女性乳腺癌er pr her-2 ki-67的表达水平与新辅助化疗疗效的相关性-correlation between expression level of er pr her - 2 ki - 67 in female breast cancer and efficacy of neoadjuvant chemotherapy.docxVIP

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女性乳腺癌er pr her-2 ki-67的表达水平与新辅助化疗疗效的相关性-correlation between expression level of er pr her - 2 ki - 67 in female breast cancer and efficacy of neoadjuvant chemotherapy.docx

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女性乳腺癌er pr her-2 ki-67的表达水平与新辅助化疗疗效的相关性-correlation between expression level of er pr her - 2 ki - 67 in female breast cancer and efficacy of neoadjuvant chemotherapy

目录中文摘要·····························································································（1）英文摘要·····························································································（2）论文题目·····························································································（4）材料与方法··························································································（4）结果···································································································（6）讨论···································································································(11)结论···································································································(13)参考文献·····························································································(14)文献综述·····························································································(16)参考文献·····························································································(24)缩略语表·····························································································(28)中文摘要目的探讨乳腺癌组织中ER、PR、HER-2、Ki-67的表达状况与新辅助化疗疗效的关系，帮助寻求能够判断与预测乳腺癌新辅助化疗疗效的相关生物学指标。方法研究对象为我院2012年至2014年经空芯针活检组织学诊断确诊的60例符合条件的女性乳腺癌患者,治疗前经影像学检查未发现远处转移，且此前均未接受任何放疗、化疗、内分泌等治疗。对这60例患者进行新辅助化疗之前，明确其腋窝淋巴结状况及常规免疫组化检测ER、PR、HER-2、Ki-67水平等。给予新辅助化疗，均采用TAC方案（盐酸表柔比星+环磷酰胺+多西他赛）进行化疗，21d为一个疗程，进行4~6个疗程后，观察疗效。化疗疗效通过采用临床体检、乳腺彩超检测及术后病理分析综合判断,评估标准按照国际抗癌联盟UICC实体瘤疗效标准进行。评价新辅助化疗的疗效，对照分析治疗疗效与各分子标记物等相关因素的关系，以及治疗前后ER、PR、HER-2及Ki-67表达的变化。结果（1）化疗4个疗程总有效率为73.3%。化疗6个疗程总有效率为86.7%，P＞0.05认为化疗效果无差异。（2）ER和PR表达之间存在相关性，Ki-67的表达与ER/PR的表达呈负相关，而HER-2的表达状态则与ER、PR和Ki-67均无明显相关性。（3）ER、PR、Ki-67在新辅助化疗前后的表达有差异，HER-2在新辅助化疗前后的表达无显著差异。结论（1）对大部分适应证患者，新辅助化疗有较好的临床疗效,4个疗程与6个疗程的新辅助化疗时间对患者产生的效果差异不大。（2）乳腺癌新辅助化疗后,ER、PR、和Ki－67的表达可发生改变，其中Ki-67发生了下调，提示新辅助化疗能降低肿瘤的增殖活性。ER、PR和Ki－67表达的改变可预测新辅助化疗的疗效。（3）ER，PR阴性的乳腺癌患者对化疗较敏感，新辅助化疗后获益更多，ER，PR可作为乳腺癌新辅助化疗的预测指标。关键词乳腺癌，新辅助化疗，ER，PR，HER-2，Ki-67CorrelationbetweenexpressionoffemalebreastcancerER,PR,HER-