Pedrini José Luiz, Francalacci Savaris Ricardo, Casales Schorr Mario, Cambruzi Eduardo, Grudzinski Melina, Zettler Cláudio Galleano
Universidade Federal de Ciências da Saúde de Porto Alegre, Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, Brazil.
Tumori. 2011 Nov-Dec;97(6):704-10. doi: 10.1177/030089161109700605.
Histological and immunohistochemical findings may vary in cases of breast cancer. Possible changes in tumor markers between biopsies performed before and after neoadjuvant chemotherapy are controversial and pose a challenge when a clinical decision is needed. The objectives of the present study were: (i) to compare the immunohistochemical expression of estrogen, progesterone and prolactin receptors and HER-2/neu in breast cancer before and after neoadjuvant chemotherapy; and (ii) to correlate the expression of these tumor markers with partial tumor response to neoadjuvant chemotherapy.
Immunohistochemical staining for breast tumor markers was performed in 90 cases of breast cancer. Statistical analysis was carried out using Fisher's exact test, McNemar's test, Spearman's correlation and the Kappa index with linear weighting (k).
Agreement between markers before and after neoadjuvant chemotherapy was fair to moderate (k = 0.37-0.51). The immunohistochemical expression of HER-2/neu and prolactin receptors showed a significant, albeit weak correlation before and after neoadjuvant chemotherapy (HER-2/neu, rho = 0.34; P = 0.0009; k = 0.35 [95% CI, 0.19-0.51]). Prolactin status changed in 28/90 cases (P = 0.001; McNemar's test), whereas no changes were found in estrogen or progesterone receptors. No association was found between tumor marker expression and tumor response.
It seems prudent to reevaluate immunohistochemical markers such as HER-2/neu after neoadjuvant chemotherapy, since the findings will guide the strategy for implementation of adjuvant systemic treatment. No correlation was found between the tumor markers analyzed in the present study and partial tumor response to neoadjuvant chemotherapy.
乳腺癌病例的组织学和免疫组化结果可能存在差异。新辅助化疗前后活检之间肿瘤标志物的可能变化存在争议，在需要做出临床决策时构成挑战。本研究的目的是：（i）比较新辅助化疗前后乳腺癌中雌激素、孕激素和催乳素受体以及HER-2/neu的免疫组化表达；（ii）将这些肿瘤标志物的表达与新辅助化疗的部分肿瘤反应相关联。
对90例乳腺癌病例进行乳腺肿瘤标志物的免疫组化染色。使用Fisher精确检验、McNemar检验、Spearman相关性分析和线性加权Kappa指数（k）进行统计分析。
新辅助化疗前后标志物之间的一致性为中等（k = 0.37 - 0.51）。新辅助化疗前后HER-2/neu和催乳素受体的免疫组化表达显示出显著但较弱的相关性（HER-2/neu，rho = 0.34；P = 0.0009；k = 0.35 [95% CI，0.19 - 0.51]）。90例中有28例催乳素状态发生变化（P = 0.001；McNemar检验），而雌激素或孕激素受体未发现变化。未发现肿瘤标志物表达与肿瘤反应之间存在关联。
新辅助化疗后重新评估HER-2/neu等免疫组化标志物似乎是谨慎的，因为这些结果将指导辅助全身治疗的实施策略。本研究分析的肿瘤标志物与新辅助化疗的部分肿瘤反应之间未发现相关性。
