乳腺癌患者新辅助化疗后ER、PR、HER2、Ki67表达变化及临床意义

目的:研究乳腺癌患者在新辅助化疗后ER、PR、HER2、Ki67的变化及临床意义。方法:选择2012年1月-2017年12月至我院进行乳腺癌新辅助化疗的患者176例进行临床研究。所有患者化疗前及术后行经B超引导下核芯针穿刺取病理活检,检测ER、PR、Ki67、HER2的表达,分析其变化情况。结果:176例乳腺癌患者新辅助化疗前ER阳性为57例,新辅助化疗后ER阳性为69例,新辅助化疗前ER阴性为119例,新辅助化疗后ER阴性107例;新辅助化疗前后状态改变了34例(19.32%),其中12例新辅助化疗前ER阴性转变为ER阳性,22例新辅助化疗前ER阳性转变为新辅助化疗后ER阴性,化疗前后患者ER表达变化有统计学差异(x~2=8.044,P=0.037);176例乳腺癌患者新辅助化疗前PR阳性为83例,新辅助化疗后PR阳性为89例,新辅助化疗前PR阴性为93例,新辅助化疗后PR阴性87例;新辅助化疗前后状态改变了82例(46.59%),其中45例新辅助化疗前PR阴性转变为PR阳性,37例新辅助化疗前PR阳性转变为新辅助化疗后PR阴性,化疗前后患者PR表达变化有统计学差异(x~2=6.311,P=0.049);176例乳腺癌患者新辅助化疗前HER2阳性为31例,新辅助化疗后HER2阳性为30例,新辅助化疗前HER2阴性为145例,新辅助化疗后HER2阴性146例;新辅助化疗前后状态改变了3例(1.70%),其中1例新辅助化疗前HER2阴性转变为HER2阳性,2例新辅助化疗前HER2阳性转变为新辅助化疗后HER2阴性,化疗前后患者HER2表达变化无统计学差异(x~2=0.522,P=0.945);176例乳腺癌患者新辅助化疗前Ki67阳性为104例,新辅助化疗后Ki67阳性为95例,新辅助化疗前Ki67阴性为72例,新辅助化疗后Ki67阴性81例;新辅助化疗前后状态改变了109例(61.93%),其中54例新辅助化疗前Ki67阴性转变为Ki67阳性,55例新辅助化疗前Ki67阳性转变为新辅助化疗后Ki67阴性,化疗前后患者Ki67表达变化有统计学差异(x~2=2.936,P=0.048),经过新辅助化疗后,Ki67出现上调表达最高,为23.86%,同时也是下调表达最高,为38.07%。HER2表达保持不变最高,为98.30%。结论:新辅助化疗会对乳腺癌患者ER、PR、Ki67的表达造成影响,其中对Ki67的影响最为显著。

A Clinical Study on the Immunohistochemical Changes of Breast Cancer after Neoadjuvant Chemotherapy and Its Influence on the Changes of Er, PR, HER2 and Ki67

ABSTRACT Objective: To study the changes and clinical significance of ER, PR, HER2, Ki67 in breast cancer patients after neoadjuvant chemotherapy. Methods: 176 patients with breast cancer undergoing neoadjuvant chemotherapy from January 2012 to December 2017 were selected for clinical study. All patients underwent B-ultrasound-guided core needle aspiration biopsy before chemotherapy and pathological examination after surgery. All pathological specimens were examined by immunohistochemistry. The changes and trends of ER, PR, HER2 and Ki67 before and after adjuvant chemotherapy were observed. Results: Among the 176 breast cancer patients, 57 were ER positive before neoadjuvant chemotherapy, 69 were ER positive after neoadjuvant chemotherapy, 119 were ER negative before neoadjuvant chemotherapy, and 107 were ER negative after neoadjuvant chemotherapy. Before and after neoadjuvant chemotherapy, the status of 34 patients (19.32%) changed, including 12 patients who were negative for ER before neoadjuvant chemotherapy to positive for ER, and 22 patients who were positive for ER before neoadjuvant chemotherapy to negative for ER after neoadjuvant chemotherapy. There was a statistical difference in ER expression before and after chemotherapy (x²=8.044, P=0.037). Among the 176 breast cancer patients, 83 were PR positive before neoadjuvant chemotherapy, 89 were PR positive after neoadjuvant chemotherapy, 93 were PR negative before neoadjuvant chemotherapy, and 87 were PR negative after neoadjuvant chemotherapy. Before and after neoadjuvant chemotherapy, the status of 82 patients (46.59%) changed, among which 45 patients changed from negative PR to positive PR before neoadjuvant chemotherapy, and 37 patients changed from positive PR to negative PR after neoadjuvant chemotherapy. There was a statistical difference in the change of PR expression before and after chemotherapy (x²=6.311, P=0.049). Among the 176 breast cancer patients, 31 were positive for HER2 before neoadjuvant chemotherapy, 30 were positive for HER2 after neoadjuvant chemotherapy, 145 were negative for HER2 before neoadjuvant chemotherapy, and 146 were negative for HER2 after neoadjuvant chemotherapy. Before and after neoadjuvant chemotherapy, the status of 3 patients changed (1.70%). Among them, 1 patient changed from negative HER2 to positive HER2 before neoadjuvant chemotherapy, and 2 patients changed from positive HER2 to negative HER2 after neoadjuvant chemotherapy. There was no statistical difference in HER2 expression before and after chemotherapy (x²=0.522, P=0.945). Among the 176 breast cancer patients, 104 were Ki67 positive before neoadjuvant chemotherapy, 95 were Ki67 positive after neoadjuvant chemotherapy, 72 were Ki67 negative before neoadjuvant chemotherapy, and 81 were Ki67 negative after neoadjuvant chemotherapy. Status changed before and after neoadjuvant chemotherapy, 109 patients (61.93%), 54 cases of neoadjuvant chemotherapy before Ki67 negative into Ki67 positive, 55 cases of neoadjuvant chemotherapy before Ki67 positive into Ki67 negative after neoadjuvant chemotherapy, Ki67 expression changes of the patients before and after chemotherapy was statistically difference (chi-square = 2.936, P=0.048), after neoadjuvant chemotherapy, Ki67 appear raised to express the highest, at 23.86%, is also a cut to express the highest, 38.07%. The expression of HER2 remained the highest at 98.30%. Conclusion: Neoadjuvant chemotherapy can affect the expression of ER, PR, HER2 and Ki67 in breast cancer patients, especially HER2.