新辅助TAC化疗对早期乳腺癌患者疗效、细胞免疫功能和Ki-67的影响

Influence of neoadjuvant chemotherapy of TAC on curative effect,cellular immunity and Ki-67 expression in early breast cancer patients

目的乳腺癌患者术后新辅助化疗可提高患者的生存期,但其免疫学机制不清,本文旨在探讨新辅助TAC化疗对患者细胞免疫功能和Ki-67表达的影响。方法选择2013年6月—2015年7月在鄞州人民医院确诊并接受新辅助化疗的90例早期乳腺癌患者按照随机数字表法分为对照组45例和试验组45例,术后对照组采用CEF方案治疗,试验组采用TAC方案,1个疗程/3周,共4个疗程。观察2组患者的临床疗效和不良反应,采用流式细胞仪检测全血CD3、CD4、CD8、自然杀伤细胞(NK)水平,采用ELISA检测肿瘤坏死因子-α(TNF-α)、白介素-2(IL-2)、白介素-6(IL-6)、白介素-10(IL-10)水平,免疫组织化学检测Ki-67表达。结果试验组总有效率为86.67%(39/45),高于对照组的68.89%(31/45),P<0.05。治疗后试验组患者的CD3、CD4、CD8、NK水平低于治疗前,且CD3、CD4、CD8显著低于对照组(P<0.05)。试验组患者的TNF-α和IL-2显著高于对照组,而IL-6和IL-10显著低于对照组(P<0.05)。治疗后2组患者Ki-67阳性率为53.33%(24/45)、57.78%(26/45),显著低于治疗前的88.89%(40/45)、84.44%(38/45),χ~2=0.997、0.402,均P<0.01,但2组间差异无统计学意义(χ~2=0.180,P=0.671)。试验组不良反应发生率37.78%(17/45)低于对照组为60.00%(27/45),χ~2=4.447,P=0.035。结论新辅助化疗TAC方案可改善早期乳腺癌患者的细胞免疫功能,降低Ki-67阳性表达,具有良好的临床疗效。

Objective Neoadjuvant chemotherapy can improve the breast cancer patients＇ survival,but its immunological mechanisms was not clear,the purpose of this paper was study the influence of neoadjuvant chemotherapy of TAC on cellular immunity and Ki-67 expression in early breast cancer patients. Methods Ninety patients with early breast cancer patients were divided into control group 45 cases and treatment group 45 cases according to random number table method.The control group was used by CEF regimen,and the treatment group was used by TAC methods,3 weeks/courses,and a total 4 courses. The clinical efficacy and adverse reactions of two groups of patients were observed. The level of CD3,CD4,CD8 and natural killer cells（ NK） of whole blood were tested by flow cytometry. The level of tumor necrosis factor alpha（ TNF-α）,interleukin 2（ IL-2）,interleukin 6（ IL-6） and interleukin 10（ IL-10） were detected by ELISA. The expression of Ki-67 was examined by immunohistochemistry. Results The total effective rate 86. 67%（ 39/45） in treatment group was higher than that of control group 68. 89%（ 31/45）,P〈0. 05. After treatment the level of CD3,CD4,CD8 and NK in the experimental group were significantly lower than before treatment,and the the level of CD3,CD4,CD8 were lower than the control group（ P〈0. 05）. The level of TNF-α and IL-2 in the treatment group were significantly higher than the control group,and IL-6 and IL-10 were significantly lower than that of control group（ P〈0. 05）. After treatment,the positive rate of Ki-67 53. 33%（ 24/45） and 57. 78%（ 26/45） were significantly lower than before treatment 88. 89%（ 40/45） and84. 44（ 38/45）,χ^2= 0. 997,0. 402,all P〈0. 01,but no difference between the two groups（ χ^2= 0. 180,P = 0. 671）. The incidence of adverse reaction 37. 78（ 17/45） in the treatment group was lower than the control group 60. 00%（ 27/45）,χ^2= 4. 447,P = 0. 035. Conclusion Neoadjuvant chemotherapy TAC scheme can improve the cellular immune function in patients with early breast cancer,reduce the positive expression of Ki-67,has a good clinical curative effect.