Influence Of Neoadjuvant Chemotherapy On Expression Of Hormonal Receptor In Breast Cancer

Breast cancer is a major malignant tumor affecting women.With the development of tumor biology,breast cancer is known as a systemic disease.Its therapy mode has changed from traditional operation to synthesis treatment combining local treatment with systemic therapy.The hormonal therapy and neoadjuvant chemotherapy(NAT,NCT) has been heeded increasingly and used broadly.Neoadjuvant chemotherapy is an important therapy for local advanced breast cancer(LABC).It not only lessens the tumor size to ensure conservative operation,but also provides a method to evalue the response of chemotherapy regimen.But there is still aguement on prognostic and predictive factors in breast cancer after neoadjuvant chemotherapy.The exact changes of estrogen receptor(ER)and progesterone receptor(PR)are unknown yet.Whether the hormonal receptor of breast cancer is changed after neoadjuvant chemotherapy and whether the change is related to the regimen or the effect of chemotherapy,these question need further research.This study was designed to explore the expression changes of hormonal receptor in breast cancer after neoadjuvant chemotherapy.Materials and Methods:There were total of 489 breast cancer patients treated with operation in Xinan Hospital from May 2005 to November 2006,and 406 of them obtained pathological diagnosis by preoperative core biopsy.Of the 489 patients,187 cases received neoadjuvant chemotherapy and operation in the Breast Disease Center of Xinan Hospital.All the187 patients were under 70 years of age and did not accept hormonal therapy or locally radiation therapy.The patients whose specimen was not enough for examination or who did not have three cycles of chemotherapy were excluded,so there were 117 cases involved in this study.All the 117 patients were female,aged 26 to 70 years,with the mean of 47 years. T1 breast cancer was in 14 cases,T2 in 58 cases,T3 in 35 cases,and T4 in 10 cases.57 patients received neoadjuvant chemotherapy of TE regimen(TAX 175 mg/m~2,EPI 60 mg/m~2,d1,q3w)and 60 patients received that of CEF regimen(CTX 500 mg/m~2,EPI 60 mg/m~2,5-Fu 500 mg/m~2,d1,q3w).The expressions of ER and PR were examined by immunohistochemical assay in samples of breast cancer tissues before and after neoadjuvant chemotherapy.The expressions of ER and PR were evaluated by Allred score. The effect of chemotherapy was evaluated according to the Response Evaluation Criteria in Solid Tumors(RECIST) of International Union Against Cancer(UICC).The data were analyzed using SPSS 13.0 statistical software.Results.1.In this study,among the cases with neoadjuvant chemtherapy,7 cases(6.0%) achieved a complete response(CR),76 cases(64.9%) a partial response(PR),and 34 cases (29.1%) stable disease(SD).There was no progress disease(PD),the response rate(RR) was 70.9%.In cases of TE regimen,5 cases(8.3%) obtained CR,44 cases(73.3%) PR,and 11 cases(18.3%) SD.There was no PD,the response rate was 81.7%.In cases of CEF regimen, 2 cases(3.5%) had CR,32 cases(56.1%) PR,and 23 cases(40.4%) SD.There was no PD, the response rate was 59.6%.The TE regimen is more effective than CEF regimen obviously(P＜0.05).2.In the cases with ER positive expression before chemotherapy,2 cases(3.6%) achieved CR,32 cases(58.2%) PR,and 21 cases(38.2%) SD after chemotherapy,there was no PD,the response rate was 61.8%.In the cases with ER negative before chemotherapy,5 cases(8.1%) had CR,44 cases(71.0%) PR,and 13 cases(21.0%) SD after chemotherapy; there was no PD,the response rate was 79.0%.The response rate of cases with ER negative is superior to that of cases with ER positive obviously(P＜0.05).In the cases with PR positive expression before chemotherapy,1 case(2.1%) had CR,30 cases(62.5%) PR, and 17 cases(35.4%) SD after chemotherapy;there was no PD,the response rate was 64.6%.In the cases with PR negative before chemotherapy,6 cases(8.7%) had CR,46 cases(66.7%) PR,and 17 cases(24.6%) SD after chemotherapy;there was no PD,the response rate was 75.4%.There is no difference between the two different groups(P＞0.05).3.After neoadjuvant chemotherapy,in 60 cases of TE regimen,the expression of ER increased in 15 cases(25%) and decreased in 8 cases(13.3%);the expression of PR increased in 12 cases(20%) and decreased in 6 cases(10%).In 57 cases of CEF regimen,the expression of ER increased in 8 cases(14.0%) and decreased in 4 cases(7.0%);the expression of PR increased in 6 cases(10.5%) and decreased in 3 cases(5.3%).Significant changes occurred in both ER and PR in TE regimen with evident increase(P＜0.05).No obvious changes were found in both ER and PR in CEF regimen.4.After neoadjuvant chemotherapy,there were 49 responsive cases in the TE regimen group,the expression of ER increased in 15 cases(30.6%) and decreased in 6 cases(12.2%), and did not changed in 28(57.2%).There was significant change in ER in the response group of TE regimen with evident increase(P＜0.05).There was no obvious change in PR expression in the response group of TE regimen,or in both ER and PR expressions in the effective group of CEF regimen and non-response group of both regimens.There were a total of 83 effective cases in both regimens,the expression of ER increased in 22 cases(26.5%) and decreased in 8 cases(9.6%),the expression of PR increased in 17 cases(20.5%) and decreased in 7 cases(8.4%).There was significant change in both ER and PR in the response group with evident increase(P＜0.05).There was no obvious change in both ER and PR expressions in the non-response group(P＞0.05).There was a significant difference between the two different effective groups(P＜0.05).Conclusions:1.The response rate of TE regimen is superior to that of CEF regimen.The response rate of the ER negative group is superior to that of the ER positive group.There is no significant difference in the response rate between the PR negative group and the PR positive group.2.Neoadjuvant chemotherapy with TE regimen influences the expression of ER and PR obviously.There is no significant influence on the expressions of ER and PR in CEF regimen.There is no significant influence on the expressions of ER and PR before and after chemotherapy if regimens are ignored.3.The changes of the expression of hormonal receptor are related to the effect of neoadjuvant chemotherapy.There is significant change in both ER and PR in the effective group with evident increase.There is no obvious change in both ER and PR in the non-effective group.There is significant difference between the two groups.