摘要目的 探讨浸润性乳腺癌纳入与不纳入Ki-67的2种分子分型[雌激素受体(ER)+孕激素受体(PR)+HER2+Ki-67与ER+PR+HER2]对患者接受新辅助化疗疗效预测作用的差异,以及肿瘤组织中的Ki-67、ER、PR和HER2的表达与新辅助化疗疗效的相关性.方法 收集2007年1月至2009年12月就诊于四川大学华西医院,经活检确诊并接受新辅助化疗的127例浸润性乳腺癌,分析2种分子分型与临床及病理疗效评估的相关性,以及新辅助化疗前后肿瘤标记、组织学级别与临床及病理疗效的相关性.结果 依据2种分子分型方法,各亚型组的临床疗效评价差异均具有统计学意义(纳入Ki-67的分型:χ2=22.40,P<0.01;未纳入Ki-67的分型:χ2=9.202,P=0.027),病理疗效评价差异均不具有统计学意义(P>0.05).临床病理指标和临床疗效评价的多因素分析中,Ki-67是预测临床完全缓解(P=0.041)和临床总体有效(P<0.01)的独立因子.临床病理指标和病理疗效的多因素分析中,只有Ki-67是独立的预测因子(P=0.041).结论 纳入Ki-67的分子分型法能更好地区分出对新辅助化疗缺乏敏感性的乳腺癌.

abstractsObjective To investigate the response to neoadjuvant chemotherapy(NAC)among different molecular subtypes of breast cancers using molecular classification with Ki-67(ER+PR+HER2+Ki-67)or without Ki-67(ER+PR+HER2). Methods One hundred and twenty-seven cases of invasive breast cancer confirmed by core needle biopsy before NAC were collected from January 2007 to December 2009 and diagnosed at West China Hospital, Sichuan University. The cases were classified into different molecular subtypes using molecular classifications with or without Ki-67. Their clinical and pathological response to NAC was evaluated and compared. Results The different subtypes using both molecular classifications showed significant difference in clinical response(with Ki-67:χ2=22.40,P<0.01;without Ki-67:χ2=9.202,P=0.027)but not pathological(P>0.05)response to NAC. By multivariate analysis, Ki-67 was predictive for a clinical complete response(P=0.041)and clinical overall response(P<0.01);also Ki-67 was the only clinicopathological factor predictive of pathological response(P = 0.041). Conclusion The molecular classification with Ki-67 is better to predict breast cancers responsiveness to NAC than the molecular classification without Ki-67.