同一乳腺癌患者新辅助化疗前后ER／PR、MVD、Neu、PCNA及MDR的表达及其相关性研究

目的探讨新辅助化疗前后同一乳腺癌患者雌／孕激素受体（ER／PR）、微血管密度（MVD）、癌基因（Neu）、增殖细胞核抗原（PCNA）及多药耐药基因（MDR）的表达有否变化及其相互关系。方法选择确诊为乳腺癌的45例患者为观察组，分别检测经新辅助化疗前后同一乳腺癌患者ER／PR、MVD、Neu、PCNA、MDR的表达，观察化疗后腋窝淋巴结（ALN）的情况；同期设未行化疗的乳腺癌40例作为对照。结果化疗前后ER／PR及PCNA的阳性表达有变化，有统计学差异（P〈O．05）；化疗前后MVD计数有变化，有统计学差异（P〈0．01）；化疗前后Neu、P—gP、GST-π阳性表达有部分变化，无统计学差异（P〉0．05）。手术后ALN转移观察组为40％（18／45），对照组为58％（23／40），有统计学差异（P〈O．05）。新辅助化疗前PR与PCNA、P—gP间有显著负相关性，PCNA与P—gP间有显著相关性；化疗后P—gP与Neu、PCNA、GST-π有非常显著相关性；化疗前后ER与PR、Neu与P—gP、P—gP与GST-π间存在有非常显著相关性。结论新辅助化疗可降低ER、PR的表达，乳腺癌患者手术后内分泌治疗与否应根据患者化疗前的受体表达情况来决定。新辅助化疗后MVD的计数及PCNA的表达的减少可能是乳腺癌术后复发减少的因素之一。新辅助化疗方案AC或TA治疗二个疗程后未见Neu表达的改变，也未见耐药性的改变，但可降低患者术后淋巴结转移率。新辅助化疗后乳腺癌患者ER／PR、MVD、Neu、PCNA、P—gP及GST-π之间的关系部分可发生改变。

The expression and the relationship between ER/PR,MVD,Neu,PCNA and MDR in breast carcinoma before and after neoadjuvant chemotherapy

Objective To investigate the expression and the relationship between ER/PR, MVD, Neu, PCNA and MDR in breast carcinoma before and after neoadjuvant chemotherapy. Methods 45 patients with breast carcinoma were treated by neoadjuvant chemotherapy as the treatment group. The expression of ER/PR, MVD, Neu, PCNA, P - gp and GST - of the same patient,s sample including bath treatment and no -treatment were examined seperately before and after neoadjuvant chemotherapy in the treatment group. Meanwhile, 40 cases of breast carcinoma patients were taken as control group. Results Before and after neoadjuvant chemotherapy, there were significant difference positive expression of ER/PR and PCNA （ P 〈 0.05 ）. MVD count had significant difference （ P 〈0.01 ）. The positive expression of Neu, P - gp and GST - π had partly changes, with no statistical difference （ P 〉 0.05 ）. After surgery, the positive expression of ALN was 40% （ 18/45 ） in the treatment group and 58% （23/40） in the control group （P 〈 0.05 ）. Before neoadjuvant chemotherapy, there were significant negative correlation between PR and PCNA, P - gp, While PCNA and GST -π had significant positive correlation. After neoadjuvant chemotherapy, there were significant correlation between P - gp and Neu, PCNA, GST - π. Before and after neoadjuvant chemotherapy, there were significant correlation between ER and PR, Nan and P - gp, P - gp and GST - π. Conclusion The postive expression of ER and PR can be decreased after neoadjuvant chemotherapy. Taking endocrine therapy in patients with chemotherapy should be based on the pre - receptor expression circumstances. After neoadjuvant chemotherapy, the decrease expression of MVD and PCNA in breast cancer may be a factor of reducing recurrence. The expression of Neu, P - gp and GST -π had no change, but it can reduce the rate of lymph node metastasis in the patients. After neoadjuvant chemotherapy, the relationship among ER/PR, MVD, Neu, PCNA, P-gp and GST-π can be changed.