Neoadjuvant chemotherapy for breast cancer patients with ER, PR, HER-2 expression
|Keywords||Breast Cancer Neoadjuvant therapy Estrogen receptor Progesterone receptor Biopsy|
[Background] breast cancer is a common female malignancy. How to develop effective integrated treatment strategy depends on biomarkers of tumor specimens immunohistochemical results, but neoadjuvant chemotherapy or neoadjuvant endocrine therapy after primary tumor will be varying degrees of pathological changes, losing prognosis and efficacy evaluation original data. The main purpose of this paper is to explore new adjuvant chemotherapy for breast cancer biomarkers detected by immunohistochemistry effects to expect to solve the following problems: 1. When to pathologic specimens by immunohistochemical staining, the original state when the coarse needle? Locally after surgery?, Or both detection? 2. If the biopsy specimens and surgical specimens inconsistent results, in order to develop therapeutic strategies which should prevail? [Patients and Methods] Retrospective analysis from January 2006 to March 2007 at the Second Affiliated Hospital of Zhejiang University Surgical Oncology, 60 hospitalized cases of female breast cancer biopsy specimens pristine condition and surgical specimens immunohistochemical results, the main research targets for the ER (oestrogen receptor), PR (progesterone receptor), HR (hormonal receptor) and HER-2 (Human epidermal growth factor receptor -2). Discussion and analysis of all the cases into two groups: accept different preoperative chemotherapy in breast cancer patients enrolled in the trial group (n = 38), did not receive preoperative chemotherapy in breast cancer patients included in the control group (n = 22). Test group neoadjuvant chemotherapy mainly FEC / FAC, AT / ET and CMF, treatment 1 to 5 times per. All data and charts all with statistical software SPSS FOR WINDOWS 13.0 for statistical analysis. Binomial paired data before and after their method using McNemar statistical test, while pairing before and after the data consistency test and correlation analysis, calculated kappa value (κ) and correlation coefficient (r). κ and r values between 0-1, after data showed that the closer a better consistency, close to 0 the opposite. The control group and the test group with the corresponding data Cochran-Mantel-Haenszel method for statistical tests, analyze different sets of data are attributed to neoadjuvant chemotherapy. [Results] test group neoadjuvant chemotherapy before biopsy specimens and surgical specimens after neoadjuvant chemotherapy ER, PR, HR and HER-2 immunohistochemical expression status compliance rates were: ER 84.2%, κ = 0.684, r = 0.688; PR 71.1%, K = 0.369, r = 0.369; HR 81.2%, κ = 0.612, r = 0.621; HER-2 92.1%, κ = 0.623, r = 0.628. Control group biopsies and surgical specimens of ER, PR, HR and HER-2 compliance rates were: ER 90.9%, κ = 0.818, r = 0.832; PR 86.4%, κ = 0.723, r = 0.726; HR 81.8%, κ = 0.627, r = 0.638; HER-2 95.4%, K = 0.831, r = 0.843. Visible, in addition to the experimental group PR status relatively poor consistency (κ, and r values are 0.369, p <0.05) in addition, ER, HR and HER-2 before and after the results were significantly better correlation, κ, and r values in 0.6 above. The test group before and after neoadjuvant chemotherapy ER-positive rates were 50.0% and 44.7%, PR positive rates were 36.8% and 34.2%, HR-positive rates were 65.8% and 57.9%, HER-2-positive rates were 13.2% and 10.5%, showing that the test group ER, PR, HR and HER-2 4 indicators biopsy specimens were significantly higher than surgical specimens; control group ER, PR, and HR-positive rate to get the same results, but HER-2 positive rate of surgery specimens than biopsy specimens. McNemar statistical test method by the test group and the control group biopsies and surgical specimens of ER, PR, HR and HER-2 status before and after the changes were not statistically significant, Cochran-Mantel-Haenszel method of statistical tests between the two groups ER, PR, HR and HER-2 status before and after the change was not statistically significant. [Discuss] either the experimental group or the control group, all cases biopsies and surgical specimens of ER, PR, HR and HER-2 status before and after the change was not statistically significant. Taking into account the experimental group, 18 (47.4%) patients received only 1-2 cycles of neoadjuvant chemotherapy, after striking out on this part of the patient 20 received three or more cycles of neoadjuvant chemotherapy in patients with biopsy specimens and surgical specimens ER, PR, HR and HER-2 expression status changes McNemar statistical analysis method, the final results of the change still no statistical significance. But these 20 patients and a control group comparison, PR positive biopsy specimens and in surgical specimens became negative when the ratio of the experimental group was significantly higher (80% vs 20%, p = 0.043). ER, PR, HER-2 both in guiding treatment or prognosis and efficacy of increasing importance on how to obtain accurate results is the key to individual therapy. Recalling 15 domestic and foreign clinical trials and found that most of the results suggest that neoadjuvant chemotherapy on hormone receptor expression was not statistically significant, even if very small changes in some patients but also because of different biopsy drawn caused. The results showed that only three of neoadjuvant chemotherapy on hormone receptor expression had a significant impact, mainly for surgical specimens after neoadjuvant chemotherapy in ER-negative rate has increased. There also did not receive preoperative tests showed that patients treated with coarse needle aspiration was higher than surgical specimens. Therefore, some scholars believe that if only by virtue of postoperative specimens when deciding whether endocrine therapy may be missing some of the original effective treatment for patients with endocrine, endocrine therapy should be recommended after core needle results shall prevail.