HER-2、p53的表达对乳腺癌蒽环类新辅助化疗疗效的影响

The efficacy of anthracycline-based neoadjuvant chemotherapy in patients with breast cancer

目的研究乳腺癌雌激素受体(ER)、孕激素受体(PR)、人类表皮生长因子受体-2(c-erbB2)及p53的表达与以蒽环类为基础的新辅助化疗(NAC)疗效之间的相关性。方法40例乳腺癌患者接受以蒽环类为基础的NAC。用免疫组化法检测NAC前ER、PR、c-erbB2及p53的表达情况,c-erbB2表达为阳性及强阳性者进一步行荧光原位杂交(FISH)检测,以确定HER-2基因的扩增水平。NAC结束后进行疗效评估。结果40例患者中,缓解30例(75%),无缓解10例(25%);HER-2基因无扩增及p53表达阴性均与高反应性相关(P均<0.05);化疗≥4个周期的患者疗效达完全缓解的比例显著高于<4个周期者(P<0.05)。结论HER-2基因无扩增及p53表达阴性的患者可能对以蒽环类为基础的化疗方案敏感;适当增加化疗周期数可能增加完全缓解率。

Objective To evaluate the predictive value of estrogen receptor （ER）, progesterone receptor （PR）, human epidermal growth factor receptor （ c-erbB2 ） -2 and p53 in anthracycline-based neoadjuvant chemotherapy （ NAC ）. Methods 40 patients with breast carcinoma were treated with anthracycline-based NAC. ER, PR, c-erbB2 and p53 were detected by immunohistocheinistry staining before NAC. Fluorescence in situ hybridization （FISH） was used to detect the HER-2 gene amplification in the cases expression of c-erbB2 protein were （ ＋ ＋ ） or （ ＋ ＋ ＋ ）. The efficacy of the regi- men was evaluated after NAC. Results OR （objective response） was observed in 30 patients （75%）, whereas NR （no response） was observed in 10 patients （25%）. HER-2 gene non-amplification status and p53-negative status were correlated with a higher OR （ P = 0.029 ,P = 0. 041 ）. The CR rate of patients received 4 cycles or more than 4 cycles NAC was significantly higher than that of less than 4 cycles （ P 〈 0.05）. Conclusions The patients with HER-2 gene non-amplification and without p53 overexpression may sensitive to anthracycline-based chemotherapy. Suitable increased NAC cycles may increase CR rates.