Yin Hong-fang, Wang Yun-hong, Qin Xiao-qi, Zhang Hong, Li Ting, Ye Jing-ming, Liu Yin-hua
Department of Pathology, First Teaching Hospital, Peking University, Beijing 100034, China.
Zhonghua Zhong Liu Za Zhi. 2009 Nov;31(11):858-62.
The aim of this study is to investigate the changes of expression of estrogen receptors (ER), progesterone receptors (PR), Her-2, Ki-67 and histological grade after neoadjuvant chemotherapy in breast cancer.
Sixty-seven patients with histopathalogically confirmed breast cancer by core needle biopsy received neoadjuvant chemotherapy. The effect of neoadjuvant chemotherapy was assessed according to the criteria of the Japanese Breast Cancer Society: non-effective (G1), mildly effective (G2), moderately effective (G3), markedly effective (G4) and completely effective (G5). All pathological slides were retrospectively reviewed. Immunohistochemical staining (EnVision method) was used to detect the expression of ER and PR, Her-2 and Ki-67. The pre- and post-neoadjuvant chemotherapy status of tumor histological grade, ER and PR, Her-2 and Ki-67 expression in the 49 cases were compared.
The effect of neoadjuvant chemotherapy was assessed in 67 patients. There were 5 cases (7.5%) in G1, 19 in G2 (28.4%), 20 in G3 (29.9%), 17 in G4 (25.4%) and 6 in G5 (9.0%), respectively. PR positive rate was 71.4% after chemotherapy versus 91.8% before chemotherapy, with a statistically significant reduction (P = 0.021). However, the ER and Her-2 expression before and after neoadjuvant chemotherapy was stable. Of the patients with invasive ductal carcinoma, 28.6% had histological grade change after neoadjuvant chemotherapy, and 85.7% of patients decreased one grade. The proportion of histological grade change in the G1, G2, G3, G4 were 0, 5.9%, 41.2% and 54.5%, respectively (P = 0.013). The average rate of Ki-67 expression decreased from 28.3% pre-chemotherapy to 11.0% post-chemotherapy (P = 0.011). After the neoadjuvant chemotherapy, the Ki-67 expression rate decreased by > 10%, > 20%, > 30%, > 40% and > 50% in 3 groups (G1 and G2, group G3, group G4 and G5) showed a tendency to be increased, with a significant difference (P < 0.05).
PR expression in breast cancer decreases after neoadjuvant chemotherapy, while ER and Her-2 expressions remain stable. After neoadjuvant chemotherapy, the histological grade and proliferation index are decreased and correlated with the response to chemotherapy. Therefore, histological grade and proliferation index may be effective complementary factors in assessment of the effectiveness of neoadjuvant chemotherapy.
本研究旨在探讨乳腺癌新辅助化疗后雌激素受体（ER）、孕激素受体（PR）、Her-2、Ki-67的表达变化及组织学分级情况。
67例经粗针穿刺活检病理确诊为乳腺癌的患者接受新辅助化疗。根据日本乳腺癌学会的标准评估新辅助化疗的效果：无效（G1）、轻度有效（G2）、中度有效（G3）、显著有效（G4）和完全有效（G5）。对所有病理切片进行回顾性分析。采用免疫组织化学染色（EnVision法）检测ER、PR、Her-2和Ki-67的表达。比较49例患者新辅助化疗前后肿瘤组织学分级、ER和PR、Her-2和Ki-67的表达情况。
对67例患者的新辅助化疗效果进行评估。G1组5例（7.5%），G2组19例（28.4%），G3组20例（29.9%），G4组17例（25.4%），G5组6例（9.0%）。化疗后PR阳性率为71.4%，化疗前为91.8%，差异有统计学意义（P = 0.021）。然而，新辅助化疗前后ER和Her-2的表达保持稳定。浸润性导管癌患者中，28.6%在新辅助化疗后组织学分级发生改变，85.7%的患者降低了一级。G1、G2、G3、G4组组织学分级改变的比例分别为0、5.9%、41.2%和54.5%（P = 0.013）。Ki-67表达的平均率从化疗前的28.3%降至化疗后的11.0%（P = 0.011）。新辅助化疗后，3组（G1和G2组、G3组、G4和G5组）中Ki-67表达率下降>10%、>20%、>30%、>40%和>50%呈现增加趋势，差异有统计学意义（P < 0.05）。
乳腺癌新辅助化疗后PR表达降低，而ER和Her-2表达保持稳定。新辅助化疗后，组织学分级和增殖指数降低，且与化疗反应相关。因此，组织学分级和增殖指数可能是评估新辅助化疗疗效的有效补充因素。
