158例乳腺癌新辅助化疗疗效与Ki-67截断值的相关分析

  目的  探讨乳腺癌分子分型、ER、PR、Ki-67表达对新辅助化疗（neoadjuvant chemotherapy，NAC）疗效的预测价值，以及不同化疗方案和周期对疗效的影响。  方法  收集2015年1月至12月158例天津医科大学肿瘤医院行NAC的女性乳腺癌患者的临床资料，对比各分子分型及不同化疗方案疗效的差异，分析评价影响疗效的临床指标，及ER、PR、Ki-67预测NAC疗效的价值。  结果  158例患者中，其中5例HER-2阳性患者行曲妥珠单抗治疗，因病例数较少未纳入统计分析。Spearman相关分析显示，NAC疗效与ER、PR表达呈负相关，与Ki-67（截断值为25%）表达呈正相关（P < 0.05）；Luminal型和非Luminal型乳腺癌患者NAC疗效的病理评价为无效分别占10.1%和1.3%，差异具有统计学意义（P=0.033）；NAC < 4个疗程的疗效达Ⅲ级仅4.8%，显著低于NAC≥4个疗程的36.0%，差异具有统计学意义（P=0.016）。Logistic多因素分析显示化疗前Ki-67表达是影响NAC疗效的独立预测因素。  结论  根据化疗前Ki-67表达可粗略预测NAC疗效，但Ki-67截断值应依据检测机构的数据进行评定；Luminal型患者经NAC治疗后无效的概率较大，化疗不敏感时可考虑手术治疗。NAC < 4个疗程时NAC疗效降低，提示NAC足疗程是提高其疗效的条件之一。 

Outcome and prognostic markers of neoadjuvant chemotherapy and cut-off value of Ki-67 in 158 breast cancer patients

Objective:To investigate the prognostic value of estrogen receptor (ER), progesterone receptor (PR), and Ki-67 in breast can-cer patients receiving neoadjuvant chemotherapy (NAC) and explore the association of chemotherapy regimens and cycles with the outcome of NAC. Methods:Clinical data of cancer patients receiving NAC were retrospectively analyzed. All the patients were admit-ted in Tianjin Medical University Cancer Institute and Hospital from January 2015 to December 2015. All statistical analyses were per-formed using SPSS version 19.0. The relationship among the outcome of NAC, molecular subtype, expression levels of ER, PR, and Ki-67, and chemotherapy regimens and cycles was investigated. Results:Only five HER-2(+) patients accepted the addition of trastuzum-ab in treatment, and few cases were excluded from the statistical analysis based on the effect of chemotherapy regimens. The effec-tiveness of NAC was positively correlated with the expression of Ki-67 whereas negatively correlated with the expression levels of ER and PR (P<0.05). In patients receiving NAC, the patients with Luminal subtype had worse outcome than those with non-Luminal sub-type (P=0.033). The invalid efficacy of pathologic evaluations of Luminal and non-Luminal NAC were 10.1%and 1.3%, respectively. No significant difference was found in the outcome among patients receiving TE, TEC, or EC-T;however, patients who received more than four cycles of NAC had better outcome than others (P=0.016). The outcome was statistically significant when the cut-off value of Ki-67 was 25%. Conclusion:Ki-67 proliferative index could be used as a prognostic marker to NAC in breast cancer patients. The cut-off value of Ki-67 should be determined on the basis of the data of each cancer patient. The curative effect of NAC was poor, and Luminal pa-tients with chemotherapy were insensitive and could be considered for surgical treatment. Patients who received less than four cycles of NAC had worse outcome than others, and prompt NAC foot treatment could improve the efficiency.