新辅助化疗后Ki-67表达变化对乳腺癌预后的影响及其与分子分型的关系

Influence of change of Ki-67 expression after neoadjuvant chemotherapy on prognosis of breast cancer and its relation with molecular subtypes

目的:探讨新辅助化疗(NCT)后Ki-67表达改变对乳腺癌预后的影响及与分子分型的关系。方法:回顾2010—2013年收治的121例接受NCT的II A^III C期乳腺癌患者资料,分析NCT后Ki-67表达变化与乳腺癌预后的关系以及其在不同分子分型中的差异。结果:NCT前Ki-67表达与患者肿瘤大小(r=0.181,P=0.047)、组织学分级(r=0.340,P<0.001)及HER-2表达(r=0.335,P<0.001)呈正相关。全组患者3年无病生存率(DFS)为73.4%,其中NCT后Ki-67减少、增加、不变患者中3年DFS分别为82.6%、61.1%、68.4%,差异有统计学意义(P=0.034);而不同分子亚型3年DSF分别为Luminal A型70.7%、Luminal B型71.4%、HER-2阳性型80.7%、基底样型(78.7%),4组间差异无统计学意义(P=0.857)。族别、治疗前HER-2状态、病理腋窝淋巴结及NCT前后Ki-67表达改变是乳腺癌患者DFS的独立影响因素(均P<0.05)。结论:乳腺癌NCT后Ki-67的变化是乳腺癌患者DFS的独立影响因素,但其变化的影响与乳腺癌的分子分型无明显关系。

Objective： To investigate the impact of the change of Ki-67 expression after neoadjuvant chemotherapy（NCT） on prognosis of breast cancer and its relation with the breast cancer molecular subtypes. Methods： The clinical data of 121 patients with stage IIA-IIIC breast cancer undergoing NCT from 2010 to 2013 were reviewed. The relationship between the change of Ki-67 expression after NCT and prognosis of breast cancer as well as the difference of Ki-67 change among different molecular subtypes were analyzed.Results： Ki-67 expression before NCT was positively correlated to tumor size（r=0.181, P=0.047）, histological grade（r=0.340, P〈0.001） and HER-2 expression（r=0.335, P〈0.001） of the patients. The 3-year disease-free survival（DFS） was 73.4%, which in patients with reduced, increased and unchanged Ki-67 expression after NCT was 82.6%, 61.1% and 68.4% respectively, and the difference was statistically significant（P=0.034）, while among patients with different molecular subtypes was 70.7% for luminal A, 71.4% for luminal B, 80.7% for HER-2 positive, and 78.7% for basal like, and the difference had no statistical significance（P=0.857）. Nationality, pre-treatment of HER-2 status, and pathologic axillary lymph node and change of Ki-67 expression after NCT were the independent influential factors for DFS of breast cancer patients（all P〈0.05）. Conclusion： The change of Ki-67 expression after NCT is an independent influential factor for DFS in breast cancer patients, but its change shows no obvious relation with breast cancer molecular subtypes.