乳腺癌新辅助化疗对激素受体表达水平的影响

Effects of Neoadjuvant Chemotherapy on Hormone Receptor Expression in Breast Cancer

摘要: 目的：探讨乳腺癌新辅助化疗对激素受体表达水平的影响，以及新辅助化疗疗效和激素受体表达的相关性。方法：选择2017年1月至2019年12月我院收治的100例乳腺癌患者进行研究。收集患者的基本临床资料，如年龄、肿瘤大小、淋巴结转移情况、是否绝经、AJCC临床分期等。使用超声引导下空芯针穿刺，采集患者部分组织标本，行常规病理和免疫组化检测；符合入组标准患者入组接受多西他赛、表柔比星、环磷酰胺方案，间隔3周，为期6周的新辅助化疗，化疗完成后接受手术治疗。术后行常规病理、免疫组化检测。比较新辅助化疗前后肿瘤组织标本的ER、PR阳性，阴性互相转化状况，以及ER、PR表达强度的变化情况，了解新辅助化疗对激素受体ER、PR表达的影响。同时观察不同的ER、PR表达对新辅助治疗疗效的影响。结果：新辅助化疗对激素受体ER、PR的表达状态及表达水平有显著影响。表达状态影响结果：新辅助化疗之后，11例患者ER的表达状态有变化，其中6例患者ER阳性表达转为ER阴性，5例患者ER阴性表达转为ER阳性，新辅助化疗前、后ER的表达状态改变率为13.414%；15例患者PR的表达状态有变化，其中8例患者PR阳性表达转为PR阴性，7例患者PR阴性表达转为PR阳性，新辅助化疗前、后PR的表达状态改变率为18.292%。新辅助化疗之后，虽然ER、PR的总体阳性表达率上升(72% vs. 86.56%; 60% vs. 71.95%)，但是ER、PR的表达水平发生明显变化，ER强阳性率较新辅助化疗前下降(30.49% vs. 40%)，弱阳性率较新辅助化疗前增加(7% vs. 13.41%)，PR强阳性率较新辅助化疗前下降(10.97% vs. 21%)，弱阳性率较新辅助化疗前增加(36.58% vs. 11%)。本研究入组患者新辅助化疗客观缓解率(ORR) 74%，其中完全缓解(CR) 35.00%，部分缓解(PR) 39.00%，疾病稳定(SD) 20.00%，疾病进展(PD) 6.00%。经过病理评估pCR率为18.00%。新辅助化疗的治疗疗效与ER及PR表达状态显著相关，ER阴性组的有效率明显高于ER阳性组(96.43% vs. 65.28%, P < 0.050)，ER阴性组的pCR率明显高于ER阳性组(60.71% vs. 1.39%, P = 0.000)，PR阴性组的有效率明显高于PR阳性组(97.5% vs. 2.50%, P = 0.000)，PR阴性组的pCR率明显高于PR阳性组(45% vs. 0.00%, P = 0.000)。结论：新辅助化疗导致部分患者ER、PR表达状态发生转变，其中ER、PR阳性转变成阴性的概率较高，ER、PR阴性转变成阳性的概率较低。

Abstract: Objective: To investigate the effects of neoadjuvant chemotherapy on hormone receptor expression in breast cancer. Methods: 100 breast cancer patients admitted to our hospital from January 2017 to December 2019 were selected for the study. Basic clinical data of the patients were collected, such as age, tumor size, lymph node metastasis, menopause, and AJCC pathological stage. Vacuum directional assisted puncture with a thick hollow core needle was used to collect part of the patient’s pathological tissue samples. Receive docetaxel, epirubicin, cyclophosphamide and interval of 3 weeks for 6 weeks of neoadjuvant chemotherapy to evaluate the therapeutic effect of neoadjuvant chemotherapy; The patient underwent resection of breast cancer and pathological tissue samples were collected during the operation. Immunohistochemical staining was performed on the pathological tissue samples collected twice to detect the expressions of ER and PR. Results: Neoadjuvant chemotherapy significantly affected the expression of hormone receptor ER and PR. Results: After neoadjuvant chemotherapy, the expression status of ER was changed in 11 patients, among which the positive expression of ER was changed to negative expression in 6 patients, and the negative expression of ER was changed to positive expression in 5 patients. The change rate of ER expression status before and after neoadjuvant chemotherapy was 13.414%. The expression status of PR was changed in 15 patients, among which PR positive expression was changed to PR negative expression in 8 patients and PR negative expression was changed to PR positive expression in 7 patients. The change rate of PR expression status before and after neoadjuvant chemotherapy was 18.292%. After neoadjuvant chemotherapy, the overall positive expression rate of ER and PR increased (72% vs. 86.56%; 60% vs. 71.95%), but the expression levels of ER and PR changed significantly, and the positive rate of ER was lower than that before neoadjuvant chemotherapy (30.49% vs. 40%). Weak positive rate increased before neoadjuvant chemotherapy (7% vs. 13.41%), strong positive rate of PR decreased (10.97% vs. 21%), and weak positive rate increased before neoadjuvant chemotherapy (36.58% vs. 11%). In this study, the objective response rate (ORR) of neoadjuvant chemotherapy was 74%, including complete response (CR) 35.00%, partial response (PR) 39.00%, disease stability (SD) 20.00%, and disease progression (PD) 6.00%. The pCR rate was 18.00% after pathological evaluation. The therapeutic effect of neoadjuvant chemotherapy was significantly correlated with the expression status of ER and PR. The effective rate of ER negative group was significantly higher than that of ER positive group (96.43% vs. 65.28%, P < 0.05), and the pCR rate of ER negative group was significantly higher than that of ER positive group (60.71% vs. 1.39%, P = 0.000). The effective rate in PR negative group was significantly higher than that in PR positive group (97.5% vs. 2.50%, P = 0.000), and the pCR rate in PR negative group was significantly higher than that in PR positive group (45% vs. 0.00%, P = 0.000). Conclusion: Neoadjuvant chemotherapy led to changes in the expression status of ER and PR in some patients, among which the probability of ER and PR positive changing to negative was high, while the probability of ER and PR negative changing to positive was low.