ER、PR、p53和Bcl-2的表达变化在乳腺癌新辅助化疗中的意义

摘要

目的:回顾性探讨乳腺癌组织中ER、PR、p53及Bcl-2表达变化在新辅助化疗(neoadjuvant chemotherapy,NAC)中的意义,指导乳腺癌化疗的选择及判断预后.方法:术前采用空心针穿刺活检予以病理确诊并行ER、PR、p53及Bcl-2测定.化疗采用CEF方案[氟尿嘧啶(flurouracil,5-FU) 500mg/m2,表柔比星(epirubicin,EPI)75mg/m2,环磷酰胺(cyclophosphamide,CTX) 500mg/m2],经3个疗程化疗,再行乳腺癌改良根治术或保乳手术,免疫组化SP法检测98例Ⅱ/Ⅲ期乳腺癌病例在疗前后乳腺癌组织中ER、PR、p53及Bcl-2的表达,比较化疗前后上述各指标阳性表达率的变化.结果:98例Ⅱ/Ⅲ期乳腺癌患者经3个周期新辅助化疗后,70例(71.4%)获得临床部分缓解.化疗前后ER、PR阳性表达率均无显著变化(P＞0.05) ;p53及Bcl-2化疗前后表达阳性率显著变化(P＜0.05),化疗有效组中p53蛋白阳性表达率显著下降(P＜0.05)而Bcl-2阳性表达率显著上升(P＜0.05).结论:ER、PR表达在新辅助化疗前后无显著差异,新辅助化疗可能通过抑制p53的表达来抑制乳腺癌的增殖并通过上调Bcl-2表达来调整肿瘤细胞分化.%Objective: To retrospectively investigate the impact of neoadjuvant chemotherapy on the expressions of ER, PR, p53 and Bcl - 2 to guide the choice of treatment and predict prognosis.Methods: The diagnosis was proved by core biopsy before operation.The expressions of ER, PR, p53 and Bcl -2 before and after operation were measured by immunohistochemical staining method in 98 patients.All the patients received 3 cycles of CEF chemotherapy regimen [fluorouracil ( 5 - FU ) 500 mg/m2, epirubicin ( EPI ) 75 mg/m2, cyclophosphamide ( CTX ) 500 mg/m2], after 3 cycles of chemotherapy modified radical mastectomy or breast -conserving surgery was performed and the ER, PR,p53 and Bcl -2 expression was measured again.To compare the positive expression before and after neoadjuvant chemotherapy.Results: In 98 patients with Ⅱ / Ⅲ breast cancer patients after 3 cycles of neoadjuvant chemotherapy,70 patients (71.4％) obtained a clinical partial remission.Before and after chemotherapy positive expression of ER, PR did not change significantly ( P ＞ 0.05 ); p53 and Bcl -2 expressions significantly changed before and after chemotherapy ( P ＜ 0.05 ).With the increasing efficacy of chemotherapy significantly the expression of p53 significantly downregulated ( P ＜ 0.05 ), but the expression of Bcl - 2 significantly upregulated ( P ＜ 0.05 ).Conclusion:The expressions of ER, PR were no significant difference before and after NAC, but NAC may suppress the expression of p53 to inhibit the tumor growth and adjust the differentiation of tumor cell through upregulating expression of Bcl -2.