新辅助化疗对乳腺癌雌、孕激素受体表达的影响及临床意义

发布时间：2018-08-28 12:55

【摘要】：目的探讨乳腺癌新辅助化疗期间雌激素(ER)、孕激素受体(PR)状态的改变及临床指导意义。方法回顾分析208例2011年1月-2015年9月期间于重庆医科大学附属第一医院行乳腺癌术前新辅助化疗的局部晚期乳癌患者的资料,包括新辅助化疗前核心穿刺标本的ER、PR表达情况以及术后病检标本的ER、PR表达情况,随访内分泌治疗的使用情况,利用统计学方法进行生存分析,评估预后。结果新辅助化疗前后ER、PR的表达约有21.2%的不一致性,κ值为0.519,提示新辅助化疗前后激素受体(HR)状态一致性差,其中新辅助化疗后HR的丢失更为显著(14.3%),新辅助化疗前HR(ER/PR)阳性的患者使用内分泌治疗在无病生存率以及总生存率上显著优于新辅助化疗前HR阴性,新辅助化疗后HR阳性的患者(P0.05),而新辅助化疗前HR阴性,新辅助化疗后HR阳性的患者与新辅助化疗前后HR均为阴性,未使用内分泌治疗的患者在无病生存率以及总生存率上无显著性差异(P0.05)。结论对于新辅助化疗前后HR表达改变的患者,新辅助化疗前HR阳性的患者使用内分泌治疗疗效明显优于新辅助化疗前HR阴性、新辅助化疗后HR阳性的患者,这类患者使用内分泌治疗疗效不佳,提示新辅助化疗增加了化疗后乳腺癌组织免疫组化中HR的假阳性率,对于新辅助化疗前核心穿刺病理标本HR阴性,新辅助化疗后残余癌组织中HR阳性的患者可能不必使用辅助内分泌治疗。
[Abstract]:Objective to investigate the changes of estrogen (ER), progesterone receptor (PR) status during neoadjuvant chemotherapy in breast cancer and its clinical significance. Methods the data of 208 patients with locally advanced breast cancer who received preoperative neoadjuvant chemotherapy in the first affiliated Hospital of Chongqing Medical University from January 2011 to September 2015 were retrospectively analyzed. The expression of ER,PR in core puncture specimens before neoadjuvant chemotherapy and ER,PR expression in post-operative biopsy specimens were included. The use of endocrine therapy was followed up and survival analysis was carried out using statistical methods to evaluate the prognosis. Results the expression of ER,PR before and after neoadjuvant chemotherapy was about 21.2%, and the 魏 value was 0.519, which suggested that the state of hormone receptor (HR) was poor before and after neoadjuvant chemotherapy. The loss of HR after neoadjuvant chemotherapy was more significant (14.3%). The disease-free survival rate and overall survival rate of patients with positive HR (ER/PR) before neoadjuvant chemotherapy were significantly higher than those without HR before neoadjuvant chemotherapy. The patients with HR positive after neoadjuvant chemotherapy (P0.05) were negative for HR before neoadjuvant chemotherapy, HR positive after neoadjuvant chemotherapy and HR before and after neoadjuvant chemotherapy. There was no significant difference in disease-free survival rate and overall survival rate between patients without endocrine therapy (P0.05). Conclusion for patients with HR expression before and after neoadjuvant chemotherapy, patients with positive HR before neoadjuvant chemotherapy are significantly better than those with HR negative before and after neoadjuvant chemotherapy, and patients with HR positive after neoadjuvant chemotherapy are better than those with positive HR before and after neoadjuvant chemotherapy. The effect of endocrine therapy on these patients was not good, suggesting that neoadjuvant chemotherapy increased the false positive rate of HR in breast cancer tissues after chemotherapy, and negative HR for core biopsy specimens before neoadjuvant chemotherapy. Patients with HR positive in residual neoadjuvant chemotherapy may not need adjuvant endocrine therapy.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

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