFR、p53、Ki-67在两者之间的表达差异.结果 TNBC与NTNBC淋巴结转移发生率差异无统计学意义[56.6％（30/53）比43.0％（55/128）,P＞0.05],组织学Ⅰ级[9.4％（5/53）与32.8％（42/128）]、Ⅲ级[50.9％（27/53）与22.7％（29/128）]所占比例差异有统计学意义（P＜0.05）;TNBC中浸润性小叶癌较少[5.7％（3/53）],髓样癌较多[15.1％（8/53）],与NTNBC [19.5％（25/128）、3.1％（4/128）]相比差异有统计学意义（P＜0.05）;EGFR、p53、Ki-67在TNBC与NTNBC中的表达率分别为62.3％（33/53）与25.0％（32/128）、71.7％（38/53）与47.7％（61/128）、84.9％（45/53）与70.3％（90/128）,差异均有统计学意义（均P＜ 0.05）.结论 TNBC有其独特的临床病理特征,EGFR、p53、Ki-67在TNBC中高表达,提示其恶性程度高,侵袭性强,预后差,EGFR、p53、Ki-67表达可以作为评估TNBC预后的重要参考因素.     

系统免疫炎性反应指数对乳腺癌新辅助化疗病理完全缓解的预测作用及其与p53的关系

目的 探讨系统免疫炎性反应指数（SII）对乳腺癌新辅助化疗（NAC）病理完全缓解（pCR）的预测作用及其与p53的关系。方法 回顾性分析387例接受新辅助化疗及手术的女性乳腺癌患者临床病理资料。Logistic回归模型进行单因素和多因素分析。结果 72例（18.6%）患者接受新辅助化疗后获得了pCR,其中低SII组48例,高SII组24例;p53阴性组39例,阳性组33例。单因素分析显示：pCR与临床T分期、激素受体（HR）状态、人表皮生长因子受体2（HER2）、Ki67值、分子分型、p53及SII相关（均P<0.05）;多因素分析显示：临床T分期、Ki67值、分子分型、p53及SII是影响乳腺癌患者pCR的独立预测因素。p53阴性的低SII组患者pCR率高于其他组。结论 SII是乳腺癌新辅助化疗病理完全缓解的独立预测因素,具有简单方便及重复性高等特点,p53阴性的低SII组患者pCR率高。     

Ki-67对三阴性乳腺癌新辅助化疗敏感性预测作用的Meta分析

目的:评价新辅助化疗中Ki-67的表达情况对三阴性乳腺癌(TNBC)获得病理完全缓解(pCR)的预测作用。方法:通过互联网检索相关文献,应用Review Manager软件对数据进行处理,系统评价Ki-67表达情况与TNBC在新辅助化疗中获得pCR的关系。结果:Ki-67基因高表达的TNBC患者pCR率明显高于Ki-67基因低表达的TNBC患者,总体合并优势比(OR)为7.35,95%CI:2.39～22.60,文献之间无明显异质性,无明显发表偏倚。结论:Ki-67可作为新辅助化疗中预测TNBC化疗敏感性的标志。     

系统免疫炎症指数与Luminal B型乳腺癌新辅助化疗病理完全缓解的关系

摘 要：［目的］ 探讨系统免疫炎症指数（systemic inflammation index,SII）与Luminal B型乳腺癌新辅助化疗病理完全缓解（pathological complete response,pCR）的关系。［方法］ 回顾性分析2015年1月至2017年1月在哈尔滨医科大学附属肿瘤医院198例接受新辅助化疗及手术的女性Luminal B型乳腺癌患者的临床病理资料。采用Logistic回归模型进行单因素和多因素分析SII与pCR的关系。［结果］ 37例患者获pCR,低SII组25例,高SII组12例,SII与pCR相关（P=0.018）。单因素分析显示：与Her-2阴性者相比,阳性者pCR更高(P<0.001);与Ki-67≤14%者相比,Ki-67＞14%者更易达到pCR(P=0.024);与低SII组相比,高SII组更难达到pCR(P=0.020)。多因素分析显示：与低SII组相比,高SII组较难获得pCR(P=0.019);与Her-2阴性者相比,Her-2阳性者pCR率更高(P=0.024);与Ki-67≤14%者相比,Ki-67＞14%者pCR率更高(P=0.019)。 亚组分析显示：在低SII组中Luminal B/Her-2(+)亚组患者pCR率更高（χ2=9.764,P=0.002）;在高SII组中Luminal B/Her-2(+)亚组患者pCR率更高,但差异无统计学意义（χ2=3.556,P=0.059）。［结论］ SII值、Ki-67值及Her-2状态是Luminal B型乳腺癌新辅助化疗后pCR的独立预测因素,低SII且Luminal B/Her-2(+)组pCR率更高,与预后相关性有待进一步研究。     

乳腺癌新辅助化疗疗效及其与生物标志物检测水平变化的相关性

目的:探讨乳腺癌新辅助化疗疗效及其与生物标志物检测水平变化的相关性。方法:通过对乳腺癌新辅助化疗患者疗效的评估以及空心针穿刺标本和手术标本的免疫组织化学染色比较,分析新辅助化疗疗效与生物标志物改变情况,以及二者的关系、影响因素。结果:在76例新辅助化疗的患者中,达到病理完全缓解（pCR）的患者有14例(18.4%),临床有效率达75.00%。对新辅助化疗疗效的相关因素分析,发现雌激素受体（ER）、孕激素受体（PR）状态与疗效相关（P均<0.05）。进一步对14例达到pCR患者的生物标志物进行分析,ER阴性的患者有10例(71.4%)、PR阴性的患者有9例(64.3%)。对比生物标志物,发现新辅助化疗患者Ki-67改变差异有统计学意义（P＜0.05）,而ER、PR、p53改变情况差异无统计学意义（P均＞0.05）。结论:新辅助化疗具有较高的临床缓解率,新辅助化疗疗效与ER、PR状态有关,ER、PR表达较弱者相对较容易达到pCR,并且新辅助化疗后患者生物标志物只有Ki-67改变。     

Ki-67与乳腺癌临床病理特征及新辅助化疗疗效的相关性

目的：分析Ki-67与乳腺癌临床病理特征对新辅助化疗（neoadjuvant chemotherapy,NCT）疗效和预后的影响,探讨NCT疗效的预测因素。方法用免疫组化法检测320例局部晚期乳腺癌患者癌组织中ER、PR、HER-2及Ki-67表达状况。进行NCT 4～6个周期后手术。分析临床病理特征与病理完全缓解率（patho-logic complete response,pCR）之间的关系。临床病理参数与疗效分析用χ2检验,影响预后因素用Cox多因素回归分析。结果 Ki-67表达与ER（r=－0.174,P=0.002）和PR（r=－0.132,P=0.019）呈负相关,与HER2（r=0.140, P=0.012）和乳腺肿瘤大小（r=0.132,P=0.019）呈正相关;ER阴性组pCR率显著高于ER阳性组（26.9%vs 7.4%,χ2=22.761,P=0.000）;PR阴性组pCR率显著高于阳性组（22.7%vs 10.9%,χ2=7.950,P=0.005）;Ki-67高表达组pCR率18.0%（41/228）优于Ki-67低表达组8.6%（8/92）（χ2=4.552,P=0.033）;化疗后Ki-67表达下降组pCR率19.8%（48/243）优于未下降组1.3%（1/77）（χ2=15.356,P=0.000）;各分子亚型间化疗疗效差异显著,Luminal A型pCR率为1.4%（1/71）,Luminal B型pCR率为15.3%（25/163）,HER2过表达型pCR率为31.3%（14/45）,三阴性型pCR率为22.0%（9/41）（χ2=20.639,P=0.000）;用Kaplan-Meier法进行生存分析,Ki-67低表达组无病生存时间（DFS）和总生存时间（OS）均优于Ki-67高表达组,两者均为P=0.034。结论 Ki-67高表达患者对化疗更敏感,但预后较差。化疗前Ki-67的表达和化疗后Ki-67变化是影响DFS独立的预后因素。ER、PR、Ki-67指数及分子分型可以作为NCT疗效的预测指标,Ki-67指数与ER、PR、HER2之间存在相关性。     

乳腺癌组织p53和Ki-67表达及其与新辅助化疗关系的研究

目的:对照观察乳腺癌患者新辅助化疗前后p53和Ki-67的表达及其变化,分析与化疗疗效的关系,并探讨其发生机制.方法:对70例经ET方案(表柔比星,紫杉醇)新辅助化疗的可手术乳腺癌患者,采用IHC法分别测定化疗前后p53和Ki-67的表达情况,与化疗疗效相对照.结果:本组患者新辅助化疗后,有效率为87.1%(61/70);p53化疗前后的表达分别为40%(28/70)和39.7%(25/63),Ki-67化疗前后的表达率分别为67.1%(47/70)和23.8%(15/63);p53阳性表达,化疗有效率明显低于阴性表达,P=0.013; Ki-67阳性表达者,化疗效果明显优于阴性表达者,P=0.021; Ki-67阳性表达率经新辅助化疗后明显降低(P=0.000),p53无明显变化.结论:ET方案新辅助化疗有较好的疗效;p53和Ki-67的表达无明显相关性;新辅助化疗后Ki-67阳性表达呈下降趋势,p53无明显变化;p53阴性,Ki-67阳性表达者显示出较好的疗效;经新辅助化疗后Ki-67下降者疗效好.     

三阴性乳腺癌组织p53和Ki-67及E-cadherin的表达及其意义

目的:探讨p53、Ki-67和E-cad-herin在三阴性乳腺癌(TNBC)组织中的表达及在预后中的意义。方法:42例TNBC患者为TNBC组,随机抽取同期非TNBC42例为对照组,统计2组p53、Ki-67和E-cadherin的表达。结果:p53在TNBC组的表达率为76.19%(32/42),对照组为54.76%(23/42),差异有统计学意义,P=0.039。Ki-67在TNBC组的表达率为85.71%(36/42),对照组为61.90%(26/42),差异有统计学意义,P=0.013。E-cadherin在TNBC组的表达率为45.24%(19/42),对照组为66.67%(28/42),差异有统计学意义,P=0.048。结论:p53、Ki-67的高表达和E-cadherin的低表达与TNBC预后差密切相关。     

Ki-67、CDK4表达与中晚期乳腺癌新辅助化疗效果的相关性分析北大核心

目的:分析Ki-67核抗原(Ki-67)、CDK4表达与中晚期乳腺癌新辅助化疗(NACT)效果的相关性。方法:回顾性选取2016年4月至2018年6月我院的中晚期乳腺癌患者70例,均于新辅助化疗后实施手术,依据化疗效果分为有效组、无效组,采用免疫组化法检测两组化疗前Ki-67、CDK4表达水平,比较不同Ki-67、CDK4表达水平患者病理完全缓解率(pCR)、2年复发转移情况。结果:有效组Ki-67高表达率、CDK4阳性率高于无效组(P<0.05);Ki-67高表达患者pCR率高于Ki-67低表达者,CDK4高表达者pCR率高于CDK4低表达者(P<0.05);Kaplan-Meier曲线显示,Ki-67低表达的乳腺癌患者2年复发转移率低于Ki-67高表达者(P<0.05),CDK4高表达的乳腺癌患者2年复发转移率与CDK4低表达者无明显差异(P>0.05);Spearman相关分析显示,乳腺癌患者Ki-67、CDK4表达变化与化疗效果呈正相关(r=0.569、0.481,P<0.05)。结论:Ki-67、CDK4高表达的乳腺癌患者经NACT后获得pCR率更高,化疗疗效更优,但Ki-67高表达者预后较差,CDK4表达情况与预后相关性不大。     

影响乳腺癌新辅助化疗后病理完全缓解的临床因素分析

目的:探讨影响乳腺癌新辅助化疗后病理完全缓解（pathological complete response,pCR）的临床因素。方法:回顾分析新辅助化疗并行根治性手术的120例女性乳腺癌患者的临床资料;所有患者均接受6~8周期EC-T方案化疗,化疗结束后2~4周行根治性手术。采用χ2检验及 Logistic 回归分析影响pCR和非pCR的临床因素。结果:疗效结果单因素分析显示:T分期、N分期、乳腺癌分子分型、治疗前Ki-67表达水平、治疗前血小板水平与乳腺癌新辅助化疗后肿瘤pCR率显著相关。Logistic二元回归分析发现乳腺癌非Luminal分子亚型和新辅助化疗前高血小板水平是影响乳腺癌新辅助化疗后pCR的独立预测因素。结论:乳腺癌非Luminal分子亚型和新辅助化疗前高血小板水平是影响乳腺癌新辅助化疗后pCR的决定性因素。     

18F-FDG PET/CT SUVmax与乳腺浸润性导管癌临床病理特征及新辅助化疗疗效的相关性

 目的 探讨¹⁸F-脱氧葡萄糖（FDG）正电子发射计算机断层扫描（PET/CT）显像治疗前病灶最大标准摄取值（maximum standard uptake value, SUV_max）与乳腺浸润性导管癌临床病理特征的关系及与新辅助化疗疗效的相关性，以指导临床个体化治疗。方法 选取佛山市第一人民医院行¹⁸F-FDG PET/CT显像的272例初治乳腺浸润性导管癌患者的临床资料进行回顾性分析，测定原发病灶的SUV_max，分析临床病理特征、分子分型及新辅助化疗疗效与原发灶SUV_max的相关性。结果 乳腺癌原发灶的SUV_max在不同T分期、不同组织学分级、有无淋巴结转移方面差异均有统计学意义（P<0.05），雌激素受体（ER）和（或）孕激素受体（PR）阳性组与阴性组的SUV_max差异有统计学意义（P<0.05），人表皮生长因子受体2（HER2）阳性组与阴性组的SUV_max差异无统计学意义（P>0.05），Ki-67高表达者SUV_max高于低表达者（P<0.05）。Basal-like型和HER2过表达型SUV_max均高于Luminal A型乳腺癌（P<0.05）。病理完全缓解组与未达到病理缓解组SUV_max差异有统计学意义（P<0.05）。结论 ¹⁸F-FDG PET/CT SUV_max与乳腺癌的临床病理特征具有较大的相关性，原发病灶SUV_max较高者更能从新辅助化疗中获益。     

Predictive Significance of p53, Ki-67, and Bcl-2 Expression for Pathologic Complete Response after Neoadjuvant Chemotherapy for Triple-Negative Breast Cancer

Purpose

Patients with triple-negative breast cancer (TNBC) with pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) have superior survival outcomes compared to those with residual disease after NAC. This study investigated the value of three biomarkers, p53, Ki-67, and Bcl-2 for predicting pCR in NAC-treated patients with TNBC.

Methods

Between 2003 and 2012, 198 patients with pathologically confirmed primary TNBC were treated with two different taxane-based chemotherapeutic regimens prior to surgery. Before NAC, expression of p53 (cutoff 25%), Ki-67 (cutoff 10%), and Bcl-2 (cutoff 10%) was assessed immunohistochemically in core biopsy specimens. The incidence of pCR was correlated with the expression of these biomarkers.

Results

Overall, pCR occurred in 37 of the 198 patients (18.7%). A significant association was observed between the pCR rate and overexpression of the p53 and Ki-67 biomarkers. Multivariate analysis showed that only p53 expression was independently associated with pCR to NAC (odds ratio, 3.961; p=0.003). The sensitivity, specificity, positive predictive value, and negative predictive value of p53 expression for predicting pCR were 77.8%, 50.3%, 26.2%, and 90.9%, respectively. The pCR rate was the lowest (5.2%) in patients with low expression of both p53 and Ki-67, and it was the highest (25.8%) when both biomarkers showed high expression.

Conclusion

Expression of p53 was significantly associated with pCR after NAC in patients with TNBC, suggesting that this biomarker might be particularly valuable in identifying TNBC patients prone to have residual disease after NAC.     

Ki-67 can be used for further classification of triple negative breast cancer into two subtypes with different response and prognosis

Introduction

Triple negative breast cancer (TNBC) has a poorer survival, despite a higher response rate to neoadjuvant chemotherapy. The purpose of this study was to identify the predictive or prognostic value of Ki-67 among patients with TNBC treated with neoadjuvant chemotherapy, and the role of Ki-67 in further classification of TNBC.

Methods

A total of 105 TNBC patients who received neoadjuvant docetaxel/doxorubicin chemotherapy were included in the present study. Pathologic complete response (pCR) rate, relapse-free survival (RFS), and overall survival (OS) were compared according to the level of Ki-67.

Results

pCR was observed in 13.3% of patients. TNBC with high Ki-67 expression (≥10%) showed a higher pCR rate to neoadjuvant chemotherapy than TNBC with low Ki-67 expression. None of the low Ki-67 group achieved pCR (18.2% in the high Ki-67 group vs. 0.0% in the low Ki-67 group, P = 0.019). However, a high Ki-67 expression was significantly associated with poor RFS and OS in TNBC, despite a higher pCR rate (P = 0.005, P = 0.019, respectively). In multivariate analysis, high Ki-67 was an independent prognostic factor for RFS in TNBC (hazard ratio = 7.82, P = 0.002). The high Ki-67 group showed a similar pattern of recurrence with overall TNBC, whereas the low Ki-67 group demonstrated a relatively constant hazard rate for relapse.

Conclusions

TNBC with high Ki-67 was associated with a more aggressive clinical feature despite a higher pCR rate. High proliferation index Ki-67 can be used for further classification of TNBC into two subtypes with different responses and prognosis.     

Response and Long-Term Effect of Patients with Triple-Negative Breast Cancer Receiving Neo-Adjuvant Anthracycline-Based

OBJECTIVE The breast cancer lack of expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER-2) is defined as the Triple-negative breast cancer (TNBC). Our purpose is to compare the response and long-term effect of the TNBC and non-TNBC patients receiving neo-adjuvant anthracycline-based chemotherapy, and to investigate the mechanisms of TNBC affecting the survivals. METHODS Data of long-term follow-up (median, 5.4 years) of 326 patients who received neo-adjuvant chemotherapy with anthracycline-based regimen, during a period from 2000 to 2003, were analyzed. Expressions of ER, PR, HER-2, P53, Ki-67 and E-cadherin were determined using immunohistochemical staining method. A multivariate Cox regression analysis was used to analyze independent prognostic factors affecting the relapse-free survival (RFS) and overall survival (OS) rates. Clinical effects of the neo-adjuvant anthracycline-based chemotherapeutic regimen and the RFS and OS rates were compared between the patients with TNBC and non-TNBC, and the correlations among the triple- negative phenotype (TNP), tumor grading and the expressions of P53, Ki-67 and E-cadherins were analyzed. RESULTS TNP, TNM staging, histological grades, clinical response of the neo-adjuvant chemotherapy and pathological complete remission (pCR) rate were the independent prognostic factors affecting the survival rates. Furthermore, 70 (21.5%) of the 326 patients suffered TNBC. Compared with the subjects in non- TNBC group, the patients with TNBC had a significantly higher pCR rate (P=0.046) and clinical response rate (P＝0.037), but also decreased 5-year RFS (P=0.001) and OS (P=0.004) rates. The RFS and OS rates were not improved in the TNBC patients who achieved a clinical remission after the neo-adjuvant chemotherapy. The triple-negative phenotype was positively correlated with the level of P53, Ki-67 expression (P＝0.007, P＝0.028), but negatively correlated with level of E-cadherin (P＝0.034).CONCLUSION Both clinical remission rate and pCR rate of the TNBC patients receiving neo-adjuvant anthracycline-based chemotherapy are high, however, the long-term effect is poor.The mechanism may relate to a strong potential of proliferation and invasive metastasis, as well as lack of an effective therapeutic target in the TNBC patients.     

Neoadjuvant chemotherapy for triple-negative breast cancer: a meta-analysis with 7168 cases简

Objective:The pathological complete response (pCR) rates of neoadjuvant chemotherapy (NAC) in triple-nega-tive breast cancer (TNBC) was reported higher than that in non-TNBC but ranged from 12%to 48%. pCR was reported to be a predictor of long overal survival and exact pCR rate of NAC in TNBC would give us some hints on how to improve outcomes of TNBC patients. The meta-analysis was conducted to estimate the pCR rate of NAC for TNBC through contrasting the pCR rates of TNBC and non-TNBC tumors in NAC. Methods:Studies were selected from the PubMed database and Cochrane Col aboration Library. pCR rates were col ected in groups of TNBC and non-TNBC tumors. Review Manager 4.2 was used to perform forest plots and funnel plots. Results:The analysis included 22 studies with 7168 patients, the aggregate pCR rate was 29.5%in TNBC group, which was 17.7%higher than non-TNBC. The summary relative risk (RR) for pCR rate of TNBC group with that of non-TNBC group was 2.55. No obvious statistical heterogeneity and publication bias was detected. Conclu-sion:This meta-analysis demonstrated that NAC showed a higher pCR rate in TNBC than non-TNBC.     

Neoadjuvant Chemotherapy in Triple Negative Breast Cancer: Correlation between Androgen Receptor Expression and Pathological Response

Background: There is growing evidence that the response to chemotherapy may be affected by Androgen Receptor (AR) expression suggesting that triple-negative breast cancers (TNBC) AR+ and quadruple negative breast cancer (QNBC) subtypes may have different diseases behavior. Methodology: We retrospectively estimated the predictive value of the AR expression in stage II and stage III TNBC patients treated with neoadjuvant chemotherapy (NAC) and correlated with the rate of pathological response (pCR). Results: Of 89 TNBC patients, 29 patients (32.6%) were TNBC AR+ and 60 patients (67.4) were QNBC. Most of the patients were less than 60 years old. Of note, approximately 62% in the QNBC group were less than 40 years old compared with 39 % in the TNBC AR+ group. The Ki-67 expression was higher in the QNBC in comparison with TNBC AR+ being 86.7% and 65.5%, respectively. QNBC subgroup showed higher rates of pCR compared with TNBC; 60% and 24%, respectively. Higher Ki-67 expression, higher grade, and lymph node involvement were statistically significantly correlated with the rate of pCR in the QNBC group (p=0.02, p=0.04, and p=0.03, respectively). In contrast, no significant association was observed between pCR and clinical-pathological features in the TNBC AR+ group. Conclusion: Our results suggested that the AR expression in TNBC may be applied as a predictive marker for NAC. TNBC AR+ had a lower rate of pCR compared with QNBC, suggesting that this subtype may have a partial chemoresistance.     

Response and long-term effect of patients with triple-negative breast cancer receiving neo-adjuvant anthracycline-based chemotherapy

OBJECTIVE The breast cancer lack of expression of estrogen receptor （ER）, progesterone receptor （PR）, and human epidermal growth factor receptor 2 （HER-2） is defined as the Triple-negative breast cancer （TNBC）. Our purpose is to compare the response and long-term effect of the TNBC and non-TNBC patients receiving neo-adjuvant anthracycline-based chemotherapy, and to investigate the mechanisms of TNBC affecting the survivals. METHODS Data of long-term follow-up （median, 5.4 years） of 326 patients who received neo-adjuvant chemotherapy with anthracycline-based regimen, during a period from 2000 to 2003, were analyzed. Expressions of ER, PR, HER-2, P53, Ki-67 and E-cadherin were determined using immunohistochemical staining method. A multivariate Cox regression analysis was used to analyze independent prognostic factors affecting the relapse-free survival （RFS） and overall survival （OS） rates. Clinical effects of the neo-adjuvant anthracycline-based chemotherapeutic regimen and the RFS and OS rates were compared between the patients with TNBC and non-TNBC, and the correlations among the triplenegative phenotype （TNP）, tumor grading and the expressions of P53, Ki-67 and E-cadherins were analyzed. RESULTS TNP, TNM staging, histological grades, clinical response of the neo-adjuvant chemotherapy and pathological complete remission （pCR） rate were the independent prognostic factors affecting the survival rates. Furthermore, 70 （21.5%） of the 326 patients suffered TNBC. Compared with the subjects in non-TNBC group, the patients with TNBC had a significantly higher pCR rate （P = 0.046） and clinical response rate （P = 0.037）, but also decreased 5-year RFS （P = 0.001） and OS （P = 0.004） rates. The RFS and OS rates were not improved in the TNBC patients who achieved a clinical remission after the neo-adjuvant chemotherapy. The triple-negative phenotype was positively correlated with the level of P53, Ki-67 expression （P = 0.007, P = 0.028）, but negatively correlated with level of E-cadherin （P = 0.034）. CONCLUSION Both clinical remission rate and pCR rate of the TNBC patients receiving neo-adjuvant anthracycline-based chemotherapy are high, however, the long-term effect is poor. The mechanism may relate to a strong potential of proliferation and invasive metastasis, as well as lack of an effective therapeutic target in the TNBC patients.     

EGFR、Ki67在三阴性与非三阴性乳腺癌中的表达及其与TNBC病理特征的相关性

目的 探讨EGFR、Ki67在三阴性与非三阴性乳腺癌中的表达差异及两者的表达与TNBC临床病理特征的关系.方法 分析non-TNBC与TNBC患者的临床病理资料,采用非生物素二步法检测76例乳腺癌标本里EGFR、Ki67的表达,对比两者在non-TNBC与TNBC中的区别.检测EGFR与Ki67在TNBC中的阳性表达率,研究其与病理参数的相关性.结果 和non-TNBC相比,TNBC多见于绝经前妇女,组织学分级较差,较易发生淋巴结转移、复发转移、远处转移,且出现较早.EGFR与Ki67在TNBC组织中的阳性表达率均高于在non-TNBC组织中的阳性表达率.EGFR、Ki67的表达与TNBC肿块直径、淋巴结转移情况、TNM分期、组织学分级之间均具有相关性.结论 EGFR与Ki67在TNBC中表达均升高.两者的表达与肿块直径、淋巴结转移情况、TNM分期、组织学分级之间均具有相关性.     

Stratifying triple-negative breast cancer: which definition(s) to use?

Triple-negative breast cancers (TNBC) have increased rates of pathologic complete response following neoadjuvant chemotherapy, yet have poorer prognosis compared with non-TNBC. Known as the triple-negative paradox, this highlights the need to dissect the biologic and clinical heterogeneity within TNBC. In the present issue, Keam and colleagues suggest two subgroups of TNBC exist based on the proliferation-related marker Ki-67, each with differential response and prognosis following neoadjuvant chemotherapy. To place results into context, we review several definitions available under the TNBC umbrella that may stratify TNBC into clinically relevant subgroups.     

三阴性乳腺癌患者的临床特征及新辅助化疗疗效与预后的相关性

 目的　探讨三阴性乳腺癌（TNBC）的临床病理特点及远期生存率。并分析其新辅助化疗的疗效与生存率的相关性。方法　研究对象为535例乳腺癌患者,其中TNBC患者75例,非TNBC患者460例,对其临床和病理资料以及 5年的无病生存（DFS）率及总生存（OS）率进行回顾性分析,并与同期的非TNBC患者进行对比。535例中88例患者接受术前新辅助化疗,TNBC患者26例,非TNBC患者62例,分析其化疗疗效与远期生存的相关性。结果　TNBC患者与非TNBC患者相比,中位年龄轻（35岁比44岁）,绝经前患者居多（88.0 % 比67.2 %,P＝0.009）;浸润性导管癌多见（92. 0 % 比80.4 %,P＝0.020）,组织学分级Ⅱ级者居多（56.0 %比17.2 %,P＝0.000）;淋巴结转移阳性者较少（33.3 %比53.9 %,P＝0.001）;TNBC组5年DFS（66.67 %）、OS（80.0 %）明显低于非TNBC组（74.78 %、90.0 %）。接受新辅助化疗的TNBC患者与非TNBC患者相比,化疗的总有效（OR）率（88.46 %比82.26 %）、临床完全缓解（cCR）率（65.38 %比37.10 %）、部分缓解（PR）率（23.08 %比45.16 %）差异均有统计学意义（P＜0.05）。新辅助化疗的TNBC患者与非TNBC患者相比,5年的OS率（73.08 %比80.65 %）差异具有统计学意义（P＝0.049）;5年的DFS率（65.38 %比72.58 %）差异具有统计学意义（P＝0.253）。分层分析发现：获得cCR的TNBC与非TNBC患者的5年DFS及OS差异无统计学意义（P＞0.05）。未获得cCR TNBC患者的5年DFS及OS均显著低于非TNBC患者（P＜0.05）,临床OR对两组的5年DFS及OS无影响（P＞0.05）。结论　TNBC多见于年轻的绝经前妇女,主要病理类型为浸润性导管癌,核分级高,淋巴结转移少见,但相对非TNBC患者有较低的DFS率和OS率,TNBC患者对新辅助化疗更敏感,更易获得cCR,获得cCR的TNBC患者预后好,未获得cCR的TNBC患者远期生存率明显低于非TNBC患者