摘要
目的分析表皮生长因子受体(epidermal growth factor receptor,EGFR)与临床病理特征对乳腺癌新辅助化疗(neoadjuvant chemotherapy,NCT)疗效和预后的影响。方法选取2013年1月至2017年1月收治的局部晚期乳腺癌患者172例,免疫组织化学检测癌组织中ER、HER2、Ki-67以及EGFR的表达,患者行NCT后1个月内手术,分析临床病理学参数和病理完全缓解率(pathologic complete response,pCR)之间的关系。结果EGFR表达和ER呈负相关(r=-0.129,P=0.018),EGFR表达和HER2(r=0.211,P=0.011)、Ki-67(r=0.195,P=0.013)以及肿瘤直径(r=0.315,P=0.007)呈明显正相关,而EGFR和患者的年龄、绝经状况以及淋巴结是否出现转移无明显关系(P>0.05);ER阴性组pCR率(25.95%)明显高于阳性组(7.81%),差异有统计学意义(P<0.05);Ki-67高表达组pCR率(32.39%)明显高于低表达组(9.90%),差异有统计学意义(P<0.05);EGFR高表达组pCR率(24.11%)明显高于低表达组(10.00%),差异有统计学意义(P<0.05);化疗后,有72.16%(131/172)的患者EGFR表达下降,下降组的pCR率为24.43%(32/131),未下降组(无变化或者出现上升)患者的pCR率为2.44%(1/41),提示化疗后EGFR变化与化疗疗效相关,差异有统计学意义(P<0.05);各分子亚型和绝经状况、化疗前肿瘤直径、疗效以及化疗前EGFR表达明显相关(P<0.05),而与年龄、淋巴结转移不相关(P>0.05);化疗前,EGFR低表达组总生存时间(total survival time,OS)和无病生存时间(disease-free survival time,DFS)均优于EGFR高表达组,差异有统计学意义(P<0.05)。化疗后EGFR下降组OS和DFS均较未下降组延长,差异有统计学意义(P<0.05)。COX多因素回归分析结果显示化疗前Ki-67、EGFR、化疗后EGFR变化是影响DFS的独立危险因素。结论EGFR高表达者对化疗更为敏感,但预后差,化疗前Ki-67、EGFR、化疗后EGFR变化是影响DFS的独立危险因素,Ki-67、ER、HGR2以及EGFR、分子亚型可以作为NCT疗效的预测指标。
Objective To investigate the effects of epidermal growth factor receptor(EGFR)protein and clinicopathologic features on the therapeutic effects of neoadjuvant chemotherapy(NCT)on breast cance and their influence on the prognosis of patient with breast cancer.Methods A total of 172 patients with local advanced breast cancer who were admitted and treated in our hospital from January 2013 to January 2017 were enrolled in the study.The levels of ER,HGR2,Ki-67 and the expression levels of EGFR were detected by immunohistochemistry.Allthe patients underwent surgical treatment at 1 month after NCT.The correlation between the clinical pathological parameters and pathological complete response rate(pCR)was analyzed.Results The EGFR expression levels were negatively correlated with those of ER(P<0.05),and the EGFR expression levels were positively correlated with those of HER2,ki-67 and tumor diameter(P<0.05 or P<0.01),however,which were not correlated with patient’s age,menopausal status and lymph node metastasis(P>0.05).The pCR rate in ER negative group(25.95%)was significantly higher than that(7.81%)in ER positive group(P<0.05).The pCR rate(32.39%)in ki-67 high expression group was significantly higher than that(9.90%)in ki-67 low expression group(P<0.05).The pCR rate(24.11%)in EGFR high expression group was significantly higher than that(10.00%)in EGFR low expression group(P<0.05).After chemotherapy,the changes of EGFR were positively correlated with the therapeutic effects,moreover the molecular subtypes were significantly correlated with menopausal status,tumor diameter before chemotherapy,therapeutic effects and EGFR expression before chemotherapy(P<0.05),however,which were not correlated with patient’s age and lymph node metastasis(P>0.05).Before chemotherapy,the total survival time(OS)and disease-free survival time(DFS)in EGFR low expression group were superiot to those in EGFR high expression group(P<0.05).After chemotherapy,the OS and DFS in EGFR decrease group were significantly longer than those in EGFR no
作者
汪中明
周怀英
吴华玲
王华中
唐瑞遥
蒋忠军
WANG Zhongming;ZHOU Huaiying;WU Hualing(Department of Oncology,The Third People’s Hospital of Yongzhou City,Hunan,Yongzhou 425000,China)
出处
《河北医药》
CAS
2020年第3期325-329,共5页
Hebei Medical Journal
基金
衡阳市科学技术发展计划项目(编号:2017KJ335)
