Ki-67在乳腺癌新辅助化疗中的表达及与病理学相关性研究

Expression of Ki-67 and its relation with pathological response after neoadjuvant chemotherapy in breast cancer

目的观察乳腺癌新辅助化疗(NAC)前后Ki-67的表达,探讨其与化疗疗效的关系。方法45例乳腺癌患者经空心针穿刺获取组织学证实,经2～4个周期采用表柔吡星加紫杉醇(ET方案)或长春瑞滨加顺铂(NP方案)新辅助化疗后进行病理学反应评价,并通过免疫组化SP法检测化疗前后Ki-67的表达变化情况。结果新辅助化疗后病理组织学反应评价:病理完全缓解(pCR)为6.67%(3/45),病理部分缓解(pPR)为64.44%(29/45),pSD为28.89%(13/45),总有效率(pCR+pPR)为71.11%。化疗前后Ki-67表达显著降低,差异有统计学意义(P<0.05),NAC后Ki-67阳性表达者病理学缓解有效率高于阴性表达者,差异有统计学意义(P<0.05)。结论ET方案(或NP方案)新辅助化疗有较好的疗效,能显著抑制肿瘤细胞的增殖,Ki-67下降患者显示较好的疗效,可作为预测新辅助化疗疗效的独立有效指标。

Objective To observe the expressions of Ki-67 before and after neoadjuvant chemotherapy in bresst cancer patients, and to discuss the relation with chemotherapy. Methods Forty-five cases of breast cancer were diagnosed by core biopsies. The expressions of Ki-67 in cancer tissue were measured by immunohistochemistry before and after NAC with epirubicin and paclitaxel （EPI,PTX） or vinorelbine and cisplatin（NVB,DDP） regimen for 2-4 cycles,and the histopathologic response of surgical specimens after NAC was observed. Results After NAC, 3 patients （ 6. 67 %） achieved pathological complete response （pCR）, 29 patients （64.44 %） achieved pathological part response（pPR）, and 13 cases （28.89%） achieved pathological stable disease（pSD）. The total response rate（RR） was 71.11%. The Ki-67 positive expression rate was much lower,there was a statistic significance after NAC（P 〈0.05） ,and pathologic effective rate was much higher than that in Ki-67 negative expression patients（P〈0.05）. Conclusion NAC with ET（EPI,PTX） or NP（NVB,DDP） regimen is effective, it can inhibit the proliferation of cancer cells, and in the patients with the Ki-67 positive expression,NAC has better effect,it could be an independent prognostic index for its response to NAC in breast cancer.