乳腺癌新辅助化疗后雌、孕激素受体表达变化的临床意义  

Clinical significance of estrogen receptor/progesterone receptor expression changes in breast cancer patients after neoadjuvant chemotherapy

作　　者：陈圣 朱明华[2] 黄焰 王怀涛 何奇[1] Chen Sheng;Zhu Minghua;Huang Yan;Wang Huaitao;He Qi(Department of Breast Surgery,International Peace Maternal and Child Healthcare Institute,School of Medicine,Shanghai Jiao Tong University,Shanghai 200030,China;Department of Breast Surgery,Fifth Medical Center,General Hospital of PLA,Beijing 100071,China;Department of Pathology,Fifth Medical Center,General Hospital of PLA,Beijing 100071,China)

机构地区：[1]上海交通大学医学院附属国际和平妇幼保健院乳腺外科,200025 [2]解放军总医院附属第五医学中心乳腺外科,北京100039 [3]解放军总医院附属第五医学中心病理科,北京100039

出　　处：《中华乳腺病杂志（电子版）》2021年第6期346-351,共6页Chinese Journal of Breast Disease(Electronic Edition)

摘　　要：目的探讨乳腺癌患者新辅助化疗(NAC)前后ER、PR表达变化与NAC疗效之间的关系。方法回顾性分析从2015年1月到2017年6月在解放军总医院第五医学中心行蒽环类联合紫杉类NAC后肿瘤未达到pCR的127例HER-2阴性浸润性乳腺癌患者的临床资料。通过免疫组织化学方法测定NAC前后肿瘤组织中ER、PR的表达。分别按照核染色比例≥1%、>10%和>20%来定义ER、PR阳性,判断NAC前后ER和PR的表达状态,两者完全一致为一致组,否则为差异组。用χ^(2)检验或秩和检验比较一致组和差异组的临床病理特征,t检验或秩和检验比较2组的肿瘤缓解率。进一步分析差异组中ER、PR的变化状态,分为ER阴转阳、ER阳转阴、PR阴转阳和PR阳转阴4个亚组,采用方差分析对3种标准下4个亚组的肿瘤缓解率进行比较。结果以1%为界值,一致组与差异组患者的临床病理特征比较,差异无统计学意义(P均>0.050)。以10%为界值,2组在PR表达上差异有统计学意义(χ^(2)=4.757,P=0.029)。以20%为界值,差异组中腋窝淋巴结转移、ER、PR阳性及三阴性乳腺癌的比例更高(χ^(2)=5.572、8.683、11.724、4.686,P=0.018、0.003、0.001、0.030)。以1%为界值,一致组和差异组的肿瘤缓解率分别为(35.9±26.8)%、(46.8±23.8)%,差异有统计学意义(t=2.190,P=0.032)。以10%及20%为界值,一致组和差异组的肿瘤缓解率比较,差异无统计学意义[M(P_(25),P_(75)):37.3(21.4,53.6)%比38.5(26.8,54.7)%,Z=0.446,P=0.656;39.1(22.7,55.1)%比39.5(27.3,56.9)%,Z=0.548,P=0.584]。在核染色比例≥1%、>10%和>20%3种标准下,4个亚组肿瘤缓解率比较,差异均无统计学意义(F=1.380、1.890、1.970,P=0.266、0.146、0.131)。结论当ER、PR以核染色比例≥1%为阳性标准时,NAC后ER或者PR状态变化的乳腺癌患者有望获得更高的肿瘤缓解率。NAC后ER、PR状态的不同变化并不会对NAC的疗效产生影响。Objective To explore the relationship between the expression changes of estrogen receptor(ER)/progesterone receptor(PR)before and after neoadjuvant chemotherapy(NAC)and the efficacy of NAC in breast cancer patients.Methods The clinical data of 127 patients with HER-2-negative invasive breast cancer who had not achieved pCR after NAC(anthracycline and docetaxel-based regimen)in the Department of Pathology,Fifth Medical Center,General Hospital of PLA from January 2015 to June 2017 were retrospectively analyzed.ER and PR expressions in tumor tissues before and after NAC were determined by immunohistochemistry.ER/PR was regarded as positive if nuclear staining percentage≥1%,>10%or>20%,respectively.The patients with different ER/PR expression status before and after NAC were in Group A,and others were in Group B.Theχ^(2) test or rank sum test was used to compare the clinicopathological characteristics between two groups.The t test or rank sum test was used to compare the tumor remission rates between two groups.According to the different change of ER and PR after NAC,Group A was divided into 4 subgroups:ER negative to positive subgroup,ER positive to negative subgroup,PR negative to positive subgroup and PR positive to negative subgroup.Analysis of variance was used to compare the tumor remission rates among 4 subgroups under the three positive expression standards.Results With nuclear staining percentage≥1%as the positive standard,there was no statistically significant difference in clinicopathological characteristics between two groups(all P>0.050).With nuclear staining percentage>10%as the positive standard,PR expression showed a significant difference between two groups(χ^(2)=4.757,P=0.029).With nuclear staining percentage>20%as the positive standard,Group A had higher rates of axillary lymph node metastasis,ER positive,PR positive and triple negative breast cancer compared with Group B(χ^(2)=5.572,8.683,11.724,4.686;P=0.018,0.003,0.001,0.030).With nuclear staining percentage≥1%as the positive standard,th

关 键 词：乳腺肿瘤 新辅助治疗 雌激素受体 孕激素受体 

分 类 号：R737.9[医药卫生—肿瘤]