乳腺癌临床病理指标以及分子分型对TEC新辅助化疗病理完全缓解的预测价值

目的  本研究旨在探讨乳腺癌临床病理指标以及乳腺癌分子分型对多西他赛联合表柔比星、环磷酰胺（TEC）的 新辅助化疗后病理完全缓解率（pathological complete response pCR）的预测价值。方法   对 214例经4周期TEC新辅助化疗的乳腺癌患者的临床病理资料进行回顾性分析；免疫组织化学检测经核心针穿刺 的癌组织雌激素受体（ER）、孕激素受体（PR）、人类表皮生长因子受体-2（HER2）、Ki67、p53表达情况，原位基 因免疫荧光杂交（FISH）检测HER2有无过表达；根据ER、PR、HER2、Ki67的表达情况将乳腺癌分为4种分子分型： LuminalA、 LuminalB、HER2过表达型和三阴性乳腺癌。分析不同的临床病理指标、不同分子分型与pCR的相关性。结果  4周期TEC新辅助化疗后pCR率为14.0%（30/214）；单因素分析：ER、PR、Ki67、乳腺癌分子分型与pCR均具有显 著相关性（P＜0.05）；乳腺癌分子分型各组间显示pCR率不同：LuminalA＜LuminalB＜HER2过表达型＜三阴性乳腺癌 ；多因素分析：与pCR具有显著相关性的分类变量为ER（OR=0.311，95%CI：0.136～0.712；P=0.006）和Ki67 （OR=2.788，95%CI：1.061～7.327；P=0.038）。结论  ER、PR、Ki67以及乳腺癌分子分型可能是TEC新辅助化疗后乳腺癌pCR的预测指标。

Predictive Values of Clinicopathological Parameters and Molecular Typing for Pathological Complete Response (pCR) in Breast Cancer Neoadjuvant Chemotherapy by TEC

Objective   To investigate whether clinical and pathological factors and molecularsubtypes of breast cancer was able to predict pathological complete response (pCR) after neoadjuvant chemotherapy using docetaxel plus epirubicin, cytoxan (TEC-NAC). Methods Two hundred and fourteen patients who underwent 4 cycles of TEC-NAC were retrospectively studied. In Core-needle biopsy specimens, estrogen receptor(ER), progesterone receptor(PR), humanepidermal growth factor receptor-2(HER2), Ki67 and p53 were detected by immunohistochemical assay, and HER2 was also detected by Fluorescence In Situ Hybridization(FISH). Breast cancer was divided into 4 molecular subtypes of LuminalA, LuminalB, HER2 overexpression and triple negative breast cancer based on the expression levels of ER, PR, HER2 and Ki67.The correlation between these Factors and pCR was analyzed.Results   Among all 214 cases, pCR was 14.0% (30/214) after 4 cycles of TEC-NAC. In the univariate analysis, the correlation between expressions of ER, PR, Ki67 and molecular subtypes of breast cancer and pCR were significant (P<0.05 all). pCR rates were LuminalA CI: 0.136 to 0.712; P=0.006) and Ki67 (OR=2.788，95% CI：1.061 to 7.327；P=0.038).Conclusion    ER, PR negative expression, Ki67-positive and molecular subtypes of breast cancer mightbe the predictors of pCR.