新辅助化疗后乳腺癌的临床病理学变化及意义

Histopathologic changes of breast cancer following neoadjuvant chemotherapy in breast cancer

目的观察乳腺癌新辅助化疗后的临床病理学改变及意义。方法60例局部进展期乳腺癌均经空心针穿刺获取组织学证实为乳腺癌，并作免疫组化行ER、PR、cerb—B2、P53、Topo～Ⅱ检测，新辅助化疗采用FEC常规化疗方案，完成4周期新辅助化疗后进行临床疗效评价。对术后标本进行常规HE、免疫组织化学染色观察。结果总有效率（RR）为91．66％（55／60），临床完全缓解率（cCR）为28．33％（17／60），临床部分缓解率（cPR）为63．33％（38／60），无变化（NC）8．33％（5／60），无疾病进展患者。其中病理完全缓解率（pCR）为23．33％（14／60），行保乳手术16例，保乳率为26．67％（16／60）。与术前病理活检标本比较，新辅助化疗后瘤体缩小变软、甚至消失，肿瘤细胞退变坏死，化疗后乳腺癌标本间质水肿、间质增生胶原化明显，癌旁乳腺组织部分导管上皮可呈轻-中度异型性；淋巴结无论有无转移均可见结构改变，转移淋巴结内可见肿瘤细胞退变坏死、间质炎细胞浸润及纤维化等。免疫组织化学未见ER、PR表达变化，cerb—B2、P53、Topo-Ⅱ表达差异无统计学意义。结论FEC新辅助化疗使多数乳腺癌原发灶及淋巴结转移灶出现不同程度变性坏死，提高手术率并增加了保乳机会，在术后辅助治疗及判断预后方面具有重要临床意义。

Objective To investigate histopathological changes of breast carcinoma following neoadjuvant chemotherapy. Methods Samples were obtained from 60 patients with breast carcinoma who received neoadjuvant chemotherapy of 5 - fluorouracil,epirubicin and cyclophosphamide, histopathologic examination and immunohistochemical examination including ER, PR, cerh - B2, P53 and Topo - Ⅱ were carried out both pre - chemotherapy core biopsies and post - chemotherapy surgical specimens. Results The total response rate RR was 91.66% （55/60）. A total of 28.33% （17/60） of the patients acquired clinical complete response ,63.33 % （38/60） clinical partial response, and 8.33 % （ 5/60 ） no change. Fourteen cases obtained pathologic complete response and no progressive disease in all patients. Histopathologic changes, such as disintegration, necrosis, infiltration of inflammatory cell, stromal edema and fibrosis occured after neoadjuvant chemotherapy. The same changes were observed in the metastatic lymph nodes. Atypical Hyperplasia was also observed in the vicinity of tumor tissue after neoadjuvant chemotherapy. The expression of ER, PR, and cerb - B2, P53, Topo -Ⅱdidn＇ t change significantly. Conclusion Neoadjuvant chemotherapy with FEC regimens is effective to both primary tumors and metastatic lymph nodes in breast cancer.