Chang J, Powles T J, Allred D C, Ashley S E, Makris A, Gregory R K, Osborne C K, Dowsett M
Department of Medicine, Royal Marden Hospital, Sutton, Surrey, United Kingdom.
Clin Cancer Res. 2000 Feb;6(2):616-21.
The aim of this study was to evaluate pretreatment clinical features and biological markers together with changes in these factors as predictors of response and relapse in patients receiving tamoxifen for primary breast cancer. Fine-needle aspiration cytology of the primary breast cancer was performed before tamoxifen treatment in 54 patients and repeated after therapy on day 14, day 60, or on both days in a subset of 35 patients. These samples were evaluated for estrogen receptor (ER), progesterone receptor (PgR), Ki67, S-phase fraction and ploidy. The overall response to tamoxifen was 57% (31 of 54 patients). Pretreatment ER and PgR significantly predicted for response by univariate analysis (P < 0.0001 and P < 0.003, respectively). By multivariate analysis, ER expression was the only independent predictor of response, and it was associated with 27 times the likelihood of response (95% confidence interval, 6-136). Increase in PgR and decrease in Ki67 on day 14 significantly predicted for response to tamoxifen (P < 0.03 and P < 0.04, respectively). Lack of ER, clinical node-positive disease, and failure to decrease Ki67 on day 14 were significantly associated with increased risk of relapse (P < 0.05). By multivariate analysis, ER expression was the only independent predictor of relapse (P < 0.005). Pretreatment and early changes in molecular marker expression may assist in the prediction of response and clinical outcome in primary breast cancer patients receiving tamoxifen.
本研究的目的是评估接受他莫昔芬治疗原发性乳腺癌患者的预处理临床特征和生物标志物，以及这些因素的变化，作为反应和复发的预测指标。对54例患者在他莫昔芬治疗前进行原发性乳腺癌细针穿刺细胞学检查，并在治疗后第14天、第60天或35例患者的这两天重复进行检查。对这些样本进行雌激素受体（ER）、孕激素受体（PgR）、Ki67、S期分数和倍性评估。他莫昔芬的总体反应率为57%（54例患者中的31例）。单因素分析显示，预处理时的ER和PgR显著预测反应（分别为P<0.0001和P<0.003）。多因素分析表明，ER表达是反应的唯一独立预测指标，其反应可能性为27倍（95%置信区间，6-136）。第14天PgR增加和Ki67降低显著预测对他莫昔芬的反应（分别为P<0.03和P<0.04）。缺乏ER、临床淋巴结阳性疾病以及第14天Ki67未降低与复发风险增加显著相关（P<0.05）。多因素分析显示，ER表达是复发的唯一独立预测指标（P<0.005）。预处理和分子标志物表达的早期变化可能有助于预测接受他莫昔芬治疗的原发性乳腺癌患者的反应和临床结局。
