乳腺癌患者Ki-67表达水平对新辅助化疗后病理学完全缓解的预测价值  

Values of Ki-67 expression level in predicting pathological complete response following neoadjuvant chemotherapy in breast cancer patients

作　　者：刘杰娜 张建国[1] 郭宝良[1] 陈晰[1] 于玺文 王卓众 柳林[1] LIU Jiena;ZHANG Jianguo;GUO Baoliang;CHEN Xi;YU Xiwen;WANG Zhuozhong;LIU Lin(Department of Breast Surgery, the Second Affiliated Hospital, Harbin Medical University, Harbin 150081, China)

机构地区：[1]哈尔滨医科大学附属第二医院乳腺外科,黑龙江哈尔滨150081

出　　处：《中国普通外科杂志》2018年第5期608-614,共7页China Journal of General Surgery

基　　金：国家自然科学基金资助项目(81372838)

摘　　要：目的:探讨乳腺癌患者Ki-67表达水平对新辅助化疗(NAC)疗效的影响。方法:收集261例行NAC且临床病理资料相对完整的乳腺癌患者,分析患者Ki-67表达以及其他临床病理因素包括分子分型、激素受体状态等与患者NAC后病理学完全缓解(pCR)的关系。结果:单因素分析结果显示,患者NAC后pCR与孕激素受体(PR)及表皮生长因子受体2(Her-2)状态、分子分型与Ki-67水平明显有关(均P<0.05);多因素分析显示,Ki-67表达水平是NAC后pCR独立预测因素(OR=5.476,95%CI=2.637~11.372,P<0.05)。此外,在雌激素受体(ER)阳性患者中,Ki-67高表达患者pCR率为低表达患者的4.282倍(OR=4.282,95%CI=1.694~10.825,P=0.002),而PR阳性患者pCR率为阴性患者的0.303倍(OR=0.303,95%CI=0.113~0.810,P=0.017),Her-2阳性者的pCR率是Her-2阴性者的2.607倍(OR=2.607,95%CI=1.023~6.642,P=0.045)。结论:乳腺癌患者Ki-67高表达是NAC后高pCR率的预测因子,同时结合其他激素受体状态,将有助于更好的指导个体化NAC。Objective： To investigate the impact of Ki-67 expression level on efficacy of neoadjuvant chemotherapy（NAC） in breast cancer patients.Methods： A total of 261 patients with relatively complete clinicopathologic data undergoing NAC were collected. The relations of pathological complete response（pCR） after NAC with Ki-67 expression and other clinicopathologic factors such as molecular subtype and hormone receptor status of the patients were analyzed. Results： The results of univariate analysis showed that pCR after NAC of the patients was significantly related to the status of progestrone receptor（PR） and epidermal growth factor receptor 2（Her-2） as well as molecular subtype and Ki-67 expression; the results of multivariate analysis revealed that only the Ki-67 expression level was the independent predictive factor for pCR after NAC（OR=5.476, 95% CI=2.637–11.372, P〈0.05）. In addition, among the patients with positive estrogen receptor（ER） expression, the pCR rate in cases with high Ki-67 expression was 4.282-fold of that in those with low Ki-67 expression（OR=4.282, 95% CI=1.694–10.825, P=0.002）, in PR positive cases was 0.303-fold of that in PR negative ones（OR=0.303, 95% CI=0.113–0.810, P=0.017）, and in Her-2 positive cases was 2.607-fold of that in their negative counterparts（OR=2.607, 95% CI=1.023–6.642, P=0.045）.Conclusion： In breast cancer patients, high Ki-67 expression level is a predictive indicator for high pCR rate after NAC. Meanwhile, it may be helpful for better individualized NAC planning with combined considerations of the status of other hormone receptors.

关 键 词：乳腺肿瘤 放化疗 辅助 前导性化疗 生物标记 肿瘤 

分 类 号：R737.9[医药卫生—肿瘤]