新辅助化疗对乳腺癌分子表型的影响

The effect of neoadjuvant chemotherapy on the molecular phenotypes of breast cancer

目的比较新辅助化疗前后乳腺癌患者肿瘤组织中ER、PR及Her-2的表达变化，探索新辅助化疗与其变化的关系。方法回顾性收集接受新辅助化疗的乳腺癌患者78例，入院之前均未接受过任何化疗、放疗及内分泌治疗。患者在化疗前均接受空心针穿刺活检明确诊断为局部浸润性癌，经4个周期化疗后接受手术治疗。化疗前后的肿瘤组织采用福尔马林固定，石蜡包埋后病理切片，应用免疫组织化学染色法检测化疗前后肿瘤组织中ER、PR和Her-2的表达情况，Her-2（＋＋）的患者通过FISH检测验证其表达情况。结果新辅助化疗前后ER、PR、Her-2的表达均发生了改变，78例患者中ER表达阳性转变为阴性的百分比为6．67％（3／45），阴性转变为阳性的百分比为24．24％（8／33）；PR表达阳性转变为阴性的百分比为23．53％（8／34），阴性转变为阳性的百分比为20．45％（9／44）；Her-2表达阳性转变为阴性的百分比为16．67％（3／18），无患者由阴性转变为阳性，但差异均没有统计学意义（P〉0．05）。ER表达在新辅助化疗后发生变化者在组织分级2级和3级患者中所占的比例分别为63．63％和36．37％，差异无统计学意义（P=0．208）；而PR表达发生变化者在组织学分级为2级和3级的患者所占比例分别为58．82％和41．18％，差异有统计学意义（P=0．016）。Her-2表达变化在组织学分级2级和3级的患者所占比例分别为66．67％和33．33％，差异无统计学意义（P=0．478）。结论新辅助化疗前后，PR的表达在3级乳腺癌中会发生明显变化，而ER，Her-2的表达未受新辅助化疗影响。

Objective To compare the change of ER, PR and Her- 2 before and after neoadjuvant chemotherapy in patients with breast cancer and explore the relationship between new adjuvant chemotherapy and the changes. Methods 78 patients with breast cancer were collected who were accepted neoadjuvant chemothera- py and all did not accept any therapy such as chemotherapy, radiotherapy and endocrine therapy before recruiting. All cases were diagnosed as locally invasive carcinoma by hollow needle biopsy before chemotherapy and all of them were operated after four cycles of chemotherapy. Tumor tissues were formalin fixed, paraffin embedded before and after chemotherapy. Immunohistochemical staining was employed to detect the expressions of ER, PR and Her -2 in tumor tissues before and after chemotherapy. FISH testing was used to verify the expression who Her -2 （ ~ ）. Results The expressions of ER, PR and Her - 2 were changed before and after neoadjuvant chemothera- py. The percentage that expression of ER change positive to negative was 6.67% （3/45） ,negative to positive was 24.24% （8/33）. The percentage that expression of PR change positive to negative was 23.53% （8/34）, and neg- ative to positive was 20.45 % （9/44）. The percentage that expression of Her - 2 change positive to negative was 16.67 % （3/18）, negative to positive was O. But there was no statistical significance （P 〉 O. 05 ）. The expression of ER expression change in proportion of histological grade 2 and 3 patients were 63.63% and 36.37% after neo- adjuvant chemotherapy, the difference was not statistically significant （P = 0. 208） ;PR expression change histolog- ical grade 2 and 3 the proportion of patients were 58.82% ,41.18%, and the difference was statistically signifi- cant（ P = 0.016）. Her- 2 expression changes in histological grade 2 and 3. The proportion of patients were 66. 67% and 33.33% ,the difference was not statistically significant （ P = 0. 478）. Conclusion Before and after neoadjuvant chemotherapy,PR expression in histological grade 3 breast cancer changed significantly. ER and Her -2 expression were unaffected by neoadjuvant chemotherapy.