乳腺癌新辅助化疗前后Ki67变化对疗效及预后的意义

目的：探讨乳腺癌新辅助化疗（NACT）前后Ki67表达变化对疗效和预后预测的临床意义。方法：回顾性分析汕头大学医学院附属肿瘤医院2009年12月—2013年9月期间收治的104例乳腺癌NACT后手术的患者。采用免疫组织化学评估配对的化疗前穿刺活检标本和手术切除标本中Ki67的表达情况。根据NACT前后Ki67的变化分为Ki67下降组和Ki67未下降（不变或升高）组，并对两组的临床病理学资料进行比较和生存分析。结果：NACT后Ki67下降组占62.5%（65/104），未下降组占37.5%（39/104）。NACT前高表达Ki67的患者经NACT后Ki67显著下降（63/91，P < 0.01）。Ki67下降组更容易获得有效的临床效果即达到临床完全/部分缓解（59/65，P=0.005），且NACT后Ki67下降值与临床疗效相关（r=0.302，P=0.002）。NACT后Ki67下降组的无病生存率明显高于Ki67未下降组，差异有统计学意义（P=0.027）；Ki67下降组的总生存率高于Ki67未下降组，但差异无统计学意义（P=0.171）。结论：乳腺癌NACT后Ki67表达下降可能是疗效和预后的预测因子。

Changes of Ki67 expression before and after neoadjuvant chemotherapy as a predictor for therapeutic response and rognosis in breast cancers

OBJECTIVE： To investigate changes of Ki67 expression before and after neoadjuvant chemotherapy (NACT) in breast cancer as a predictor of therapeutic response and prognosis. METHODS： Retrospective analyses were conducted on 104 patients with breast cancer who received NACT at the Shantou University Medical College Cancer Hospital from December 2009 to September 2013. Expression of Ki67 was assessed using immunohistochemistry in pre-chemotherapy core-needle biopsy and post-surgical specimens. Clinicopathological characteristics， therapeutic responses， and survival were compared between the Ki67- reduced group and the Ki67-unchanged/increased group during NAC. RESULTS： Both the reduced and unchanged/increased groups accounted for 62.5% (65/104) and 37.5% (39/104)，respectively. Ki67 levels were significantly reduced in patients with higher Ki67 expression (63/91， P < 0.01) before NACT. Patients with reduced Ki67 after NAC showed significantly enhanced therapeutic response，such as clinical complete response and clinical partial response (59/65， P=0.005). In addition， the decreased value of Ki67 during NACT was significantly correlated with therapeutic response (r=0.302， P=0.002). The disease- free survival rates in the Ki67 reduced group was higher than that in the Ki67 unchanged/increase group (P=0.027). The overall survival rates in the Ki67 reduced group was higher than that in the Ki67 unchanged/increase group，but the difference was not statistically significant (P=0.171). CONCLUSION： The reduction of Ki67 expression after NACT could be a predictor for therapeutic response and prognosis in breast cancers.