【摘要】：目的探討乳腺癌新輔助化療期間雌激素(ER)、孕激素受體(PR)狀態(tài)的改變及臨床指導(dǎo)意義。方法回顧分析208例2011年1月-2015年9月期間于重慶醫(yī)科大學(xué)附屬第一醫(yī)院行乳腺癌術(shù)前新輔助化療的局部晚期乳癌患者的資料,包括新輔助化療前核心穿刺標(biāo)本的ER、PR表達(dá)情況以及術(shù)后病檢標(biāo)本的ER、PR表達(dá)情況,隨訪內(nèi)分泌治療的使用情況,利用統(tǒng)計(jì)學(xué)方法進(jìn)行生存分析,評(píng)估預(yù)后。結(jié)果新輔助化療前后ER、PR的表達(dá)約有21.2%的不一致性,κ值為0.519,提示新輔助化療前后激素受體(HR)狀態(tài)一致性差,其中新輔助化療后HR的丟失更為顯著(14.3%),新輔助化療前HR(ER/PR)陽(yáng)性的患者使用內(nèi)分泌治療在無(wú)病生存率以及總生存率上顯著優(yōu)于新輔助化療前HR陰性,新輔助化療后HR陽(yáng)性的患者(P0.05),而新輔助化療前HR陰性,新輔助化療后HR陽(yáng)性的患者與新輔助化療前后HR均為陰性,未使用內(nèi)分泌治療的患者在無(wú)病生存率以及總生存率上無(wú)顯著性差異(P0.05)。結(jié)論對(duì)于新輔助化療前后HR表達(dá)改變的患者,新輔助化療前HR陽(yáng)性的患者使用內(nèi)分泌治療療效明顯優(yōu)于新輔助化療前HR陰性、新輔助化療后HR陽(yáng)性的患者,這類(lèi)患者使用內(nèi)分泌治療療效不佳,提示新輔助化療增加了化療后乳腺癌組織免疫組化中HR的假陽(yáng)性率,對(duì)于新輔助化療前核心穿刺病理標(biāo)本HR陰性,新輔助化療后殘余癌組織中HR陽(yáng)性的患者可能不必使用輔助內(nèi)分泌治療。
[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.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R737.9

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