摘要
目的探讨新辅助化疗在提高保乳及可手术率,评价化疗敏感性,消除全身微转移灶等方面的优越性;肿瘤组织中ER、PR、增殖细胞核抗原(PCNA)的表达状态对于治疗方式的选择及治疗效果的预测的意义。方法通过免疫组化SP法分别检测78例Ⅱ/Ⅲ期的乳腺癌病例在化疗前后乳腺癌组织中ER、PR、PCNA的表达。术前采用空心针穿刺活检予以病理确诊并行ER、PR、PCNA的测定。化疗方法统一采用CEF方案[氟尿嘧啶(5-FU)500mg/m2,表柔比星(Epi-ADM)75mg/m2,环磷酰胺(CTX)500mg/m2],经过3个疗程的化疗,再行乳腺癌改良根治术或保乳手术,比较化疗前后以上各指标表达的变化。新辅助化疗的临床疗效通过体检和乳腺B超测量肿瘤的最大直径,按WHO判定的统一标准来评价。结果 78例Ⅱ/Ⅲ期乳腺癌患者经3个周期的新辅助化疗后,65例(83.3%)获得了临床部分缓解,无完全缓解病例,无进展病例。化疗前后ER、PR的表达均无显著变化(P>0.05);78例患者中ER发生变化为22例,PR为24例;化疗后29例PCNA由高表达变为低表达(P<0.01),化疗前后表达强度显著变化(P<0.05),且化疗疗效提高PCNA蛋白表达显著下降(P<0.05)。结论新辅助化疗(NAC)可能部分通过抑制PCNA的表达来抑制乳腺癌的增值,但对ER、PR的表达化疗前后无显著差异。
Objective To explore the role of Neoadjuvant chemotherapy （NAC） in improving the rate of breast-conserving and tumor resection, evaluating the sensitivity of chemotherapy and eliminating the mierometastasis focus. To evaluate the effects of the expression of ER,PR and PCNA in tumor on the choice of treatment and prediction of prognosis for patients with breast cancer. Methods The expressions of ER, PR and PCNA in cancer tissues were measured by using the immunohistochemical staining method（ S-P technique） in 78 patients with breast cancer of Grade I[-]II before and after the chemotherapy. The diagnosis was confirmed by biopsy before operation. All the patients received 3 cycles of the CEF chemotherapy regimen [ fluorouracil （5-FU） 500 mg/m2 ,epirubiein（Epi-ADM） 75 mg/m2 ,cyclophosphamide（CTX） 500 mg/m2 ]. After 3 cycles of chemotherapy,the modi- fied radical mastectomy or breast-conserving surgery was performed. The clinical effect of neoadjuvant chemotherapy was assessed according to the WHO criterion by measuring the size of tumor by physical examination and B type ultrasound. Results After 3 cycles of neoadjuvant chemotherapy, 65 patients （83.3%） obtained a clinical partial remission, no cases of complete remission and PD. Before and after chemotherapy expression of ER, PR did not change significantly （ P 〉 0.05 ） ; PCNA expression were down-regulated in 29 patients（P 〈0.01 ） ,the expression intensity of PCNA significantly changed before and after chemotherapy （ P 〈 0.05 ）. The expression of PCNA was significantly down-regulated with the increased efficacy of chemotherapy （P 〈 0.05 ）. Conclusion There was no significant difference in the expressions of ER and PR before and after NAC. But NAC may inhibit the tumor growth by partially suppressing the expression of PCNA.
出处
《中华全科医学》
2011年第8期1172-1173,1240,共3页
Chinese Journal of General Practice
基金
安徽省卫生厅资助项目(09C230)
关键词
乳腺癌
新辅助化疗
ER
PR
PCNA
Breast. cancer
Neoadjuvant Chemotherapy
Estrogen receptor
Progesterone receptor
Proliferating cell nuclear antigen
作者简介
通讯作者：罗传瑜，电子信箱：luoehuanyu55@sina．com
