Analysis of associations between molecular subtypes and responses to neoadjuvant chemotherapy in primary breast cancer patients

目的 探讨原发性乳腺癌分子分型与新辅助化疗疗效之间的相关性.方法 收集2000年1月至2009年1月,北京大学肿瘤医院乳腺癌预防治疗中心接受4～8周期新辅助化疗患者的化疗前组织标本,集中用免疫组织化学法检测激素受体(HR)、人表皮生长因子受体2(HER2)及增殖相关抗原Ki-67的表达水平并据其进行分型,分析分子分型与563例患者新辅助化疗疗效的关系.结果 HR-/HER2-型、HER2+型及HR +/HER2-型的病理完全缓解(pCR)率分别为38.9％、17.9％和8.3％,总体比较差异有统计学意义(P＜0.001).在HR +/HER2-型中,Ki-67高表达组比低表达组的pCR率高(P=0.004)；而HR高表达组与非高表达组的pCR率比较,差异无统计学意义(P =0.256).结论 乳腺癌分子分型与新辅助化疗疗效有关,HR-/HER2-型和HER2+型对化疗更敏感；在HR +/HER2-型中,Ki-67高表达者更易从化疗中获益.To explore the correlations between molecular subtypes and responses to neoadjuvant chemotherapy in primary breast cancer patients.The core-needle biopsy specimens were collected from 563 patients undergoing 4-8 cycles of neoadjuvant chemotherapy between January 2001 to January 2009. And immunohistochemical assays were employed to detect the levels of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and Ki-67 proliferation index simultaneously. Molecular subtypes were divided on the basis of immunohistochemical results. And the associations between molecular subtypes and responses to neoadjuvant chemotherapy were analyzed in 563 patients.The pathological complete response (pCR) rates of patients with hormone receptor-negative/HER2-negative subtype (HR-/HER2-) , HER2-positive subtype (HER2+) and hormone receptor-positive/HER2-negative subtype (HR+/HER2-) were 38.9%, 17.9% and 8.3% respectively. In univariate analysis, there were significant differences in pCR rates among the groups (P < 0.001) . In multivariate analysis, the patients with HER2+ subtype had a significantly higher pCR rate than those with HR+/HER2- subtype (OR = 0.344, P = 0.002) . Whereas the patients with HER2+ subtype had a significantly lower pCR rate than those with HR-/HER2- subtype (OR = 2.453, P = 0.007) . Among HR+/HER2-subtypes, a higher pCR rate was observed in the group of high expression level of Ki-67 proliferation index (Ki-67 ≥ 20%) (P = 0.004) . But no significant differences existed in pCR rates between the group of high expression level of hormone receptor and the group of non-high expression level (P = 0.256) .There were correlations between molecular subtypes and responses to neoadjuvant chemotherapy in primary breast cancer patients. Patients of HER2+and HR-/HER2- subtype are more likely to respond to neoadjuvant chemotherapy. Among HR+/HER2-subtypes, those with a high level of Ki-67 proliferation index tend to benefit from neoadjuvant chemotherapy.PubMed中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)0221711-17159