刘英,黄建军
LIU Ying,HUANG Jianjun

• 1:达州市第二人民医院普外科
• 2:贵阳医学院附院乳腺外科

摘要(Abstract)：

目的:观察乳腺癌新辅助化疗(neoadjuvant chemotherapy,NAC)前后雌激素受体(ER),孕激素受体(PR)、人类表皮生长因子受体2(HER-2)、细胞角蛋白5/6(CK5/6)、表皮生长因子受体(EGFR)表达及对化疗疗效的预测价值。方法:收集82例确诊为乳腺浸润性导管癌的病例,临床Ⅱa~Ⅲb期,取NAC前后乳腺癌灶组织,应用免疫组织化学(IHC)Envision二步法检测ER、PR、HER-2、EGFR及CK5/6的表达水平,并将指标表达情况与化疗效果进行对比,评价其对化疗效果的预测价值。结果:7例患者化疗后达病理完全缓解(pCR)不能进行IHC检测,其余75例患者在NAC前后ER、PR、HER-2、EGFR、CK5/6的表达变化差异无统计学意义,完全缓解(CR)8例,部分缓解(PR)61例,客观有效率(CR+PR)84.1%(69/82),疾病稳定(SD)7例,无疾病进展(PD)病例;ER(+)组与ER(-)组、PR(+)组与PR(-)组化疗疗效差异具有统计学意义(P<0.05),但HER-2(+)组与(-)组、EGFR(+)组与EGFR(-)组、CK5/6(+)组与CK5/6(-)组的化疗有效率差异均无统计学意义(P>0.05)。结论:NAC前后ER、PR、HER-2、EGFR及CK5/6表达变化对乳腺癌化疗效果判断的参考意义不大,NAC前ER、PR阳性的乳腺癌病人对化疗更敏感,二者可作为预测化疗疗效的指标。
Objective: To observe the expression of estrogen receptor( ER),progesterone receptor( PR),human epidermal growth factor receptor 2( HER-2),cytokeratin 5/6( CK5/6),epidermal growth factor receptor( EGFR) before and after neoadjuvant chemotherapy( NAC) in breast cancer tissue,to understand the possible value of the molecular targets in predicting chemotherapeutic effects.Methods: Eighty-two patients with breast infiltrating ductal carcinoma,clinical stage Ⅱa ~ Ⅲb,were selected. Immunohistochemistry was employed to detect the expression levels of ER,PR,HER-2,EGFR and CK5 /6 in breast cancer tissues before and after neoadjuvant chemotherapy. The test results were compared with chemotherapeutic effects. Results: Immunohistochemical detection could not be carried out in 7 cases who obtained pathological complete response( pCR) after chemotherapy. No significant difference was found in ER,PR,HER-2,EGFR and CK5 /6 expression levels of the other 75 cases before and after NAC. There were 8 complete remission( CR) cases,60 partial remission( PD)cases and 7 cases stable( SD) cases,and there was no case with progressive disease( PD). The objective effective rate( CR + PR) was 84. 1%( 69 /82). The differences of chemotherapeutic effects were statistically significant between ER( +) and ER(-) group as well as between) R( +) and PR(-) group( P <0.05),but there was no significant difference in chemotherapeutic effects between Her-2( +) and Her-2(-) group,between EGFR( +) and EGFR(-) group as well as between the CK5 /6( +) and the CK5 /6(-) group( P > 0. 05). Conclusions: The expression changes of ER,PR,HER-2,EGFR and CK5 /6 has little meaning in predicting chemotherapeutic effects of breast cancer; Breast cancer patients who express ER and PR positively are more sensitive to chemotherapy,both of them may be molecular indicators for forecasting the chemotherapeutic effects.

关键词(KeyWords)： 乳腺癌;新辅助化疗;雌激素受体;孕激素受体;HER-2;EGFR;CK5/6;病理完全缓解
breast cancer;neoadjuvant chemotherapy;estrogen receptor;progesterone receptor;human epidermal growth factor receptor-2;epidermal growth factor receptor;cytokeratin 5 /6;pathological complete remission

Abstract:

Keywords:

基金项目(Foundation): 贵州省科技厅项目[黔科合LG字(2011)041号]

作者(Author): 刘英,黄建军
LIU Ying,HUANG Jianjun

DOI: 10.19367/j.cnki.1000-2707.2014.05.019

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