Ki67在三阴性和非三阴性乳腺癌中的表达及疗效预后分析

The expression of Ki67 in triple negative and non-triple negative breast cancer and its impact on clinical outcomes of neoadjuvant chemotherapy

目的比较Ki67在三阴性乳腺癌(TNBC)和非三阴性乳腺癌(NTNBC)中的表达,探讨Ki67表达与不同分子亚型新辅助化疗(NCT)疗效及预后。方法选取2010年1月至2014年1月间收治的320例乳腺癌患者NCT的资料。比较Ki67表达在TNBC和NTNBC中的区别。结果320例患者中,TNBC 41例,NTNBC 279例,TNBC中Ki67增殖指数(42.56±26.55)明显高于NTNBC(26.44±19.5),差异有统计学意义(P<0.001)。Ki67高表达组病理完全缓解(p CR)率(18.0%)明显高于低表达组(8.7%),差异有统计学意义(P=0.037)。TNBC化疗后p CR水平(22.0%)高于NTNBC(14.3%),差异有统计学意义(P=0.206)。TNBC和NTNBC的3年无病生存期(DFS)分别为79.4%和82.3%(P=0.719);总生存期(OS)分别为85.7%和91.8%(P=0.127)。TNBC的p CR率(22.0%)显著高于Luminal A型(1.4%,P<0.001),但预后明显差于Luminal A型,3年OS分别为85.7%和97.3%(P=0.008)。NCT Ki67下降组p CR率为19.8%(48/243),明显高于未下降组的1.3%(1/77),差异有统计学意义(P<0.001),且预后明显优于未下降组。结论 Ki67表达在TNBC中最高。Ki67高表达组对化疗更敏感,近期疗效好,但预后较差,化疗后Ki67下降组疗效更好。

Objective To compare the expression of Ki67 in Triple Negative （TNBC） and Non-tri- ple Negative Breast Cancer（NTNBC） and to explore the impact of Ki67 on pathological response and prog- nosis of neoadjuvant chemotherapy in different molecular subtypes. Methods Data was collected from 320 patients who received neoadjuvant treatment in Cancer Hospital, Chinese Academy of Medical Sciences from January 2010 to January 2014, and then we compared the expression status of Ki67 in TNBC and NTNBC. Results In the 320 patients, 41 cases were TNBC while 279 were NTNBC, and the mean value of Ki67 in TNBC was noticeably higher than that of NTNBC. The difference was statistically significant [ （42. 56 ± 26. 55 ）vs（26. 44 ± 19. 5 ） ,P 〈 0. 001 ]. The pCR rate in the group with high expression of Ki67 （18.0%） was significantly higher than the low expression group （8. 7%, P =0. 037）. The pCR rate in patients with TNBC was higher than NTNBC （22. 0% vs 14. 3% ,P =0. 206）. 3-year DFS and OS of TNBC and NTNBC were 79. 4% vs 82. 3% ,P=0. 719;85.7% vs 91.8% ,P=0. 127. The pCR rate of TNBC （22. 0% ） wasnoticeably higher than Luminal A Type （ 1.4%, P 〈 0. 001 ）, but the prognosis was obviously worse than that of Luminal A Type. 3-year OS was 85. 7% and 97. 3% respectively （P =0. 008）. The pCR rate of the group with deereased Ki-67 was 19. 8% （48/243）, which was evidently higher than the non-decreasing group （1.3%, 1/77）. The difference was statistically significant. However, the prognosis was apparently better than the non-decreasing group. Conclusions The expression of Ki67 was the highest in TNBC. Pa- tients with higher expression of Ki67 were more sensitive to chemotherapy and displayed better short-term re- sponse, but the prognosis this subgroup was poor. Decreased Ki67 after chemotherapy was associated with better response to NCT.