三阴性乳腺癌新辅助化疗后Ki67表达变化与患者生存的关系  

Correlation between Ki67 expression change after neoadjuvant chemotherapy and prognosis of triple negative breast cancer patients

作　　者：梁晨露 王晨[1] 俞星飞[1] 李永峰[1] 杨红健[1] Liang Chenlu;Wang Chen;Yu Xingfei;Li Yongfeng;Yang Hongjian(Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China)

机构地区：[1]浙江省肿瘤医院乳腺外科

出　　处：《中华乳腺病杂志（电子版）》2019年第3期145-149,共5页Chinese Journal of Breast Disease(Electronic Edition)

基　　金：浙江省中医药科学研究基金资助项目(2017ZA030)

摘　　要：目的探讨三阴性乳腺癌新辅助化疗后Ki67表达变化与患者预后的关系。方法回顾性分析浙江省肿瘤医院2010年1月至2015年12月收治的102例三阴性乳腺癌患者临床资料。采用免疫组织化学方法检测新辅助化疗前后Ki67的表达情况。根据Ki67表达的变化将患者分为3组:A组,Ki67由低表达(≤20%)转为高表达(>20%);B组,Ki67表达无变化;C组,Ki67由高表达转为低表达。然后,采用Kruskal-Wallis秩和检验分析新辅助化疗后Ki67变化模式与患者疗效的关联性,并用Kaplan-Meier生存曲线和COX风险比例回归模型进行生存分析。结果 102例患者中,A组有11例(10.8%),B组有49例(48.0%),C组有42例(41.2%)。Ki67表达变化与新辅助化疗疗效临床评估及病理学评估均存在显著性关联(χ~2=23.617、41.412,P均<0.001)。中位随访34个月,A、B、C组的DFS率分别为36.4%、60.4%和88.1%,C组患者DFS率明显高于A组和B组(χ~2=14.980,P<0.001;χ~2=9.878,P=0.002)。3组之间OS率比较,差异无统计学意义(χ~2=5.683,P=0.058)。COX风险比例回归模型显示,新辅助化疗后Ki67表达降低是DFS和OS的独立影响因素(HR=0.401, 95%CI:0.243~0.659,P<0.001;HR=0.387, 95%CI:0.170~0.881,P=0.024)。结论新辅助化疗后Ki67表达变化与临床疗效评估及病理学评估间存在相关性。Ki67的变化可用于预测三阴性乳腺癌患者的预后,这对于该类患者新辅助化疗后的后续治疗具有一定的指导意义。Objective To investigate the correlation between Ki67 expression change after neoadjuvant chemotherapy(NCT) and prognosis of triple negative breast cancer(TNBC) patients.Methods We retrospectively analyzed the clinical data of 102 TNBC patients in Zhejiang Cancer Hospital from January 2010 to December 2015. Immunohistochemistry was adopted to detect the expression of Ki67 after NCT. Patients were divided into three groups according to the change of Ki67 expression: group A, from low expression(Ki67≤20%) to high expression(Ki67>20%);group B, no change;group C, from high expression to low expression. Then the correlation of Ki67 expression change after neoadjuvant chemotherapy with efficacy was analyzed by Kruskal-Wallis test. Kaplan-Meier survival curve and COX multivariate regression model were used for survival analysis.Results In 102 patients, there were 11 patients(10.8%) in group A, 49(48.0%) in group B and 42(41.2%) in group C. Ki67 expression change was correlated with clinical response(χ~2=23.617, P<0.001) and pathological response(χ~2=41.412, P<0.001) of NCT. The median follow-up was 34 months. The DFS rate of group A,B and C was 36.4%,60.4% and 88.1%, respectively. The DFS rate in group C was significant higher than that in group A(χ~2=14.980, P<0.001) or group B(χ~2=9.878, P=0.002). There was no significant difference in OS rate among three groups(χ~2=5.683, P=0.058). According to the Cox multivariate regression model, Ki67 expression change was an independent factor of DFS(HR=0.401, 95%CI:0.243-0.659, P<0.001) and OS(HR =0.387, 95%CI:0.170-0.881, P=0.024).Conclusions Ki67 expression change after NCT is correlated with clinical and pathological response. Meanwhile, Ki67 expression change can also be used to predict the prognosis of triple-negative breast cancer patients, which can provide guidance for the treatment after NCT.

关 键 词：化学疗法 KI67抗原 预后 乳腺肿瘤 

分 类 号：R737.9[医药卫生—肿瘤]