The Expression And Significance Of ER, PR And HER-2 Before And After Neoadjuvant Chemotherapy In Breast Carcinoma Tissue.

[Objective]To study the relationship of the expression of ER, PR and HER-2 and the effect of neoadjuvant chemotherapy (NACT) on locally advanced breast cancer and the influence of the expression of ER, PR and HER-2 before and after NACT of breast cancer, while studying the neoadjuvant chemotherapy for patients diagnosed with locally advanced breast cancer. Clearly analysing the successful cases of NACT for breast cancer, can help to predict the sensitivity to NACT for different patients, to direct individual treatment, to enhance efficiency of treatment, to avoid worsening prognosis caused by ineffective treatment.[Methods]Collecting all the information of patients admitted in the second department of breast surgery of the First Affiliated Hospital of Zhengzhou University from Aug 2008 to Sep 2010.They are all female, have single sided breast cancer,with an average age of 43.7 years, in the median age 45 years. Apply Doppler ultrasound and analyse the original location of tumor of breast and condition of regional lymph nodes pre and post NACT. Clinically analyze refer to AJCC of version 2002, part TNM(figure 1). All the cases are single sided, with no history of operation of breast and adjunctive chemotherapy, radiology treatment and endocrine treatment.Line in all cases are confirmed by the Pathological neo-adjuvant one week before the NACT is applied. Pathology category is infiltrating cancer of duct.This group of patients were treated with uniform chemotherapy "TEC". Adopt uniform NACT treatments:, docetaxel (75mg/m2)+Epirubicin (50mg/m2)+cyclophosphamide (500mg/m2), in the first days each chemotherapy cycles, one cycle lasts 21 days.each patients adopt 3 cycles treatments. AFTER NACT, according to the world health organization (WHO) solid tumor response standard assessment the effect of NACT.Using immunohistochemistry S-P method to detect the expression of ER, PR, and HER-2 of breast cancer berore and after the NACT. Using SPSS 13.0 statistical software to analysis the data, then analyze the relationship between these and NACT for breast cancer.[Results]1.52 patients received 3 cycle of NACT directed by programme technology,35 patients reacted positively to NACT, the RR is 67.3%, in which 6 cases achieved clinical complete remission(CR),29 cases achieved partial remission(PR).13 cases achieves stable disease(SD), and 4 cases achieved progressive disease(PD). And 2 cases achieved pCR according to pathological analyzing.2.52 patients received 3 cycle of NACT directed by programme technology,17 patients with ER(-) reacted positively to NACT, the RR in these is 85.0%((17/20); the RR in patients with ER(+) is 56.3%(18/32). There are a significant difference between patients with ER (-) and ER(+)(P<0.05).21 patients with PR (-) reacted positively to NACT, the RR in these is 80.0%(21/25); the RR in patients with PR(+) is 51.6%(14/27). There are a significant difference between patients with PR(-) and PR(+)(P<0.05). To determine the expression of receptors of hormone, can predict the sensitivity to NACT of patients diagnosed with breast cancer partially.3.52 patients received 3 cycle of NACT directed by programme technology,16 patients with HER-2(-) reacted positively to NACT, the RR in these is 68.2% (15/22); the RR in patients with HER-2(+) is 53.3%(16/30). It seems that the patients with HER-2(-) can get more benefit from the NACT.But there do not have a significant difference between patients with HER-2(-) and HER-2(+) (P<0.05).4. The expression of ER and PR partialy change before and after NACT. Before the chemotherapy, there are 32 of these patients with ER(+),20 with ER(-). After the chemotherapy, there are some changes happened.The amount of patients with ER(+) increases to 39,and with ER(-) induced to 13.There are a significant difference between pre and post NACT with the expression of ER. Before the chemotherapy, there are 27 of these patients with PR(+),25 with PR(-). After the chemotherapy, there are some changes happened.The amount of patients with PR(+) increases to 31, and with ER(-) induced to 21. There are a significant difference between pre and post NACT with the expression of PR.5. The expression of HER-2 partialy change before and after NACT. Before the chemotherapy, there are 30 of these patients with HER-2(+),22 with HER-2 (-).After the chemotherapy, the amount of patients with HER-2 (+) increases to 38,and with HER-2 (-) induced to 14. But there do not have a significant difference between pre and post NACT with the expression of HER-2.[Conclusions]NACT for breast cancer is effective. The expression before chemotherapy of ER,PR is related to the efficiency of NACT. The patients with ER(-) and PR(-) get more benefit than those with ER(+) and PR(+) in the process of NACT. The expression of ER and PR partialy change before and after NACT. The amount of positive cells relatively increases after chemotherapy. There is nothing related between the expression of HER-2 and the efficiency of NACT. The expression of HER-2 does not has a significant difference pre and post chemotherapy. To determine the expression of receptors of hormone and HER-2,can predict the sensitivity to NACT of patients diagnosed with breast cancer partially and help to direct the individual adjunctive chemotherapy for breast cancer patients initially.