乳腺癌新辅助化疗前后Ki-67、HER-2、ER和PR的变化与临床缓解率的关系

The relationship between the changes of Ki-67,HER-2,ER and PR as well as the clinical response rate Pre- and post- Neoadjuvant chemotherapy

目的 比较新辅助化疗前后的乳腺癌患者肿瘤组织中Ki-67、HER-2、ER和PR的改变,探索其变化与临床缓解情况之间的关系.方法 回顾性收集接受新辅助化疗的乳腺癌患者103例,本次观察前均未行任何放疗、化疗和内分泌治疗.化疗前接受14G空心针刺活检诊断为局部浸润性导管癌或小叶癌.患者经4个周期化疗后94例患者接受手术切除.化疗前后的肿瘤组织采用福尔马林固定,石蜡包埋病理切片法,免疫组化染色法检测化疗前后肿瘤组织中Ki-67、HER-2、ER和PR的变化情况.采用WHO标准评价化疗后的临床缓解率.结果 103例病例经新辅助化疗后有9例发生转移,94例经化疗后进行了手术治疗.术前穿刺和术后肿瘤组织切片染色比较,Ki-67、ER和PR表达发生了明显的改变,而HER-2的前后变化差异不显著.但是,仅Ki-67的表达变化与肿瘤缓解率的关系显著.结论 在乳腺癌的新辅助治疗中,Ki-67的变化可能作为预测新辅助化疗肿瘤缓解率的一个指标,对临床用药和化疗结局有一定的指示作用.

Objective To compare the change of Ki - 67, HER - 2, ER and PR before and after neoad- juvant chemotherapy in breast cancer tumor, and explore the relationship between the changes and clinical re- sponse rate. Methods 103 patients with breast cancer were included in this study who didn＇t accept any therapy such as radiotherapy, chemotherapy and endocrine therapy before recruiting. All cases were diagnosed as local in- filtrating ductal carcinoma or lobular carcinoma by 14G hollow needle biopsy. 94 patients were operated after 4 cy- cles chemotherapy. Tumor tissues were formalin - fixed, paraffin - embedded. Immunohistochemical staining was employed to detect the expression of Ki - 67, HER - 2, ER and PR. The clinical response rate was evaluated by WHO criteria. Results 9 patients of 103 cases had metastasis after neoadjuvant chemotherapy,and 94 cases un- derwent surgery after chemotherapy treatment. Pre - and postoperative tumor biopsy tissue sections stained were compared. The level of expression of Ki - 67, ER and PR changed significantly, and HER - 2 before and after the chemotherapy was not significant. However, only the change of Ki - 67 expression was significantly correlated with tumor response rate. Conclusion Ki -67 expression as an indicator may be used to predict the tumor response rate during neoadjuvant chemotherapy of clinical outcome in breast cancer patients.