激素受体和HER-2及Ki-67预测乳腺癌新辅助化疗疗效价值的分析

Analysis of the value of hormone receptor,HER-2 and Ki-67 in predicting the efficacy of neoadjuvant chemotherapy in breast cancer

目的:探讨乳腺癌组织中雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(HER-2)及Ki-67的表达状态对新辅助化疗反应的预测作用以及化疗前后其表达差异对疗效的影响。方法:免疫组织化学方法检测新辅助化疗前后118例乳腺癌组织的ER、PR、HER-2及Ki-67的表达情况,并分析其与新辅助化疗疗效的关系。结果:118例新辅助化疗乳腺癌病例中,ER-和PR-组pCR分别为26.1%和27.1%,明显高于ER+组11.1%和PR+组6.8%,P=0.003。HER-2和Ki-67的表达对新辅助化疗疗效无显著影响。新辅助化疗前ER、PR与Ki-67的表达呈明显负相关,P<0.001;新辅助化疗后Ki-67的高表达病例数显著减少,P=0.001。结论:ER-/PR-的患者对新辅助化疗更为敏感,Ki-67在化疗后发生了显著下调,提示新辅助化疗能降低肿瘤的增殖活性。ER、PR及Ki-67可以作为新辅助化疗疗效的预测指标。

OBJECTIVE： This study investigated the relationships among ER, PR, HER-2, Ki-67 expressions and the efficacy 6f neoadjuvant chemotherapy in breast cancer. METHODS：The expression of ER, PR, HER-2, Ki-67 were examined by immunohistochemical staning before and after neoadjuvant chemotherapy. The clinical response was assessed using WHO creteria. RESULTS：Among a total of 118 breast cancer patients, ER-negative tumors （26. 1%） or PR- negative tumors （27.1%） were more likely to attain pCR than ER-positive （11.1%, P=0. 034） or PR- positive tumors （6.8 %, P= 0. 003）. The expression of HER-2 and Ki-67 were not correlated with the efficacy of neoadjuvant chemother apy in breast cancer. Higher Ki-67 proliferation indices were associated with ER-/PR- tumors （P〈0. 001）. The number of patients who expressed high Ki-67 proliferation indices significantly decreased after neoadjuvant chemotherapy （P= 0. 001）. CONCLUSIONS： Neoadjuvant chemotherapy could induce anti-proliferation and proapoptosis in vivo. The re- sponse to neoadjuvant chemotherapy was much better in ER-negative and PR-negative tumors. The expression of ER, PR, and Ki-67 could serve as nredictors for neoadiuvant chemotheraov in breast cancer.