乳腺癌新辅助化疗不同方案近期疗效观察及化疗前后Ki-67的表达变化

Comparison of the short term effectiveness of different neoadjuvant chemotherapy regimen in breast cancer and analyses of the change of Ki-67 before and after neoadjuvant chemotherapy

目的比较多西他赛联合表柔比星(TE)与多西他赛联合表柔比星及环磷酰胺(TEC)方案在乳腺癌新辅助化疗(NAC)中的近期疗效,观察化疗前后Ki-67的表达变化,并分析其与化疗疗效的相关性及对化疗是否有预测作用。方法 63例Ⅱ～Ⅲ期乳腺癌患者随机分为两组,分别接受TE和TEC方案化疗,观察化疗后病理反应并评价两组的近期疗效和毒副反应。应用免疫组化法检测NAC前后Ki-67的表达,并分析表达改变原因和其与临床疗效的相关性。结果TE组与TEC组的有效率分别为84.4%(27/32)、87.1%(27/31),差异无显著性。TEC组白细胞、血小板减少发生率均较TE组高(P<0.05),化疗前Ki-67的表达高于化疗后(P<0.01)。Ki-67表达的改变与NAC的临床疗效有关(P<0.05)。结论 TE与TEC方案在乳腺癌NAC中的疗效相似,但TE方案骨髓抑制较TEC方案轻,值得临床推广应用。Ki-67表达的改变与NAC的临床疗效有关,可能是预测化疗疗效的敏感因子。

Objective To compare and analysis the effect of two neoadjuvant chemotherapy（NAC） regimens（TE and TEC）.To evaluate the change in Ki-67 before and after NAC and to assess the possible relationship between biomarker and curative effect of NAC.Methods The data of 63 female patients with stageⅡ and Ⅲa breast cancer was retrospectively analyzed.All patients were received NAC with TE or TEC regimen before operation.Ki-67 determinations were detected by immunohistochemistry.Changes of markers expression were evaluated after NAC and their correlations with tumor response were analyzed.Results 32 patients with breast cancer received TE regimen before operation,the rate of RR was 84.4%（27 /32）.31 patients received TEC regimen,the rate of RR was 87.1%（27 /31）.In the differences of the clinical response rate between TE and TEC regimen,there were no significant differences.The side effect of TEC was more seriously,which mainly included leucopenia and alopecia.The difference of Ki-67 before and after primary chemotherapy was significant（P0.01）.There were significant correlations between changes of Ki-67 expression and clinical response（P0.05）.Conclusion The effect of the two NAC regimens（TE and TEC） are similar.The bone marrow suppression of TE regimen is less seriously.It is recommended to utilized widespreadly in clinic.The results suggest that the changes of Ki-67 expression may be related to tumor response,and can be used to predict the sensitivity of treatment.