| PurposeWith the development of the knowledge about breast cancer, the view that breast cancer is an systemic disease has been widely accepted. Neoadjuvant chemotherapy has been a very important part of breast cancer systemic treatment. Neoadjuvant chemotherapy can downsize the tumors and increase the rate of breast-conserving surgery; control the micro-metastasis focus; provide information on tumor response to the chemotherapeutic agent. Many clinical researches show that the pathological complete responses after neoadjuvant chemotherapy helps in achieving longer overall survival and disease-free survival.But only 3%～30% of patients that accept breast cancer neoadjuvant chemotherapy can get pathological complete responses. Most patients can't get pathological complete responses. Beside, some patients have disease progression because of resistance to the chemotherapeutic agent. So finding the indicators that can predict the neoadjuvant chemotherapy's effect is very important to individual therapy.We had studied the relationship between the expression of the biological markers including ER, PR, HER2, Ki67, p53, Bcl-2 and Topo-Ⅱαand the pathological complete responses after neoadjuvant chemotherapy. The goal of this study was to explore the predictive value of those biological markers for the pathological complete responses of neoadjuvant chemotherapy in breast cancer.Participants and methods:This was a 1:1 match case-control study. From December 2008 to December 2010,15 female patients with breast cancer in the Second Hospital Of Shandong University Breast Surgery Department getting pathological complete responses after taking TE neoadjuvant chemotherapy were enrolled in the study group. Age from 34-62 years old (medianage 48),7 patients were premenopause and 8 patients were postmenopausal. All of the tumor were Invasive ductal carcinomas, stageⅡA 6 cases, stageⅡB 4 cases, stageⅢA 5 cases. All of the patients did not discover distant metastases. They were gave TE (Docetaxel 75mg/m2 +Epirubicin 60mg/m2) neoadjuvant chemotherapy for 3～6 cycles(mean 5.3±1.18).The 15 cases in the study group were 1:1 paired with patients form the data base of TE neoadjuvant chemotherapy patients that did not get the pathological complete responses in our department, according to age(±5 years), pausimenia or not, pathologic category, tumor size(±1cm) and Chemotherapy cycles. The screened 15 patients were enrolled as the control group. All of the patients did not get any chemotherapy, radiotherapy or endocrine therapy before enrolled in this study.We examine the expression of the ER, PR, HER2, Ki67, p53, Bcl-2 and Topo-Ⅱαusing the immunohistochemistry (twostepmethod) and learn the relationship between those biological markers and pathological complete responses. All statistical analysises were performed by SPSS16.0.Results:In the study group, the rate of ER positive was 33.3%(5 cases), and the rate of ER negative was 66.7%(10 cases).In the control group, the rate of ER positive was 80%(12 cases), and the rate of ER negative was 20%(3 cases).The Ki67 scores from 0 to 20% of the study group and the control group were 6.7%(1 cases) and 33.3%(5 cases); 21%～40% were 40%(6 cases) and 26.7%(4 cases); 41%～60% were 13.3%(2 cases) and 26.7%(4 cases); 61%～80% were 40%(6 cases) and 13.3%(2 cases). Using the matching counting material McNemarχ2 Test, we could get that ER state had relationship with pathological complete responses of the neoadjuvant chemotherapy (p=0.039). By the Wilcoxon Ranks Test, we could get that Ki67 also had relationship with pathological complete responses(Z=-2.07, p=0.039). In a multivariate model, ER negative was the only predictive of the pathological complete responses (p=0.05, OR=0.125,95%CI:0.016～0.999).The statuses of PR, HER2, p53, Bcl-2 and Topo-Ⅱαdid not show significant difference between the study group and the control group(p>0.05).Conclusion:ER state and Ki67 score had relationship with pathological complete responses of the neoadjuvant chemotherapy. The statuses of PR, HER2, p53, Bcl-2 and Topo-Ⅱαdid not show significant difference between the study group and the control group. ER negative was the only predictive of the pathological complete responses of the neoadjuvant chemotherapy which could guide the clinical treatment of breast cancer. |
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