Ki-67指数及血清CA15-3水平对ER阳性乳腺癌患者新辅助内分泌治疗疗效及预后的预测价值  

Predictive value of Ki-67 index and serum CA15-3 level on the efficacy and prognosis of neoadjuvant endocrine therapy for estrogen receptor positive breast cancer patients

作　　者：张凌捷 葛睿 程爱群 胡天华 ZHANG Lingjie;GE Rui;CHENG Aiqun;HU Tianhua(Department of General Surgery,Fudan University Affiliated East China Hospital,Shanghai 200040,China)

机构地区：[1]复旦大学附属华东医院普外科,上海200040

出　　处：《现代肿瘤医学》2024年第23期4443-4448,共6页Journal of Modern Oncology

摘　　要：目的:探讨Ki-67指数及血清糖类抗原15-3(carbohydrate antigen 15-3,CA15-3)水平对雌激素受体(estrogen receptor,ER)阳性乳腺癌患者新辅助内分泌治疗疗效及预后的预测价值。方法:选取2016年01月至2022年05月医院收治的接受新辅助内分泌及手术治疗且ER阳性的乳腺癌患者90例。采用免疫组化SP法染色测定癌组织中Ki-67表达,并测定新辅助内分泌治疗前和治疗后患者血清CA15-3水平。Logistic回归分析Ki-67和CA15-3与ER阳性乳腺癌患者新辅助内分泌治疗疗效的关系,ROC曲线分析上述指标对疗效的预测价值。术后随访1年,记录无病生存期(disease-free survival,DFS)。根据治疗前Ki-67指数和血清CA15-3水平,将患者分为4个组,A组为Ki-67低表达、CA15-3正常,B组为Ki-67低表达、CA15-3升高,C组为Ki-67高表达、CA15-3正常,D组为Ki-67高表达、CA15-3升高,分析Ki-67指数及血清CA15-3水平与ER阳性乳腺癌患者预后的关系。结果:与新辅助内分泌治疗前比较,新辅助内分泌治疗后乳腺癌患者Ki-67指数和血清CA15-3水平均显著降低(P<0.05)。治疗前Ki-67指数是ER阳性乳腺癌患者新辅助内分泌治疗后病理完全缓解(pathological complete remission,pCR)的独立影响因素(P<0.05)。Ki-67联合CA15-3预测ER阳性乳腺癌患者新辅助内分泌治疗pCR的曲线下面积、敏感度、特异度分别为0.927、89.64%、85.26%,均高于单项检测(P<0.05)。A组、B组、C组、D组患者1年DFS率分别为90.32%、64.29%、63.16%、30.00%,B、C、D组患者1年DFS率均显著低于A组,D组患者1年DFS率显著低于B组和C组(P<0.05)。治疗前Ki-67指数高表达和治疗前CA15-3水平升高是影响ER阳性乳腺癌患者DFS的独立危险因素(P<0.05)。结论:Ki-67指数及血清CA15-3水平可有效预测ER阳性乳腺癌患者新辅助内分泌治疗疗效和预后,且联合检测预测效能更高。Objective:To explore the predictive value of Ki-67 index and serum carbohydrate antigen 15-3(CA15-3)level on the efficacy and prognosis of neoadjuvant endocrine therapy in patients with estrogen receptor(ER)positive breast cancer.Methods:90 ER-positive breast cancer patients who received neoadjuvant endocrine and surgical treatment and were admitted to the hospital from January 2016 to May 2022 were selected.Immunohistochemical SP staining was used to detect Ki-67 expression in cancer tissues,and serum CA15-3 levels were measured before and after neoadjuvant endocrine therapy.Logistic regression was used to analyze the relationship between Ki-67 and CA15-3 and the efficacy of neoadjuvant endocrine therapy in ER-positive breast cancer patients,and ROC curve was used to analyze the predictive value of the above indexes for efficacy.Disease-free survival(DFS)was recorded after 1-year follow-up.According to the Ki-67 index and serum CA15-3 level before treatment,the patients were divided into four groups.Group A had low Ki-67 expression and normal CA15-3,Group B had low Ki-67 expression and high CA15-3,Group C had high Ki-67 expression and normal CA15-3,and Group D had high Ki-67 expression and high CA15-3.The relationship between Ki-67 index and serum CA15-3 level and the prognosis of ER-positive breast cancer patients was analyzed.Results:Ki-67 index and serum CA15-3 level in breast cancer patients after neoadjuvant endocrine therapy were significantly lower than those before neoadjuvant endocrine therapy(P<0.05).The Ki-67 index before treatment was independent influencing factor of pathological complete remission(pCR)after neoadjuvant endocrine therapy in ER positive breast cancer patients(P<0.05).Ki-67 combined with CA15-3 predicted the area under the curve,sensitivity,and specificity of neoadjuvant endocrine therapy pCR in ER-positive breast cancer patients were 0.927,89.64%,and 85.26%,respectively,which were higher than single detection(P<0.05).The 1-year DFS rates in groups A,B,C and D were 90.32%,64.29%,63.16

关 键 词：乳腺癌 雌激素受体阳性 新辅助内分泌治疗 KI-67指数 糖类抗原15-3 

分 类 号：R737.9[医药卫生—肿瘤]