摘要目的:探讨乳腺癌新辅助化疗前后免疫标志物表达的改变及化疗效果的相关因素。方法:回顾性分析2016年1月至2018年12月南京医科大学第一附属医院200例接受新辅助化疗的乳腺癌患者，研究其化疗前后雌激素受体（ER）、孕激素受体（PR）、HER2、Ki-67的变化情况，分析新辅助化疗反应的预测因子。结果:200例乳腺癌患者，Luminal A型16例，Luminal B型108例，HER2过表达36例，三阴性40例。经新辅助化疗后，25例患者（12.5%）获得病理完全缓解，免疫组织化学ER、HER2表达在新辅助化疗前后差异无统计学意义（ P>0.05），而PR、Ki-67的表达差异具有统计学意义（ P<0.05）。在单因素分析中，肿瘤<5 cm（ P=0.009）、非Luminal型乳腺癌（ P=0.001）、ER阴性（ P=0.001）、PR阴性（ P=0.029）及HER2阳性（ P=0.001）与新辅助化疗病理缓解相关，多因素回归分析在校正其他变量后，肿瘤<5 cm［ P=0.020，OR=2.581，95% CI（1.207，5.753）］、ER阴性［ P=0.011，OR=2.264，95% CI（1.207，4.248）］及HER2阳性［ P=0.007，OR=2.412，95% CI（1.275，4.561）］仍为新辅助化疗病理缓解的预测因子。 结论:乳腺癌新辅助化疗能够降低Ki-67及PR的表达水平，ER阴性、HER2阳性与乳腺癌新辅助化疗病理缓解相关，对新辅助化疗预后评估具有一定的指导意义。

abstractsObjective:To investigate changes in the expression of immunohistochemical (IHC) markers and factors associated with the effect of chemotherapy before and after neoadjuvant chemotherapy (NAC).Methods:A retrospective study included 200 breast cancer patients treated with NAC between January 2016 and December 2018. We analyzed the changes in the expression of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and Ki-67 in pre- and post-treated samples and the predictive factors of NAC.Results:Among the 200 cases, 16 cases were luminal A, 108 cases were luminal B, 36 cases were HER2 +subtype, and 40 cases were basal-like. Twenty-five patients (12.50%) achieved pathological complete remission (PCR).There were significant differences in PR and Ki-67 before and after NAC but there were no differences in ER and HER2.In univariate analysis, factors associated with PCR were tumor less than 5 cm( P=0.009), non-luminal breast cancer ( P=0.001), ER negative( P=0.001), PR negative ( P=0.029) and HER2 positive( P=0.001). Tumor less than 5 cm [ P=0.020, OR=2.581, 95% CI (1.207, 5.753)], ER negative [ P=0.011, OR=2.264, 95% CI (1.207, 4.248)] and HER2 positive[ P=0.007, OR=2.412, 95% CI (1.275, 4.561)] remained predictive variables in multivariate analysis after correction for the other variables. Conclusions:The expression of Ki-67 decreases after NAC. Negative PR and ER and positive HER2 status are related to the efficacy of pCR for breast cancer, and have guiding significance for the prognosis evaluation of NAC.