CAJ | 학술논문

目的探讨原发性乳腺癌分子分型与新辅助化疗疗效之间的相关性.方法收集2000年1月至2009年1月,北京大学肿瘤医院乳腺癌预防治疗中心接受4～8周期新辅助化疗患者的化疗前组织标本,集中用免疫组织化学法检测激素受体(HR)、人表皮生长因子受体2(HER2)及增殖相关抗原Ki-67的表达水平并据其进行分型,分析分子分型与563例患者新辅助化疗疗效的关系.结果 HR-/HER2-型、HER2+型及HR +/HER2-型的病理完全缓解(pCR)率分别为38.9％、17.9％和8.3％,总体比较差异有统计学意义(P＜0.001).在HR +/HER2-型中,Ki-67高表达组比低表达组的pCR率高(P=0.004)；而HR高表达组与非高表达组的pCR率比较,差异无统计学意义(P =0.256).结论乳腺癌分子分型与新辅助化疗疗效有关,HR-/HER2-型和HER2+型对化疗更敏感；在HR +/HER2-型中,Ki-67高表达者更易从化疗中获益.
목적 탐토원발성유선암분자분형여신보조화료료효지간적상관성.방법 수집2000년1월지2009년1월,북경대학종류의원유선암예방치료중심접수4～8주기신보조화료환자적화료전조직표본,집중용면역조직화학법검측격소수체(HR)、인표피생장인자수체2(HER2)급증식상관항원Ki-67적표체수평병거기진행분형,분석분자분형여563례환자신보조화료료효적관계.결과 HR-/HER2-형、HER2+형급HR +/HER2-형적병리완전완해(pCR)솔분별위38.9％、17.9％화8.3％,총체비교차이유통계학의의(P＜0.001).재HR +/HER2-형중,Ki-67고표체조비저표체조적pCR솔고(P=0.004)；이HR고표체조여비고표체조적pCR솔비교,차이무통계학의의(P =0.256).결론 유선암분자분형여신보조화료료효유관,HR-/HER2-형화HER2+형대화료경민감；재HR +/HER2-형중,Ki-67고표체자경역종화료중획익.
Objective To explore the correlations between molecular subtypes and responses to neoadjuvant chemotherapy in primary breast cancer patients.Methods The core-needle biopsy specimens were collected from 563 patients undergoing 4-8 cycles of neoadjuvant chemotherapy between January 2001 to January 2009.And immunohistochemical assays were employed to detect the levels of estrogen receptor (ER),progesterone receptor (PR),human epidermal growth factor receptor 2 (HER2) and Ki-67 proliferation index simultaneously.Molecular subtypes were divided on the basis of immunohistochemical results.And the associations between molecular subtypes and responses to neoadjuvant chemotherapy were analyzed in 563 patients.Results The pathological complete response (pCR) rates of patients with hormone receptor-negative/HER2-negative subtype (HR-/HER2-),HER2-positive subtype (HER2 +) and hormone receptor-positive/HER2-negative subtype (HR +/HER2-) were 38.9％,17.9％ and 8.3％ respectively.In univariate analysis,there were significant differences in pCR rates among the groups (P ＜ 0.001).In multivariate analysis,the patients with HER2 + subtype had a significantly higher pCR rate than those with HR +/HER2-subtype(OR =0.344,P =0.002).Whereas the patients with HER2 ± subtype had a significantly lower pCR rate than those with HR-/HER2-subtype (OR =2.453,P =0.007).Among HR +/HER2-subtypes,a higher pCR rate was observed in the group of high expression level of Ki67 proliferation index (Ki-67 ≥ 20％) (P =0.004).But no significant differences existed in pCR rates between the group of high expression level of hormone receptor and the group of non-high expression level(P =0.256).Conclusion There were correlations between molecular subtypes and responses to neoadjuvantchemotherapy in primary breast cancer patients.Patients of HER2 + and HR-/HER2-subtype are morelikely to respond to neoadjuvant chemotherapy.Among HR +/HER2-subtypes,those with a high level of Ki-67 proliferation index tend to benefit from neoadjuvant chemotherapy.