【摘要】：目的1通過對乳腺癌患者新輔助化療前后ER、PR、Her-2和Ki-67的表達變化情況的數(shù)據(jù)統(tǒng)計分析,從而分析新輔助化療對乳腺癌分子表達物的影響;2通過數(shù)據(jù)整理,分析ER、PR、Her-2和Ki-67在新輔助化療前后變化情況,為乳腺癌患者個體化治療提供依據(jù),進一步推測此類變化對患者預(yù)后的意義及研究價值。方法實驗樣本選用華北理工大學附屬醫(yī)院及唐山市人民醫(yī)院2010年1月至2014年1月收治乳腺癌患者62例,均為單側(cè)乳房患病的女性患者,無患側(cè)乳腺手術(shù)史及輔助化療或放療史,年齡31-73歲之間,中位年齡53歲。根據(jù)《NCCN指南》中標準新輔助化療方案,均采用TAC新輔助化療方案(多西他賽75mg/m2,多柔比星50 mg/m2,環(huán)磷酰胺500 mg/m2),以3周(即21天)為一個化療周期,共行3個周期的術(shù)前化療治療。采用免疫組化S-P法檢測樣本中乳腺癌患者在新輔助化療前后ER、PR、Her-2及Ki-67的表達情況,整理數(shù)據(jù)使用統(tǒng)計學軟件SPSS19.0分析ER、PR、Her-2及Ki-67的表達在新輔助化療前后的改變情況,分析新輔助化療對乳腺癌分子表達物的影響以及預(yù)測此類變化對患者預(yù)后的意義和研究價值。結(jié)果新輔助化療前后部分乳腺癌患者腫瘤分子表達物發(fā)生了變化。新輔助化療前ER(—)患者為35例,ER(+)患者27例,化療后ER(—)患者33例,ER(+)患者29例,化療前后ER由陰性轉(zhuǎn)為陽性者5例,由陽性轉(zhuǎn)為陰性者3例,改變率為12.9%,比較新輔助化療前后數(shù)據(jù),差異不具有統(tǒng)計學意義(P0.05)。新輔助化療前PR(—)患者為37例,PR(+)患者25例,化療后PR(—)患者34例,PR(+)患者28例,化療前后PR由陰性轉(zhuǎn)為陽性者5例,由陽性轉(zhuǎn)為陰性者2例,改變率為11.3%,比較新輔助化療前后數(shù)據(jù),差異不具有統(tǒng)計學意義(P0.05)。新輔助化療前Her-2(低表達)患者為23例,Her-2(過表達)患者39例,化療后Her-2(低表達)患者16例,Her-2(過表達)患者46例,化療前后Her-2由低表達轉(zhuǎn)為過表達者8例,由過表達轉(zhuǎn)為低表達者1例,改變率為14.5%,比較新輔助化療前后數(shù)據(jù),差異不具有統(tǒng)計學意義(P0.05)。新輔助化療前Ki-67(—)患者為38例,Ki-67(+)患者24例,化療后Ki-67(—)患者49例,Ki-67(+)患者13例,化療前后Ki-67由陰性轉(zhuǎn)為陽性者2例,由陽性轉(zhuǎn)為陰性者13例,改變率為24.2%,比較新輔助化療前后數(shù)據(jù),差異具有統(tǒng)計學意義(P0.05)。新輔助化療可改變部分乳腺癌患者的Ki-67分子表達,但對于ER、PR及Her-2的分子表達無明顯影響。結(jié)論1本研究結(jié)果表明:Ki-67在NAC后陽性表達率降低(P0.05),而ER、PR、Her-2的表達狀態(tài)在NAC前后未發(fā)生明顯變化。2 Ki-67在NAC前后表達水平的改變,對于患者預(yù)后的評估具有臨床研究價值。
[Abstract]:Objective 1 to analyze the effect of neoadjuvant chemotherapy on molecular expression of breast cancer by statistical analysis of the changes of ERR PRN Her-2 and Ki-67 expression in breast cancer patients before and after neoadjuvant chemotherapy. To analyze the changes of Her-2 and Ki-67 in patients with breast cancer before and after neoadjuvant chemotherapy, to provide evidence for individualized treatment of breast cancer, and to further speculate the significance and value of these changes in the prognosis of patients with breast cancer. Methods Sixty-two breast cancer patients were selected from affiliated Hospital of North China University of Technology and people's Hospital of Tangshan City from January 2010 to January 2014. All of them were female patients with unilateral breast disease and had no history of breast surgery or adjuvant chemotherapy or radiotherapy. The age ranged from 31 to 73 years, with a median age of 53 years. According to the standard neoadjuvant chemotherapy regimen in NCCN guidelines, TAC neo-adjuvant chemotherapy regimen (docetaxel 75 mg / m2, doxorubicin 50 mg / m2, cyclophosphamide 500 mg/m2) was used for three cycles of preoperative chemotherapy. Immunohistochemical S-P method was used to detect the expression of ERP Her-2 and Ki-67 in breast cancer patients before and after neoadjuvant chemotherapy. Statistical software SPSS19.0 was used to analyze the changes of ERP Her-2 and Ki-67 expression before and after neoadjuvant chemotherapy. To analyze the effect of neoadjuvant chemotherapy on the molecular expression of breast cancer and its significance in predicting the prognosis of breast cancer. Results before and after neoadjuvant chemotherapy, the tumor molecular expression of some breast cancer patients changed. There were 35 cases of ER (-) before neoadjuvant chemotherapy, 27 cases of ER (-) and 29 cases of ER (-) after chemotherapy. Before and after chemotherapy, ER (-) changed from negative to positive in 5 cases, and from positive to negative in 3 cases. The change rate was 12.9, compared with the data before and after neoadjuvant chemotherapy, the difference was not statistically significant (P0.05). There were 37 cases of PR (-) before neoadjuvant chemotherapy, 25 cases of PR (-), 28 cases of PR (-) after chemotherapy, 5 cases of PR changed from negative to positive before and after chemotherapy, and 2 cases changed from positive to negative. The change rate was 11. 3%, the difference was not statistically significant (P0.05) compared with the data before and after neoadjuvant chemotherapy. Before neoadjuvant chemotherapy, there were 23 cases of Her-2 (overexpression) in 39 cases, 16 cases of Her-2 (low expression) in 16 cases (overexpression) before and after chemotherapy, and 8 cases of Her-2 changed from low expression to overexpression before and after chemotherapy. The rate of change from over-expression to low-expression was 14.5. the difference was not statistically significant before and after neoadjuvant chemotherapy (P0.05). There were 38 patients with Ki-67 (-) before neoadjuvant chemotherapy, 24 patients with Ki-67 and 13 patients with Ki-67 (-) after chemotherapy. Before and after chemotherapy, Ki-67 changed from negative to positive in 2 cases, and from positive to negative in 13 cases. The change rate was 24. 2%, compared with the data before and after neoadjuvant chemotherapy, the difference was statistically significant (P0.05). Neoadjuvant chemotherapy could change the expression of Ki-67 molecules in some breast cancer patients, but had no significant effect on the expression of ERP PR and Her-2 molecules. Conclusion 1 the results of this study showed that the positive expression rate of Ki-67 decreased after NAC (P0.05), but the expression of ERG PR-Her-2 did not change significantly before and after NAC. The expression level of .2 Ki-67 before and after NAC had a clinical value in evaluating the prognosis of patients.
【學位授予單位】：華北理工大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R737.9
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本文編號：2181655