癌症进展
癌癥進展
암증진전
ONCOLOGY PROGRESS
2015年
3期
291-297
,共7页
桑蝶%王佳玉%袁芃%马飞%李青%张频%樊英%蔡锐刚%罗扬%李俏%徐兵河
桑蝶%王佳玉%袁芃%馬飛%李青%張頻%樊英%蔡銳剛%囉颺%李俏%徐兵河
상접%왕가옥%원봉%마비%리청%장빈%번영%채예강%라양%리초%서병하
乳腺癌%新辅助化疗%Ki-67%病理完全缓解%预后因素%预测因素
乳腺癌%新輔助化療%Ki-67%病理完全緩解%預後因素%預測因素
유선암%신보조화료%Ki-67%병리완전완해%예후인소%예측인소
breast cancer%neoadjuvant chemotherapy%Ki-67%pathologic complete response%prognostic factor%predictive factor
目的：分析Ki-67与乳腺癌临床病理特征对新辅助化疗（neoadjuvant chemotherapy，NCT）疗效和预后的影响，探讨NCT疗效的预测因素。方法用免疫组化法检测320例局部晚期乳腺癌患者癌组织中ER、PR、HER-2及Ki-67表达状况。进行NCT 4～6个周期后手术。分析临床病理特征与病理完全缓解率（patho-logic complete response，pCR）之间的关系。临床病理参数与疗效分析用χ2检验，影响预后因素用Cox多因素回归分析。结果 Ki-67表达与ER（r=－0.174，P=0.002）和PR（r=－0.132，P=0.019）呈负相关，与HER2（r=0.140， P=0.012）和乳腺肿瘤大小（r=0.132，P=0.019）呈正相关；ER阴性组pCR率显著高于ER阳性组（26.9%vs 7.4%，χ2=22.761，P=0.000）；PR阴性组pCR率显著高于阳性组（22.7%vs 10.9%，χ2=7.950，P=0.005）；Ki-67高表达组pCR率18.0%（41/228）优于Ki-67低表达组8.6%（8/92）（χ2=4.552，P=0.033）；化疗后Ki-67表达下降组pCR率19.8%（48/243）优于未下降组1.3%（1/77）（χ2=15.356，P=0.000）；各分子亚型间化疗疗效差异显著，Luminal A型pCR率为1.4%（1/71），Luminal B型pCR率为15.3%（25/163），HER2过表达型pCR率为31.3%（14/45），三阴性型pCR率为22.0%（9/41）（χ2=20.639，P=0.000）；用Kaplan-Meier法进行生存分析，Ki-67低表达组无病生存时间（DFS）和总生存时间（OS）均优于Ki-67高表达组，两者均为P=0.034。结论 Ki-67高表达患者对化疗更敏感，但预后较差。化疗前Ki-67的表达和化疗后Ki-67变化是影响DFS独立的预后因素。ER、PR、Ki-67指数及分子分型可以作为NCT疗效的预测指标，Ki-67指数与ER、PR、HER2之间存在相关性。
目的：分析Ki-67與乳腺癌臨床病理特徵對新輔助化療（neoadjuvant chemotherapy，NCT）療效和預後的影響，探討NCT療效的預測因素。方法用免疫組化法檢測320例跼部晚期乳腺癌患者癌組織中ER、PR、HER-2及Ki-67錶達狀況。進行NCT 4～6箇週期後手術。分析臨床病理特徵與病理完全緩解率（patho-logic complete response，pCR）之間的關繫。臨床病理參數與療效分析用χ2檢驗，影響預後因素用Cox多因素迴歸分析。結果 Ki-67錶達與ER（r=－0.174，P=0.002）和PR（r=－0.132，P=0.019）呈負相關，與HER2（r=0.140， P=0.012）和乳腺腫瘤大小（r=0.132，P=0.019）呈正相關；ER陰性組pCR率顯著高于ER暘性組（26.9%vs 7.4%，χ2=22.761，P=0.000）；PR陰性組pCR率顯著高于暘性組（22.7%vs 10.9%，χ2=7.950，P=0.005）；Ki-67高錶達組pCR率18.0%（41/228）優于Ki-67低錶達組8.6%（8/92）（χ2=4.552，P=0.033）；化療後Ki-67錶達下降組pCR率19.8%（48/243）優于未下降組1.3%（1/77）（χ2=15.356，P=0.000）；各分子亞型間化療療效差異顯著，Luminal A型pCR率為1.4%（1/71），Luminal B型pCR率為15.3%（25/163），HER2過錶達型pCR率為31.3%（14/45），三陰性型pCR率為22.0%（9/41）（χ2=20.639，P=0.000）；用Kaplan-Meier法進行生存分析，Ki-67低錶達組無病生存時間（DFS）和總生存時間（OS）均優于Ki-67高錶達組，兩者均為P=0.034。結論 Ki-67高錶達患者對化療更敏感，但預後較差。化療前Ki-67的錶達和化療後Ki-67變化是影響DFS獨立的預後因素。ER、PR、Ki-67指數及分子分型可以作為NCT療效的預測指標，Ki-67指數與ER、PR、HER2之間存在相關性。
목적：분석Ki-67여유선암림상병리특정대신보조화료（neoadjuvant chemotherapy，NCT）료효화예후적영향，탐토NCT료효적예측인소。방법용면역조화법검측320례국부만기유선암환자암조직중ER、PR、HER-2급Ki-67표체상황。진행NCT 4～6개주기후수술。분석림상병리특정여병리완전완해솔（patho-logic complete response，pCR）지간적관계。림상병리삼수여료효분석용χ2검험，영향예후인소용Cox다인소회귀분석。결과 Ki-67표체여ER（r=－0.174，P=0.002）화PR（r=－0.132，P=0.019）정부상관，여HER2（r=0.140， P=0.012）화유선종류대소（r=0.132，P=0.019）정정상관；ER음성조pCR솔현저고우ER양성조（26.9%vs 7.4%，χ2=22.761，P=0.000）；PR음성조pCR솔현저고우양성조（22.7%vs 10.9%，χ2=7.950，P=0.005）；Ki-67고표체조pCR솔18.0%（41/228）우우Ki-67저표체조8.6%（8/92）（χ2=4.552，P=0.033）；화료후Ki-67표체하강조pCR솔19.8%（48/243）우우미하강조1.3%（1/77）（χ2=15.356，P=0.000）；각분자아형간화료료효차이현저，Luminal A형pCR솔위1.4%（1/71），Luminal B형pCR솔위15.3%（25/163），HER2과표체형pCR솔위31.3%（14/45），삼음성형pCR솔위22.0%（9/41）（χ2=20.639，P=0.000）；용Kaplan-Meier법진행생존분석，Ki-67저표체조무병생존시간（DFS）화총생존시간（OS）균우우Ki-67고표체조，량자균위P=0.034。결론 Ki-67고표체환자대화료경민감，단예후교차。화료전Ki-67적표체화화료후Ki-67변화시영향DFS독립적예후인소。ER、PR、Ki-67지수급분자분형가이작위NCT료효적예측지표，Ki-67지수여ER、PR、HER2지간존재상관성。
Objective To analyze the impact of clinical pathological factors on efficacy and prognosis of primary breast cancer patients treated with neoadjuvant chemotherapy (NCT), and explore the predictive factors affecting the efficacy of neoadjuvant chemotherapy in breast cancer. Method A total of 320 patients with locally advanced breast cancer were enrolled in this study. And the status of cancer tissue ER, PR, HER2 and Ki-67 in these patients were retrospectively reviewed. The patients received surgery after 4-6 cycles of NCT. We analyzed the relationship be-tween clinical pathological characteristics and pathologic complete response(pCR). Parameter of clinical pathological and analysis of curative effect were performed by χ2 test. Prognostic factors were determined by COX multivariate re-gression. Result Ki-67 index negatively correlated with ER (r=-0.174, P=0.002)/PR (r=-0.132, P=0.019) expres-sion. Higher Ki-67 index was associated with larger tumor size (r=0.132, P=0.019) and HER2 overexpression (r=0.140, P=0.012). pCR rate was higher in ER/PR negative patients than ER/PR positive patients (respectively 26.9%vs 7.4%, χ2=22.761, P=0.000; 22.7% vs 10.9%; χ2=7.950, P=0.005 ). patiens with Ki-67 high expression had higher pCR rate than those with Ki-67 low expression, (18.0% vs 8.6%, χ2=4.552, P=0.033). patiens with Ki-67 decreased group after neoadjuvant chemotherapy got higher pCR rate than those Ki-67 undecreased group, (19.8% vs 1.3%, χ2=15.356, P=0.000). Molecular subtype exerted a differential effect on response to NCT. Patients in Luminal A got low-er pCR rate 1.4% (1/71). Compared with Luminal B 15.3% (25/163), HER2 overexpression subtype 31.3% (14/45), and triple-negative phenotype 22.0% (9/41). (χ2=20.639, P=0.000). Patients with Ki-67 low expression had longer DFS (P=0.034) and OS (P=0.034) than those with Ki-67 high expression. Conclusion Ki-67 high expression corre-lated with better response to NCT but worse prognosis. Ki-67 expression and Ki-67 change after chemotherapy are in-dependent prognostic(DFS)factors. ER, PR, Ki-67 and molecular subtype may be the predictive factors of NCT effect. Ki-67 index associated with ER, PRand HER2.
