The Study Of The Changes Of ER、PR、HER-2、Ki-67、p53 In Luminal Type Breast Cancer And The Long-term Efficacy

Objective To compare the changes of ER、PR、HER-2、Ki-67 and p53 before and after neoadjuvant chemotherapy about Luminal type of breast cancer,and to investigate the efficiency of neoadjuvant therapy and the prognostic factors.Methods This study were retrospectively analyzed 131 cases of Luminal type of breast cancer treated in Tianjin Medical University Cancer Institute and Hospital during October 2010 and July 2013,all patients with preoperative neoadjuvant chemotherapy.Clinicopathologic data was collected.The evaluation of clinical curative effect based on palpation and imageological examination,such as breast ultrasound,breast X-ray radiography,breast MRI and CT,etc.We evaluated the clinical curative effect of chemotherapy in accordance with RECIST solid tumor curative effect evaluation standard.Factors affecting the p CR was determinated by χ2 test and the changes of index before and after neoadjuvant chemotherapy were determinated by t test,and ROC curve was drawing according to immunohistochemical index.Kaplan-Meier unvariate analysis were used to evaluate the survival rate,and multiple-factor analysis used Cox proportional hazards regression model.We roled p<0.05 for the statistically significant difference.Results 131 cases of Luminal type of breast cancer efficiency evaluation:the clinical overall response rate(ORR)was 55.7%(73/131),and pathological complete response was 11.5%(15/131).PR-negative cases’ ORR was significantly higher than that of PR-positive(82.6% vs50.0%,p=0.004).PR-negative cases’ p CR was also significantly higher than that of PR-positive(26.1% vs 8.3%,p=0.015).No statistical significance was found about that of HER-2、Ki-67 and p53(p>0.05).The area under the ROC curve about PR expression index to predict p CR was 0.711,which suggested that PR expression predicting p CR was statistically significant(p=0.008).Results showed that PR(36.32%vs29.91%)、HER-2(1.23+vs1.07+)and Ki-67(33.88%vs22.47%)expression obviously decreased after neoadjuvant chemotherapy(p<0.05),while ER and p53 expressed no difference before and after neoadjuvant chemotherapy(p>0.05).We analyzed the changes of ER、PR、HER-2、Ki-67 and p53 expression before and after NAC,which may relate to the ORR.Results showed that ER(38.1%vs66.7%vs46.9%,p=0.028)、PR(29.0%vs53.3%vs65.0%,p=0.010)、Ki-67(10.0%vs67.1%vs42.9%,p=0.000)showed statistically significant in these three groups,which showed no difference in HER-2 and p53(p>0.05).But the 5 years DFS(34.8%vs51.8%vs53.3%)and OS(37.2%vs55.3%vs74.8%)showed statistically significant in these three groups about HER-2 expression(p<0.05).Analysing the ORR and p CR rate under different clinicopathologic features showed that BMI<25kg/m2 group had a significantly higher rate of p CR than BMI≥25kg/m2 group(17.1%vs3.6%,p=0.017).Lymph node negative group had a significantly higher rate of p CR than lymph node positive group(35.7% vs4.9%,p=0.000).Multi-factor analysis showed that age,lymph node staging and clinical stage were independent prognostic factor for disease-free survival(p<0.05),while lactation history and lymph node staging were independent prognostic factor for the overall survival of patients(p<0.05).Conclusion PR、HER-2 and p53 expression reduced after neoadjuvant chemotherapy in Luminal type breast cancer.The efficiency of neoadjuvant chemotherapy for Luminal type breast cancer had correlation with PR expression,BMI and lymph node metastasis.In which PR negative expression before NAC,BMI<25 kg/m2 group and no lymph node metastasis had better efficiency of NAC.PR expression level in predicting Luminal type breast cancer’s neoadjuvant chemotherapy curative effect had certain value.The lower the PR expression,the greater the chance of p CR.p CR will be related to the disease-free survival and overall survival of Luminal type breast cancer,but it is not an independent prognostic factor.Therefore,people with the younger age,the higher lymph node staging and the higher clinical stage may have the worse prognosis,which indicating that prompt treatment for such patients should be more aggressive.