新辅助化疗前后Ki-67的表达改变与不同分子分型乳腺癌化疗疗效的相关性  

Correlation study of the different expression changes of Ki-67 after neoadjuvant chemotherapy and chemotherapy curative effect for the different molecular classification breast cancers

作　　者：吴秀萍 刘飞 吴赛红 冉旺军 曾得学 郑小燕 胡连娣 谢源福[2] 卓延红[2] 

机构地区：[1]福建省漳州正兴医院乳腺外科,363000 [2]福建医科大学附属漳州市医院放疗科

出　　处：《国际肿瘤学杂志》2015年第12期891-895,共5页Journal of International Oncology

摘　　要：目的探讨新辅助化疗前后Ki-67的表达改变与不同分子分型乳腺癌化疗疗效的关系。方法采用简单随机抽样方法选取2008年3月—2010年3月于福建省漳州正兴医院乳腺外科就诊的乳腺癌患者160例（Luminal A型40例、Luminal B型61例、HER-2过表达型21例、三阴性38例），所有纳入病例均予以新辅助化疗，每21天为一个周期，共4周期。检测新辅助化疗前后Ki67的表达，分析Ki67表达变化与不同分子分型乳腺癌化疗疗效的相关性。结果新辅助化疗后，Luminal A型、Luminal B型、HER-2过表达型和三阴性乳腺癌的病理完全缓解率分别为12.5%、14.8%、19.0%、28.9%，差异有统计学意义（χ2=8.992，P=0.030）。对于Luminal A型和三阴性乳腺癌患者，新辅助化疗后Ki-67表达降低者与Ki-67升高或持平者相比，5年无瘤生存率的差异均有统计学意义（81.3%∶61.3%，χ2=9.021，P=0.031；54.3%∶41.2%，χ2=7.583，P=0.043）。多因素分析显示，新辅助化疗疗效（RR=3.12，95%CI为1.37～3.54，χ2=12.183，P=0.001）、临床分期（RR=2.16，95%CI为1.22～2.79，χ2=8.057，P=0.005）是影响Luminal A型乳腺癌无瘤生存率的独立因素；新辅助化疗疗效（RR=2.57，95%CI为1.87～3.15，χ2=4.832，P=0.027）、临床分期（RR=2.70，95%CI为1.72～3.79，χ2=5.218，P=0.015）和Ki67表达改变（RR=2.15，95%CI为2.13～2.38，χ2=4.276，P=0.044）是影响三阴性乳腺癌无瘤生存率的独立因素。结论新辅助化疗前后Ki-67的表达改变是影响三阴性乳腺癌无瘤生存率的独立因素，Ki-67对三阴性乳腺癌的预后有一定的参考价值。Objective To explore the correlation of the different expression changes of Ki-67 after neoadjuvant chemotherapy and chemotherapy curative effect for the different molecular classification breast cancers. MethodsOne hundred and sixty cases with breast surgery in Zhengxing Hospital of Zhangzhou of Fujian Province from March 2008 to March 2010 were selected using simple random sampling method （40 cases of Luminal A, 61 cases of Luminal B, 21 cases of HER2 over expression type, 38 cases of three negative breast cancer）. All included patients were treated with neoadjuvant chemotherapy, every 21 days for a cycle, a total of 4 cycles. The expressions of Ki67 before and after neoadjuvant chemotherapy were detected, and the correlations of Ki67 expression changes and chemotherapy curative effect for the different molecular classification breast cancers were analyzed. ResultsAfter neoadjuvant chemotherapy, the pathological complete response rates of the four types of breast cancer were 12.5%, 14.8%, 19.0%, 28.9%, with statistical significant （χ2=8.992, P=0.030）. For Luminal A type and triple negative breast cancer, there were statistical significant differences for 5year disease free survival rates of patients with Ki-67 decreased and those patients with Ki67 increased or to usual （81.3% vs. 61.3%, χ2=9.021, P=0.031; 54.3% vs. 41.2%, χ2=7.583, P=0.043）. Multifactor analysis revealed that neoadjuvant chemotherapy curative effect （RR=3.12, 95%CI： 1.373.54, χ2=12.183, P=0.001） and clinical stage （RR=2.16, 95%CI： 1.222.79, χ2=8.057, P=0.005） were independent factors for patients with Luminal A type breast cancer. Neoadjuvant chemotherapy curative effect （RR=2.57, 95%CI： 1.873.15, χ2=4.832, P=0.027）, clinical stage （RR=2.70, 95%CI： 1.723.79, χ2=5.218, P=0.015） and expression change of Ki67 （RR=2.15, 95%CI： 2.132.38, χ2=4.276, P=0.044） were independent factors for patients with triple negative breast cancer. ConclusionThe expression chan

关 键 词：肿瘤辅助疗法 KI-67抗原 乳腺肿瘤 

分 类 号：R737.9[医药卫生—肿瘤]