乳腺癌新辅助化疗前后ER、PR、Ki-67和Her-2变化

目的 探讨乳腺癌患者新辅助化疗前后雌激素受体(ER)、孕激素受体(PR)、Ki-67抗原(Ki-67)、人表皮生长因子受体-2(Her-2)表达的变化及意义.方法 回顾性分析99例接受新辅助化疗的乳腺癌患者临床资料,观察化疗近期疗效,免疫组化检测化疗前后乳腺癌组织中ER、PR、Ki-67、Her-2的表达,分析化疗前四者的相关性,疗效与其化疗前表达的关系以及化疗对其表达的影响.结果 新辅助化疗前ER与PR呈显著正相关(r=0.731,P=0.000),与Ki-67呈显著负相关(r=-0.298,P=0.003),PR也与Ki-67呈显著负相关(r=-0.265,P=0.014);化疗结束后16例获得PCR,PCR率为16.16%,ER、PR阴性表达的患者病理完全缓解(PCR)率高于阳性表达患者,差异有统计学意义(χ2值分别为12.038、10.834,均P<0.05);化疗前激素受体、Ki-67和Her-2阳性/阴性表达或过表达/非过表达间总有效率的比较差异均无统计学意义(χ2值分别为0.38、0.17、0.13、0.04,均P>0.05);除去16例获得PCR患者,剩余83例患者新辅助化疗后Ki-67阳性率显著降低,差异有统计学意义(χ2=7.923,P<0.05),ER、PR阳性率、Her-2过表达率均无显著变化,差异均无统计学意义(χ2值分别为0.965、1.364、0.392,均P>0.05).结论 ER、PR阴性表达的乳腺癌患者Ki-67表达增加,提示增殖能力较强,而新辅助化疗可以下调Ki-67表达,降低肿瘤的增殖活性,ER、PR阴性患者对新辅助化疗更为敏感.乳腺癌组织ER、PR和Ki-67表达的变化可以有效预测新辅助化疗的疗效.

Expression changes of ER,PR, Ki-67 and Her-2 in patients with breast cancer before and after neoadjuvant chemotherapy

Objective To explore the expression changes and significance of estrogen receptor ( ER) , progesterone receptor ( PR) , Ki-67 and human epidermal growth factor receptor-2 (Her-2) in patients with breast cancer before and after neoadjuvant chemotherapy.Methods Retrospective analysis was conducted on clinical data of 99 patients with breast cancer who treated by neoadjuvant chemotherapy.The recent curative effect was observed and the expressions of ER, PR, Ki-67 and Her-2 before and after neoadjuvant chemotherapy were detected with immunohistochemical method.The correlation among them before chemotherapy, the relationship between the expressions of them before neoadjuvant chemotherapy and curative effect as well as the influence of neoadjuvant chemotherapy on expressions were analyzed.Results The expression of ER before neoadjuvant chemotherapy was significantly positively related to PR ( r =0.731, P =0.000), while significantly negatively related to Ki-67 (r =-0.298, P =0.003).And the expression of PR before neoadjuvant chemotherapy was also significantly negatively related to Ki-67 (r=-0.265, P=0.014).There were 16 cases with pathologic complete response (PCR) after chemotherapy, and the PCR rate was 16.16%.The PCR rate in ER and PR negative expression patients was higher than that in patients with positive expression, and the difference was statistically significant (χ2 value was 12.038 and 10.834, respectively, both P<0.05).Before chemotherapy, the total effective rate between hormone receptor, Ki-67 and Her-2 positive/negative expression or overexpression/non overexpression had no statistical significance (χ2 value was 0.38, 0.17, 0.13 and 0.04, respectively, all P>0.05).The positive rate of Ki-67 after neoadjuvant chemotherapy in 83 cases decreased significantly, and it was statistically significant (χ2 =7.923, P<0.05).The positive rate of ER and PR and overexpressoin rate of Her-2 had no significant changes, and the differences were not statistically significant (χ2 value was 0.965, 1.364 and 0.392, respectively, all P >0.05).Conclusion The expression of Ki-67 increases in patients with breast cancer whose expressions of ER and PR are negative, which indicates that proliferation is strong.The neoadjuvant chemotherapy can cut down the expression of Ki-67 and reduce tumor proliferation activity.Patients whose expressions of ER and PR are negative are more sensitive to neoadjuvant chemotherapy.The expression changes of ER, PR and Ki-67 in breast cancer tissue can effectively predict the curative effect of neoadjuvant chemotherapy.