乳腺癌穿刺活检对HR和HER-2及Ki-67评价可靠性以及化疗对其影响研究  

Evaluation of breast biopsy to HR,HER-2 and Ki-67 and neoadjuvant chemotherapy's effect on them

作　　者：葛文凯[1,2] 杨奔[2] 左文述[2] 于志勇[2] 刘岩松[2] 郑刚[2] 郑美珠[2] 杨莉[2] 

机构地区：[1]济南大学.山东省医学科学院医学与生命科学学院,山东济南250022 [2]山东省肿瘤医院外科二病区.山东省乳腺病防治中心,山东济南250117

出　　处：《中华肿瘤防治杂志》2014年第11期847-853,共7页Chinese Journal of Cancer Prevention and Treatment

基　　金：山东省科技发展计划(2011GSF11823)

摘　　要：目的:研究乳腺癌空芯针穿刺活检(core needle biopsy,CNB)对激素受体(hormone receptor,HR)、HER-2及Ki-67表达状况评价的可靠性,探讨新辅助化疗(neoadjuvant chemotherapy,NAC)对乳腺癌分子生物学信息表达的影响,分析上述生物学指标对NAC疗效的预测价值。方法:选择2012-03-01-2013-01-31山东省肿瘤医院外科收治的乳腺癌患者177例,其中行NAC者95例作为NAC组,未行NAC者82例作为对照组。免疫组织化学SP法检测两组患者CNB和治疗性手术切除标本中ER、PR、HER-2及Ki-67的表达状况,依据Miller-Payne分级系统评价化疗后病理反应,依据实体瘤反应评价标准(response evaluation criteria in solid tumors,RECIST)进行新辅助化疗的疗效评价。结果:对照组患者CNB和手术切除标本ER表达一致率为97.6%(80/82),PR为95.1%(78/82),HER-2为97.6%(80/82),Ki-67为92.7%(76/82),Spearman等级相关系数均>0.8,P均<0.05。NAC组和对照组CNB和手术切除标本比较,ER表达状况改变率分别为12.4%(10/79)和3.9%(2/82),差异有统计学意义,P=0.014;PR表达状况改变率分别为24.0%(19/79)和2.4%(4/82),差异有统计学意义,P=0.001;HER-2表达状况改变率分别为5.1%(4/79)和2.4%(2/82),差异无统计学意义,P=0.379;Ki-67表达状况改变率分别为38.0%(30/79)和7.3%(6/82),差异有统计学意义,P<0.001。NAC前后ER阳性率分别为64.6%和53.2%,差异无统计学意义,P=0.146;PR阳性率分别为63.3%和45.6%,差异有统计学意义,P=0.025;Ki-67高表达率分别为45.6%和15.2%,差异有统计学意义,P=0.017。化疗反应分级与ER、PR、HER-2表达变化无相关性,P均>0.05;与Ki-67表达变化明显相关,P=0.008。ER和PR表达状况与NAC疗效无相关性,P均>0.05;HER-2阳性的乳腺癌患者NAC有效率为81.8%,阴性者有效率为50.7%,差异有统计学意义,P=0.010;Ki-67高表达乳腺癌患者NAC有效率为70.2%,低表达者有效率为45.5%,差异有统计学意义,P=0.029。结论:CNB与手术切除标本在判断HR、HER-2和Ki-67表达状OBJECTIVE：To study the reliability of core needle biopsy in evaluating the status of hormone receptor, HER-2 and Ki-67 in breast cancer,investigate the effects of chemotherapy on these biological factors and the predictive value of these biological factors in neoadjuvant chemotherapy. METHODS：Among the 177 cases of breast cancer patients in our department from March 2012 to January 2013, the expressions of ER, PR, HER-2 and Ki-67 were examined by immunohistochemical method between the core needle biopsies and surgical excision specimens in 95 patients with NAC. As a control group,we analyzed sample pairs from 82 patients without NAC. Pathological response of NAC was assessed using the Miller-Payer system and clinical response of NAC was evaluated by RECIST（response evaluation criteria in solid tumors）. RESULTS The expressions of ER 97.6% （80/82） ,PR 95.1% （78/82） ,HER-2 97.6% （80/82）and Ki-67 92.7% （76/82） had good coincidence between the core needle biopsies and surgical excision specimens. Ten（12.4o//00）of 79 patients with NAC showed the ER status modulation in the surgically removed specimen as compared with 2 （3.9%） of 82 patients without NAC,P=0. 014. Nineteen（24.0%） of 79 patients undergoing NAC appeared PR status alteration in the final surgical specimen,whereas only 4（2.4%） of 82 patients without NAC did,P=0. 001. The shift of HER-2 status was found in 4（5.1%） of 79 patients with NAC and in 2（2.4%） of 82 patients without NAC,respectively,P〈0. 379. Thirty （38.0%） of 79 patients with NAC and 6 （7.3~） of 82 patients without NAC showed the Ki-67 status changed in the surgically removed specimen,P〈0. 001. The positive rates of ER before and after NAC were 64.6% and 53.2% ,P= 0. 146. The positive rates of PR before and after NAC were 63.3% and 45.6% ,P=O. 025. The high expression rates of Ki-67 before and after NAC were 45.6% and 15.2% ,P〈0. 017. The status of ER,PR had no obvious relation with the efficiency of NAC （P〈0.05）. The efficiency of

关 键 词：乳腺肿瘤 空芯针穿刺活检 新辅助化疗 激素受体 雌激素受体 孕激素受体 HER-2 KI-67 

分 类 号：R737.9[医药卫生—肿瘤]