| [Background] Breast cancer is one of the most common malignant tumors in women. The selection of a systemic breast cancer therapy is based on the expression pattern of immunohistochemical prognostic markers,which would be altered by the primary systemic therapy. In our study we sought to determine whether neoadjuvant chemotherapy may alter these expression patterns within the tumors and tried to solve the problems as follows:when should the immunohistochemical prognostic markers be evaluated?When the primary specimen was obtained by core needle biopsy,or the surgical specimen after primary systemic therapy?If the expression patten of immunohistochemical prognostic markers differs in the biopsy specimen and surgical specimen ,which should we choose when we work out the therapy strategy?[Patients and methods] From January 2006 to March 2007, 38 breast cancer patients treated with neoadjuvant chemotherapy and 22 non-neoadjuvant therapy patients(control) with adequate tissue samples were identified. The expression pattern of ER(oestrogen receptor),PR(progesterone receptor),HR(hormonal receptor) and HER-2(Human epidermal growth factor receptor-2) was analyzed in primary core biopsiy and surgical specimen in both groups. Changes between the two groups were compared with to determine if alterations were due to neoadjuvant chemotherapy or tissue sampling. The statistical work was completed with the help of SPSS FOR WINDOWS 13.0.[Results] We calculated accuracy, the weighted kappa value and Spearman's rank correlation of the expression of ER,PR,HER-2 in biopsy sample and surgical specimen. The modulation of steroid receptor and HER-2 status in preoperatively treated patients was tested by Cochran-Mantel-Haenszel statistics,and the result was negtive. The accuracy of ER evaluation in the biopsy material of patients withoutintervening chemotherapy was 90.9% ( k =0.818,r=0.832), and 84.2%( k =0.684,r=0.688) in patients treated preoperatively. In terms of PR assessment, we obtained slightly inferior results: accuracy was 86.4% ( k. =0.723, r=0.726) in patients without preoperative treatment, and 71.1%( k. =0.369, r=0.369) in patients undergoing preoperative therapy. The agreements of the HER-2 status were 95.4%( k =0.831,r=0.843) and 92.1%( k =0.623,r=0.628) in control group and neoadjuvant group respectively.[Discussion] We failed to achieve a significant change in the expression of immunohistochemical prognostic markers ER,PR and HER-2 in patients with breast cancer in biopsy specimen and surgical specimen regardless of neoadjuvant chemotheapy. Nevertheless we notided that there were 18(47.4%) patients treated by neoadjuvant chemotherapy less than 3 cycles in the neoadjuvant group. When these patients were kicked out, changes of the expression of immunohistochemical prognostic markers were estimated before and after neoadjuvant chemotherapy statistically in the other 20 patients,and the result was still negative. But when the primary PR-positve patients in the neoadjuvant group were compared with the control group,patients showed a significant increase in surgical PR-negative proportion in the neoadjuvant group,the proportion was 80% vs 20%,p=0.043. We have concluded that ER,PR and HER-2 measurement in core needle biopsy is a reliable basis in clinical practice for selecting patients for primary and adjuvant systemic treatment. Preoperative cytotoxic chemotherapy induced a significant extent of variation in the PR expression of breast cancer cells. |
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