新辅助化疗对乳腺癌患者ER、PR、HER-2及Ki67表达的影响
Effects of neoadjuvant chemotherapy on the expression of ER, PR, HER-2 and Ki67 in breast cancer patients

摘要：目的 探讨新辅助化疗对4种分子标志物ER、PR、HER-2以及Ki67表达的影响，为乳腺癌患者精准个体化治疗提供依据。方法 收集2013年1月1日至2015年12月31日在西安交通大学第一附属医院行根治性手术的乳腺癌患者165例，其中接受术前新辅助化疗患者(NAC组)62例，未接受者(对照组)103例。所有患者均收集术前以及术后病理标本，通过免疫组织化学SP法检测ER、PR、HER-2以及Ki67的表达变化。结果 与对照组比较，NAC组患者化疗前后ER表达改变率分别为12.1%(7/58)和7.8%(8/103)，无统计学差异(P=0.378)；PR表达改变率分别为10.3%(3/58)和10.7%(11/103)，无统计学差异(P=0.227)；HER-2表达改变率分别为8.6%(5/58)和22.3(23/103)，差异有统计学意义(P=0.026)；Ki67表达改变率分别为39.7%(23/58)和19.4%(20/103)，差异有统计学意义(P=0.006)。此外，Ki67高表达的乳腺癌患者行新辅助化疗的有效率为63.8%(30/47)，Ki67低表达的患者行新辅助化疗的有效率为33.3%(5/15)，两组差异具有统计学意义(P=0.038)。结论 新辅助化疗可以改变乳腺癌患者HER-2及Ki67的状态，而且术前高水平Ki67表达患者的化疗效果更好。
ABSTRACT: Objective To investigate the effect of neoadjuvant chemotherapy on the expression of four molecular markers ER, PR, HER-2 and Ki67, so as to provide the basis for accurate individualized treatment of breast cancer patients. Methods We enrolled 165 breast cancer patients who underwent radical surgery in the First Affiliated Hospital of Xi’an Jiaotong University from January 1, 2013 to December 31, 2015. Among them, 62 patients received preoperative neoadjuvant chemotherapy (NAC group), and 103 received no adjuvant (control group). We collected all the patients’ preoperative and postoperative pathological specimens; we detected the expression levels of ER, PR, HER-2 and Ki67 by immunohistochemical method. Results Compared with that in control group patients, in NAC group the change rate of ER expression was 12.1% (7/58) and 7.8% (8/103) before and after chemotherapy, respectively, with no significant difference (P=0.378); the change rate of PR expression was 10.3% (3/58) and 10.7% (11/103), with no significant difference (P=0.227); the change rate of HER-2 expression was 8.6% (5/58) and 22.3 (23/103), with significant difference (P=0.026); the change rate of Ki67 expression was 39.7% (23/58) and 19.4% (20/103), with significant difference (P=0.006). In addition, the effective rate of neoadjuvant chemotherapy for breast cancer patients with high Ki67 expression was 63.8% (30/47), that of neoadjuvant chemotherapy in patients with low Ki67 expression was 33.3% (5/15), with significant differences between the two groups (P=0.038). Conclusion Neoadjuvant chemotherapy can change the status of HER-2 and Ki67 in breast cancer patients, in which the high Ki67 expression level predicts better effect of chemotherapy