新辅助化疗前后乳腺癌患者的临床病理特征变化

Changes in clinical and pathologic characteristics before and after neoadjuvant chemotherapy for breast cancer

目的探讨乳腺癌患者新辅助化疗前后的临床病理特征变化及与临床疗效的关系。方法回顾性选取2017年5月至2019年10月间北京协和医院肿瘤医院深圳医院收治的39例行新辅助化疗的乳腺癌患者,分析患者原发灶、区域淋巴结转移灶、雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(HER2)和增殖核抗原Ki-67等的变化,并探讨与临床疗效的相关性。结果20.5%的患者对新辅助化疗无反应(疾病进展和疾病稳定),12.8%的患者达病理完全缓解。新辅助化疗后,2.5%的患者ER表达阳性转阴性,20.5%的患者PR表达阳性转阴性,2.5%的患者阴性转阳性,7.7%的患者HER2表达阳性转阴性。Ki-67按照<15%、15%~30%和≥30%的范围分级,新辅助化疗后,51.3%的患者化疗前后处于同一范围,46.2%的患者由高一级降到低一级范围甚至更低一级。二元Logistics回归分析发现,患者Ki-67范围变化与疗效密切相关。新辅助化疗前后,69.2%的患者发生原发灶(T)降期,38.5%的患者发生区域淋巴结(N)降期。结论新辅助化疗可改变乳腺癌患者重要分子标记物的表达状态,但对治疗和预后的影响仍需进一步研究;Ki-67与新辅助化疗疗效相关,可能是新辅助化疗疗效的一个预测指标。

Objective To discuss the changes in clinical and pathologic characteristics of breast cancer patients before and after neoadjuvant chemotherapy and its relationship with clinical efficacy.Methods Clinical data of 39 patients undergoing neoadjuvant chemotherapy for breast cancer was retrospectively selected at Peking Union Medical College Cancer Hospital Shenzhen Campus from May 2017 to October 2019.Changes in primary lesions,regional metastatic lymph nodes,estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor receptor(HER2)and proliferating cell nuclear antigen Ki-67 were analyzed and its relationship with clinical efficacy was discussed.Results Twenty point five percent patients did not get response to neoadjuvant chemotherapy(progressive disease and stable disease)and 12.8%patients achieved pathologic complete response(pCR).After neoadjuvant chemotherapy,the expression of ER changed from positive to negative in 2.5%patients.The expression of ER changed from positive to negative in 20.5%patients and from negative to positive in 2.5%patients.The expression of HER2 changed from positive to negative in 7.7%patients.Ki-67 were established three categories based on Ki-67 levels:low(<15%),intermediate(15%to 30%)and high(≥30%).After neoadjuvant chemotherapy,Ki-67 values remained the same in 51.3%patients and Ki-67 values reduced from high-level category to low-level category in 46.2%patients.Binary logistic regression analysis showed that changes in the category of Ki-67 were closely associated with the treatment efficacy.After neoadjuvant chemotherapy,descending phase of primary lesions(T)occurred in 69.2%patients and descending phase of regional lymph node(N)occurred in 38.5%patients.Conclusion Neoadjuvant chemotherapy can alter the expression of important molecular markers in patients with breast cancer.Further research is needed to discuss its effect on treatment and the outcomes.Ki-67 is associated with the efficacy of chemotherapy and could be a marker for predicting the efficacy of neoadjuvant chemotherapy.