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目的探讨HER-2表达与乳腺癌不同方案新辅助化疗疗效的关系,为HER-2阳性患者筛选有效的化疗方案。方法应用CMF、CEF、NEF3种化疗方案对132例局部进展期乳腺癌进行新辅助化疗。所有患者完成2个周期新辅助化疗后评价疗效,免疫组织化学SP法检测标本中HER-2的表达。结果CMF、CEF、NEF三组总有效率分别为39.5%(17/43)、54.3%(25/46)和72.1%(31/43)。常见不良反应主要表现为骨髓抑制、胃肠道反应和脱发。CMF、CEF和NEF三组白细胞下降发生率分别为34.9%(15/43)、58.7%(27/46)、60.5%(26/43),CMF组明显低于其余两组。三组其他不良反应均无显著性差异(P>0.05)。CMF、CEF、NEF三组患者化疗前后HER-2阳性表达率均无显著性差异。CMF组HER-2阳、阴性患者总有效率分别为21.1(4/19)、54.2(13/24),差异有显著性(P<0.05);CEF组HER-2阳、阴性患者总有效率分别为42.9(9/21)、64.0(16/25),NEF组HER-2阳、阴性患者总有效率分别为65.0(13/20)、78.3(18/23),差异无显著性(P>0.05)。结论新辅助化疗对乳腺癌HER-2表达无影响,HER-2阳性患者对CMF方案不敏感,对CEF、NEF较敏感。
Objective To investigate the relationship between HER-2 expression and the efficacy of neoadjuvant chemotherapy in breast cancer and to screen effective HER-2-positive chemotherapy regimens. Methods Thirty-two patients with locally advanced breast cancer were treated with neoadjuvant chemotherapy using CMF, CEF and NEF regimens. All patients completed 2 cycles of neoadjuvant chemotherapy to evaluate the efficacy of immunohistochemical SP method to detect HER-2 expression in specimens. Results The total effective rates of CMF, CEF and NEF were 39.5% (17/43), 54.3% (25/46) and 72.1% (31/43) respectively. Common adverse reactions mainly manifested as myelosuppression, gastrointestinal reactions and hair loss. The incidences of leukopenia in CMF, CEF and NEF groups were 34.9% (15/43), 58.7% (27/46) and 60.5% (26/43), respectively. The CMF group was significantly lower than the other two groups. There was no significant difference in other adverse reactions among the three groups (P> 0.05). The positive rates of HER-2 in CMF, CEF and NEF groups before and after chemotherapy had no significant difference. The total effective rates of HER-2 positive and negative patients in CMF group were 21.1 (4/19) and 54.2 (13/24), respectively, with significant difference (P <0.05). The total effective rate of HER-2 positive and negative patients in CEF group Respectively, 42.9 (9/21) and 64.0 (16/25) respectively. The total effective rate of HER-2 positive and negative patients in NEF group was 65.0 (13/20) and 78.3 (18/23) respectively, with no significant difference > 0.05). Conclusion Neoadjuvant chemotherapy has no effect on the expression of HER-2 in breast cancer. HER-2 positive patients are not sensitive to CMF regimen and sensitive to CEF and NEF.