HER2阳性乳腺癌患者新辅助化疗后免疫分型变化的研究

目的探讨HER2阳性乳腺癌新辅助化疗后雌激素受体(ER)、孕激素受体(PR)、细胞增殖核抗原Ki－67(Ki－67)、HER2变化。 方法回顾性分析2012年1月至2017年12月进行乳腺癌新辅助化疗且HER2为阳性的患者66例资料。所有患者化疗前行经超声引导下穿刺取病理活检，并于术后行病理检查。采用SPSS19.0统计学软件处理，观察患者在辅助化疗前后ER、PR、Ki67、HER2水平变化，采用(例，%)表示，行卡方检验，以P<0.05为差异有统计学意义。 结果66例HER2阳性乳腺癌新辅助化疗患者化疗后，PR出现上调表达最高，为19.32%，同时也是下调表达最高，为25.57%；ER保持不变比例最高(74.43%)；Ki67下调率为23.86%，明显高于上调率的12.50%，保持不变比例63.64%；66例患者中7例患者经过新辅助化疗后HER2转为阴性，转阴率为10.61%。 结论HER2阳性乳腺癌新辅助化疗后部分患者的ER、PR、会出现上调或者下调的变化，Ki－67出现一定比例的下降、HER2部分转阴，这种变化对乳腺癌的分型以及术后治疗药物的选择均会产生影响。

Immunotyping changes of HER2 positive breast cancer patients after neoadjuvant chemotherapy

Objective To study the immunotyping changes of HER2 positive breast cancer after neoadjuvant chemotherapy. Methods A retrospective analysis was made on 66 cases of breast cancer of HER2 positive treated with neoadjuvant chemotherapy from January 2012 to December 2017. All patients underwent ultrasound-guided core needle biopsy before chemotherapy, and pathological examination after surgery. SPSS19.0 statistical software was used to observe the changes of estrogen receptor(ER), progesterone receptor(PR), cell proliferation nuclear antigen Ki67(Ki67) and HER2 levels in patients before and after adjuvant chemotherapy. Chi-square test was used to show that there was significant difference between patients before and after adjuvant chemotherapy with P<0.05. Results After neoadjuvant chemotherapy in 66 HER2-positive breast cancer patients, PR up-regulated rate was 19.32%, and down-regulated rate was 25.57%. ER remained unchanged(74.43%). Ki67 down-regulated rate was 23.86%, which was significantly higher than the up-regulated rate of 12.50%, and the unchanged rate was 63.64%. 7 of 66 patients turned negative after neoadjuvant chemotherapy in HER2. The negative conversion rate was 10.61%. Conclusion ER and PR of some patients with HER2-positive breast cancer after neoadjuvant chemotherapy may be up-regulated or down-regulated. Ki-67 may be down-regulated in a certain proportion and HER2 may be negative. These changes will affect the classification of breast cancer and the choice of post-operative therapeutic drugs.