新辅助化疗对乳腺癌的组织学分级和生物学指标表达的影响

目的 探讨新辅助化疗对乳腺癌的组织学分级和生物学指标表达的影响.方法 67例接受新辅助化疗的原发性乳腺癌女性患者在化疗前均有核芯针活检结果作为组织学诊断依据,化疗后效果的组织学评估参照日本乳腺癌学会制定的判定标准,分为无效(G1)、轻度有效(G2)、中度有效(G3)、显著有效(G4)和完全有效(G5)5级.采用免疫组化EnVision法对化疗前后的肿瘤组织进行染色,比较化疗前后雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(Her-2)和Ki-67的表达变化.结果 全组67例患者化疗效果的组织学评估结果显示,G1、G2、G3、G4和G5的患者分别为5例(7.5%)、19例(28.4%)、20例(29.9%)、17例(25.4%)和6例(9.0%).全组有49例患者在化疗前后具有ER、PR、Her-2和Ki-67表达情况的评估结果.化疗后PR阳性率为71.4%,与化疗前(91.8%)相比,差异有统计学意义(P=0.021);而化疗前后ER和Her-2的表达保持稳定.14例浸润性导管癌患者在新辅助化疗后组织学分级发生变化,其中降1级者12例,占85.7%.新辅助化疗后,组织学分级有变化者在G1、G2、G3和G4组中所占的比例分别为0、5.9%、41.2%和54.5%(P=0.013).Ki-67的平均表达率从化疗前的28.3%下降到化疗后的11.0%(P=0.011).化疗后Ki-67的表达率下降＞10%、＞20%、＞30%、＞40%和＞50%者在G1和G2组、G3组、G4和G5组中所占的比例均呈增加趋势,且差异均有统计学意义(均P＜0.05).结论 新辅助化疗后,乳腺癌组织的PR表达显著降低,而ER和Her-2的表达保持稳定;乳腺癌组织的组织学分级和Ki-67的表达也降低,并且好的化疗效果与组织学分级和Ki-67的表达降低相关.

Effect of neoadjuvant chemotherapy on histologic grade and expression of biological markers in breast cancer

Objective The aim of this study is to investigate the changes of expression of estrogen receptors(ER),progesterone receptors(PR),Her-2,Ki-67 and histological grade after neoadjuvant chemotherapy in breast cancer.Methods Sixty-seven patients with histopathalogically confirnled breast cancer by core needle biopsy received neoadjuvant chemotherapy.The effect of neoadjuvant chemotherapy was assessed according to the criteria of the Japanese Breast Cancer Society:non-effective(G1),mildly effective(G2),moderately effective(G3),markedly effective(G4)and completely effective(G5).All pathological slides were retrospectively reviewed.Immunohistochemical staining(EnVision methed)was used to detect the expression of ER and PR,Her-2 and Ki-67.The pre-and post-neoadjuvant chemotherapy status of tumor histological grade,ER and PR,Her-2 and Ki-67 expression in the 49 cases were compared.Results The effect of neoadjuvant chemotherapy was assessed in 67 patients.There were 5 cases(7.5%)in G1,19 in C2(28.4%),20 in G3(29.9%),17 in G4(25.4%)and 6 in G5(9.0%),respectively.PR positive rate was 71.4%after chemotherapy versus 91.8%before chemotherapy.with a statistically significant reduction(P=0.021).However,the ER and Her-2 expression before and after neoadjuvant chemotherapy was stable.Of the patients with invasive ductal carcinoma.28.6%had histological grade change after neoadjuvant chemotherapy,and 85.7%of patients decreased one grade.The proportion of histological grade change in the G1,G2,G3,G4 were 0,5.9%,41.2% and 54.5%,respectively(P=0.013).The average rate of Ki-67 expression decreased from 28.3%pre-chemotherapy to 11.0%postchemotherapy(P:0.01 1).After the neoadjuvant chemotherapy,the Ki-67 expression rate decreased by ＞10%,＞20%,＞30%,＞40% and ＞50% in 3 groups(G1 and G2,group G3,group G4 and G5)showed a tendency to be increased,with a significant difference(P＜0.05).Conclusion PR expression in breast cancer decreases after neoadjuvant chemotherapy,while ER and Her-2 expressions remain stable.After neoadjuvant chemotherapy,the histological grade and proliferation index are decreased and correlated with the response to chemotherapy.Therefore,histological grade and proliferation index may be effective complementary factors in assessment of the effectiveness of neoadjuvant chemotherapy.