Correlation Analysis Between ER、PR、Her-2and Ki-67and Neoadjuvant Chemotherapy In Locally Advanced Breast Cancer

Objecttive: To investigate the correlation between ER、PR、Her-2and Ki-67and locally advanced breast cancer in neoadjuvant chemotherapy.Methods: The data of55patients with locally advanced breast cancer are analyzed Retrospectively, which received neoadjuvant chemotherapy in the first Affiliated Hospital of Fujian Medical University from January2009to December2010. Based on the expression of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor expression2(Her-2), and Ki-67status determined by immunohistochemistry pre-and post-neoadjuvant chemotherapy, the cases were divided into Luminal-type, Her-2positive and triple-negative phenotype. Comparatively Analysis correlation between ER, PR, Her-2and Ki-67as well as clinical data and the efficacy and prognosis of breast cancer in neoadjuvant chemotherapy. The data were analysised by SPSS19.0software system and it was significant statistically when P<0.05.Results:1. In the total55patients with locally advanced breast cancer, molecular subtypes correlated with histological grade significantly (X2=11.480, P=0.003), but not with age, T stage, N stage, histological type apprently(P>0.05).2. The efficacy of different molecular subtypes in neoadjuvant chemotherapy differ significantly (X2=6.101, P=0.047), the Luminal-type had the lowest efficiency (67.6%), while the triple negative stay intermediately (90%) and the Her-2positive was highest remissive rate (100%).3. In the Kaplan-Meier survival analysis，there is significant differences in three subtypes (P<0.05), Luminal-type with a longer disease-free survival (70.6%, P=0.028) and overall survival (64.7%, P=0.031), compared with the worst prognosis triple negative type.4. Pathologic complete response was received in6cases(10.9%), which was related between molecular typing, histological grade and the number of chemotherapy cycles (P<0.05). In the Kaplan-Meier survival analysis, compared with non-pathological complete response, the disease-free survival (83.3%vs48.9%, P=0.05) and overall survival (100%vs48.9%, P=0.047) of pathologic complete remission were obviously prolonged.5. The change in Ki-67was observed in52.3%among total patients between pre-and post-chemotherapy and the reduction was in majority, however, ER, PR, Her-2expression were not significantly different (P>0.05). Further analysis showed the remission rate was significantly higher in Ki-67reduced group than Ki-67non-reduced group (45.5%vs32.7%, P=0.011), the same as the rate of pathologic complete response (10.9%vs0%, P=0.008).6. For analysis of clinical response in neoadjuvant chemotherapy, the DFS and OS were significantly different on ER, PR and Ki-67levels before chemotherapy and Ki-67reduction between pre-and post-chemotherapy in univariate analysis(P<0.05), furthermore, ER expression (P=0.047,95%CI0.021-1.349) and Ki-67reduction (P=0.043,95%CI0.235-5.362) were independent prognostic factors in multivariate analysis.7. In the follow-up prognosis analysis, Ki-67reduced group had distinctively longer DFS (70.3%vs42.9%, P=0.023) and OS (70.3%vs39.4%, P=0.024) than non-reduced group after neoadjuvant themotherapy. Ki-67high expression group received lower disease-free survival (20.8%vs54.8%, P=0.023) and overall survival (16.7%vs58.1%, P=0.024) than the low expression group, but it had no significant difference between high and low expression of Ki-67group before NAC on DFS (46.3%vs64.3%, P=0.231) and OS (43.9%vs64.3%, P=0.287).Conclusion:1. Different molecular subtypes had different efficacy and prognosis and were identified to be an significant prognostic factors, which were important for individual treatment of locally advanced breast cancer.2. Pathological complete response predicted better outcome in locally advanced breast cancer after neoadjuvant chemotherapy, which was relevant with molecular typing, tumor histological grade and the number of cycles of chemotherapy.3. Ki-67expression was reduced significantly after neoadjuvant chemotherapy, while there was no difference for ER, PR, Her-2status.4. Before neoadjuvant chemotherapy, low ER, low PR, high Ki-67and Ki-67reduction befor and after chemotherapy indicate better efficacy relatively, further more, ER expression before chemotherapy and Ki-67reduction were independent predicting factor.5. The reduction of Ki-67expression before and after chemotherapy predicte better response and prognosis than non-reduction group.