新辅助化疗联合改良根治术治疗不同亚型乳腺癌的疗效及对相关标志物水平的影响

The efficacy of neoadjuvant chemotherapy combined with modified radical mastectomy in the treatment of different subtypes of breast cancer and its influence on the level of related markers

目的:探究新辅助化疗联合改良根治术在不同分子亚型乳腺癌患者中的应用及对硒结合蛋白1(SBP1)、Runt相关转录因子3(RUNX3)表达与定位的影响。方法:选取我院2017年01月-2019年01月收治的186例乳腺癌患者,依照免疫组化结果分为三阴型(46例)、人表皮生长因子受体-2过表达型[HER-2(+)](45例)、Luminal A型(48例)及Luminal B型(47例),均采用新辅助化疗联合改良根治术治疗,观察不同分子亚型治疗效果,SP免疫组化检测对比治疗前后孕激素受体(PR)、雌激素受体(ER)、HER-2、细胞增殖抗原(Ki-67)及SBP-1表达,Western-blot检测乳腺癌组织及癌旁组织中RUNX3蛋白表达,免疫荧光检测RUNX3亚细胞定位。结果:不同亚型乳腺癌控制率和治疗有效率比较差异显著(P <0.05)。新辅助化疗联合改良根治术治疗前不同分子亚型ER、PR、HER-2及Ki-67表达存在显著差异(P <0.05);新辅助化疗联合改良根治术后ER、PR、HER-2表达状态未发生明显变化(P> 0.05),Ki-67表达出现明显下降,且不同分子亚型间Ki-67下降结果比较差异显著(P <0.05)。新辅助化疗联合改良根治术后,SBP1在不同亚型乳腺癌中表达均较治疗前显著提高,各分子亚型SBP1水平比较差异显著(P <0.05)。不同亚型乳腺癌RUNX3表达存在明显差异,乳腺癌细胞核中表达明显增多,细胞浆中表达明显降低(P <0.05);新辅助化疗联合改良根治术后各分子亚型乳腺癌RUNX3水平得到显著提高(P <0.05)。结论:新辅助化疗联合改良根治术在不同亚型乳腺癌中的应用效果较好,通过对乳腺癌分子标志物、SBP1及RUNX3的测定可为临床治疗效果的判断提供有效预测指标。

Objective:To explore the effect of neoadjuvant chemotherapy combined with modified radical mastectomy on breast cancer patients with different molecular subtypes and the expression and localization of selenium-binding protein 1(SBP1)and Runt-related transcription factor 3(RUNX3).Methods:A total of 186 breast cancer patients admitted to our hospital from January 2017 to January 2019 were enrolled.According to the results of immunohistochemistry,they were divided into three negative types(46 cases)and human epidermal growth factor receptor-2 overexpression type[HER-2(+)](45 cases),Luminal type A(48 cases)and Luminal type B(47 cases),and they were treated with neoadjuvant chemotherapy combined with modified radical mastectomy to observe the therapeutic effects of different molecular subtypes.Immunohistochemistry detected progesterone receptor(PR),estrogen receptor(ER),HER-2,cell proliferation antigen(Ki-67)and SBP-1 expression.Western-blot detected RUNX3 protein expression in breast cancer tissues and adjacent tissues.Immunity fluorescence detected RUNX3 subcellular localization.Results:The control rate and treatment efficiency of different subtypes of breast cancer were significantly different(P<0.05).There were significant differences in the expression of ER,PR,HER-2 and Ki-67 between different subtypes of neoadjuvant chemotherapy combined with modified radical mastectomy(P<0.05).The expression of ER,PR and HER-2 after neoadjuvant chemotherapy combined with modified radical mastectomy did not change significantly(P>0.05),the expression of Ki-67 decreased significantly,and the difference of Ki-67 between different molecular subtypes was significantly different(P<0.05).After neoadjuvant chemotherapy combined with modified radical mastectomy,the expression of SBP1 in different subtypes of breast cancer was significantly higher than that before treatment,and the level of SBP1 in each subtype was significantly different(P<0.05).The expression of RUNX3 in different subtypes of breast cancer was significantly different,the expression of nucleus in breast cancer cells increased significantly,and the expression in cytoplasm was significantly decreased(P<0.05).The level of RUNX3 in breast cancer was significantly improved in neoadjuvant chemotherapy combined with modified radical mastectomy(P<0.05).Conclusion:Neoadjuvant chemotherapy combined with modified radical mastectomy has a good effect in different subtypes of breast cancer.The determination of molecular markers,SBP1 and RUNX3 can provide effective predictors for the judgment of clinical treatment.