新辅助化疗疗效与乳腺癌Ki67、P53表达的关系

目的探讨新辅助化疗对乳腺癌Ki67、P53表达的影响,以及新的病理评估分级与Ki67、P53的关系。方法 用免疫组织化学染色法分别检测40例Ⅱ～Ⅲ期乳腺癌患者新辅助化疗前后Ki67、P53和其他生物学指标的表达,采用WHO实体肿瘤疗效评价标准和本院病理科制定的病理学分级标准分别对新辅助化疗疗效进行临床综合评估及病理学评价;根据Ki67、P53阳性细胞的百分数分为低表达组和高表达组,分别探讨Ki67、P53不同表达水平与新辅助疗效之间的关系。计数资料采用χ2检验或Fisher精确概率法,等级资料采用非参数秩和检验,相关性分析采用spearman相关。结果 （1）Ki67、P53在乳腺癌组织中的阳性表达率分别为62.5%（25/40）、40.0%（16/40）,高表达率分别为27.5%（11/40）、15.0%（6/40）。Ki67表达与HER-2状态有关（P=0.004）,而与患者年龄、临床分期、ER状态等无关（P〉0.050）;P53表达与一般病理因素均无关（P〉0.050）。（2）Ki67高表达患者新辅助化疗疗效优于低表达的患者（P=0.049）。（3）与新辅助化疗前相比,新辅助化疗后Ki67的阳性表达率显著下降（P=0.027）,但P53的阳性表达率无明显变化（P〉0.050）。（4）经病理学分级评估,Ki67表达的变化程度与新辅助化疗反应有相关性（r=0.347,P=0.028）,但P53的变化程度与新辅助化疗反应无相关性（P〉0.050）。结论 Ki67可作为预测和评估乳腺癌新辅助化疗疗效的生物学指标。

Relationship between the pathological assessment levels of neoadjuvant chemotherapy and the expressions of Ki67 and P53 in breast cancer

Objective To study the effect of neoadjuvant chemotherapy on the expressions of Ki67 and P53 in breast cancer tissues, and analyze the relationship between the pathologic grading and Ki67 and P53 expressions. Methods The expressions of Ki67, P53 and other biological parameters in 40 patients with stage II and III breast cancer were examined by immunohistochemical staining before and after neoadjuvant chemotherapy. Response Evaluation Criteria in Solid Tumors and the pathological grading made in the Pathological Department of our hospital were used to assess clinically the neoadjuvant chemotherapy effect According to the percentages of Ki67 positive and P53 positive cells patients were grouped into low and high expressions to study the correlation between response to noeadjuvant chemotherapy and different expression levels of Ki67 and P53. Chi-square test or Fisher's exact test was used for numeration data, nonparametric test for ranked data, and Spearman's rank correlation test for correlation between the response to neoadjuvant chemotherapy and the changes of Ki67 and P53 expressions. Results (l)The positive rates of Ki67 and P53 expressions in breast cancer tissues were 62. 5%(25/40) and 40. 0%( 16/40), respectively, and high expression rates were 27. 5% (11/40) and 15. 0% (6/40), respectively. The Ki67 expression was correlated with HER-2 status (P=0.004), but independence of the age, the clinical stage and the ER condition (P>0. 050). The P53 expression had no relationship with general pathological factors (P>0. 050). (2)Patients with high expression of Ki67 were more likely responded to neoadjuvant chemotherapy than those of low expression (P=0.049). (3)The positive expression rate of Ki67 decreased significantly after neoadjuvant chemotherapy compared to before chemotherapy(P=0. 027),but there was no change of P53 (P>0. 050). (4)The changes of Ki67 was correlated with response to neoadjuvant chemotherapy(r=0.347,P=0.028), but the changes of P53 was not correlated with the response of neoadjuvant chemotherapy (P>0. 050). Conclusions Ki67 may be used as the maker to predict efficiency of neoadjuvant chemotherapy.