新辅助化疗对乳腺癌患者survivin、Ki-67、ER、C-erbB-2、p53和肿瘤组织学分级的影响及其疗效预测意义

目的探讨新辅助化疗对乳腺癌survivin、Ki-67、ER、C-erbB-2、p53和肿瘤组织学分级的影响,同时研究这些指标对新辅助化疗的疗效预测作用。方法通过免疫组织化学S-P法检测和HE染色对化疗前空芯针穿刺标本和化疗后手术切除的30例乳腺癌组织的survivin、Ki-67、ER、C-erbB-2、p53和肿瘤组织学分级的表达情况。化疗方案为CAF（CTX 600 mg/m^2,THP 50 mg/m2,5-FU500 mg/m^2）和TA（艾素75 mg/m^2,THP 30 mg/m^2）,每3周1疗程,用药2～3个疗程。化疗疗效通过采用临床体检、乳腺彩超检测及术后病理分析综合判断。结果 30例患者中70.0%（21/30）获PR,SD为30.0%（9/30）,全组无恶化病例,总有效率为70.0%（21/30）。通过对化疗前后的指标比较发现：新辅助化疗能降低Ki-67的表达（P〈0.01）和肿瘤分级（P〈0.05）。化疗前后survivin、ER、C-erbB-2和p53表达无明显变化（P〉0.05）。Ki-67高表达（≥20%）、肿瘤分级高的患者和Ki-67低表达（〈20%）、肿瘤分级较低的患者相比,化疗疗效更明显（P〈0.05）。结论新辅助化疗能显著降低乳腺癌组织Ki-67的表达和肿瘤分级,而对survivin、ER、C-erbB-2和p53表达均无显著影响,Ki-67高表达（≥20%）、肿瘤分级高的患者对化疗更敏感、短期疗效更显著。

Expression of survivin,Ki-67,ER,C-erbB-2 and p53 in neoadjuvant chemotherapy and its predictive value for therapeutical response of breast cancer

Objective To investigate the expression of survivin,Ki-67,estrogen receptor,C-erbB-2 and p53 in neoadjuvant chemotherapy and its predictive value for therapeutic response of breast cancer.Methods Thirty patients with breast cancer were treated with three cycles of CAF（CTX 600 mg/m2,ADM 50 mg/m2,5-FU 500 mg/m2） and TA（docetaxel 75 mg/m2,THP 30 mg/m2）.Tumor response was assessed by clinical examination,B ultrasonography and pathological assessment;tumor grade was scored according to the Elston-Ellis classification.The immunohistochemical staining S-P method was used to examine the expression of survivin,Ki-67,estrogen receptor,C-erbB-2 and p53.Results The overall response rate was 70.0%（21/30）,stable disease was 30.0%（9/30）,and no progressive disease.Tumor grade（P〈0.05）and the expression of Ki-67（P〈0.01）were high before treatment,and were lower after chemotherapy,but the expression of estrogen receptor,C-erbB-2,p53 was not changed（P〉0.05）.Compared to the lower tumor grade and lower Ki-67 count,the higher tumor grade and higher Ki-67 were related to better response（P〈0.05）.Conclusions The expression of Ki-67 and tumor grade may decrease in neoadjuvant chemotherapy for breast cancer,but the expression of estrogen receptor,C-erbB-2 and p53 is not changed.The high tumor grade,high Ki-67 might be associated with better response.