CAJ | 학술논문

目的分析不同分子分型乳腺癌患者的临床病理特征,了解新辅助治疗前后Ki-67的表达变化对不同分子分型乳腺癌患者预后的预测作用.方法回顾性分析2007年8月至2008年8月天津医科大学肿瘤医院乳腺外科收治的178例初治乳腺癌患者的临床资料,术前均经粗针吸穿刺活检证实为乳腺癌,并给予蒽环类联合紫杉类药物新辅助化疗.根据免疫组化染色结果进行分子分型,分析不同分子分型乳腺癌患者的临床病理特征以及Ki-67表达变化对不同分型乳腺癌患者预后的影响.结果 Luminal A型42例,Luminal B型78例,人表皮生长因子受体2(HER-2)过表达型22例,三阴性36例.新辅助化疗后,达到病理完全缓解(pCR)的患者27例,占15.2％,其中Luminal A型、Luminal B型、HER-2过表达型以及三阴性乳腺癌患者的pCR率分别为14.3％、10.3％、18.2％和25.0％,差异有统计学意义(P =0.040).在Luminal A型和三阴性乳腺癌中,新辅助治疗后Ki-67表达降低的患者无病生存率明显提高(P=0.019和P=0.022).Cox多因素分析的结果显示,临床分期、新辅助化疗的疗效、新辅助化疗后Ki-67的表达情况是影响三阴性乳腺癌患者无病生存率的独立因素(均P＜0.05).结论新辅助化疗后Ki-67的表达情况是影响三阴性乳腺癌患者无病生存率的独立因素.
목적 분석불동분자분형유선암환자적림상병리특정,료해신보조치료전후Ki-67적표체변화대불동분자분형유선암환자예후적예측작용.방법 회고성분석2007년8월지2008년8월천진의과대학종류의원유선외과수치적178례초치유선암환자적림상자료,술전균경조침흡천자활검증실위유선암,병급여은배류연합자삼류약물신보조화료.근거면역조화염색결과진행분자분형,분석불동분자분형유선암환자적림상병리특정이급Ki-67표체변화대불동분형유선암환자예후적영향.결과 Luminal A형42례,Luminal B형78례,인표피생장인자수체2(HER-2)과표체형22례,삼음성36례.신보조화료후,체도병리완전완해(pCR)적환자27례,점15.2％,기중Luminal A형、Luminal B형、HER-2과표체형이급삼음성유선암환자적pCR솔분별위14.3％、10.3％、18.2％화25.0％,차이유통계학의의(P =0.040).재Luminal A형화삼음성유선암중,신보조치료후Ki-67표체강저적환자무병생존솔명현제고(P=0.019화P=0.022).Cox다인소분석적결과현시,림상분기、신보조화료적료효、신보조화료후Ki-67적표체정황시영향삼음성유선암환자무병생존솔적독립인소(균P＜0.05).결론 신보조화료후Ki-67적표체정황시영향삼음성유선암환자무병생존솔적독립인소.
Objective This study was conducted to analyze the Ki-67 expression before and after neoadjuvant chemotherapy and clinicopathological characteristics of different biological breast cancer phenotypes.The significance and prognostic predictive value of the changes of Ki-67 expression in different biological breast cancer phenotypes were analyzed.Methods A regression analysis was performed on 178 patients with invasive breast carcinoma who accepted neoadjuvant chemotherapy at Tianjin Medical University Cancer Institute and Hospital from August 2007 to August 2008.These patients were subtyped by hormone receptor status and HER-2 status.The Ki-67 index (percentage of Ki-67-positive cancer cell nuclei) was determined by immunohistochemistry.The prognostic value of Ki-67 index for disease-free survival (DFS) in different biological breast cancer phenotypes was analyzed using Kaplan-Meier survival and multivariable Cox regression.Results The overall pathologic CR (pCR) rate,defined as no invasive residuals in the breast and axilla,was 15.2％.The highest pCR rate of 25.0％ was observed in the TNBC patients,which was 14.3％,10.3％ and 18.2％ in the luminal A,luminal B and HER2 overexpressing patients,respectively (P =0.040).The changes of Ki-67 expression in pre-NAC and post-NAC patients showed a prognostic significance in luminal A and TNBC (P =0.019 and P =0.022,respectively) cases.Clinical stage,the efficacy of NAC,and changes of Ki-67 expression between pre-and post-NAC were independent prognostic factors in TNBC patients who did not achieve pCR.Conclusions The Ki-67 expression after neoadjuvant chemotherapy is an independent prognostic factor affecting the disease-free survival (DFS) in TNBC patients who have not achieved pCR.