medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2018-10-146-149medsovet-2547Research ArticleОригинальные исследованияOriginal studiesСмена фенотипа рака молочной железы (ER, PR, HER2) после неоадъювантного леченияBreast cancer biomarker (ER, PR, HER2) changes in the phenotype after neoadjuvant treatmentБашлыкВ. О.BashlykV. O.КудайбергеноваА. Г.KudaibergenovaA. G.

Кандидат медицинских наук

Санкт-Петербург

АртемьеваА. С.ArtemyevaA. S.

Кандидат медицинских наук

Санкт-Петербург

МуравцеваА. Л.MuravtsevaA. L.ЧирскийВ. С.ChirskyV. S.

Доктор медицинских наук, профессор

Санкт-Петербург

СемиглазоваТ. Ю.SemiglazovaT. Yu.

Доктор медицинских наук 

Санкт-Петербург

КлименкоВ. В.KlimenkoV. V.

Кандидат медицинских наук 

Санкт-Петербург

СемиглазовВ. Ф.SemiglazovV. F.

Член-корреспондент РАН, доктор медицинских наук, профессор

ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Петрова» Минздрава РоссииРоссияN.N.Petrov National Medical Research Cancer Centre of Oncology, Federal State Budgetary Institution of the Ministry of Health of Russia,Russian Federation201818072018010146149Copyright © Башлык В.О., Кудайбергенова А.Г., Артемьева А.С., Муравцева А.Л., Чирский В.С., Семиглазова Т.Ю., Клименко В.В., Семиглазов В.Ф., 20182018Башлык В.О., Кудайбергенова А.Г., Артемьева А.С., Муравцева А.Л., Чирский В.С., Семиглазова Т.Ю., Клименко В.В., Семиглазов В.Ф.Bashlyk V.O., Kudaibergenova A.G., Artemyeva A.S., Muravtseva A.L., Chirsky V.S., Semiglazova T.Y., Klimenko V.V., Semiglazov V.F.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/2547

Цель: исследовать фенотип рака молочной железы (ER/PR, FOXA1, HER2, Ki67), а также динамику изменений данных маркеров в опухоли до и после неоадъювантной химиотерапии (НХТ), сравнить их с метастазами в регионарных лимфоузлах (ЛУ). Материалы и методы. Предметом исследования являлась группа пациентов с карциномами молочной железы, получавших НХТ по схемам TAC и TC, у которых на фоне лечения были выявлены метастазы в регионарных ЛУ (ypN1,2,3). Результаты. Пациенты были разделены на три группы. Первая группа (n = 11, первичная опухоль и опухоль после НХТ). Конверсия экспрессии гормональных рецепторов была как в сторону увеличения (37,5%), так и в сторону снижения (62,5%). Экспрессия HER2 изменилась на 36,4%, только в сторону увеличения.

Вторая группа (n = 32, резидуальная опухоль и региональные метастазы). Конверсия гормональных рецепторов была отмечена в 12,5%. Экспрессия HER2 изменилась на 21,87%. В третьей группе (n = 11, первичная опухоль до начала НХТ и метастазы в ЛУ после лечения). Конверсия ER в 18,2% в виде полной потери, PR в 54,5%. Экспрессия HER2 возросла в 45,5%. Экспрессия FOXA1 оставалась стабильной во всех случаях после НХТ, где экспрессия гормональных рецепторов уменьшалась или исчезала. Выводы. В эру персонализированной терапии и НХТ патоморфологическое изучение иммуногистохимического статуса метастазов в ЛУ необходимо, поскольку почти в 20% случаев изменяется гормонально-рецепторный статус, при этом сигнальный путь для рецепторов стероидных гормонов сохраняется. Статус экспрессии онкопротеина HER2 изменяется почти в половине случаев при сравнении первичной биопсии и метастаза после проведенной НХТ.

Objective: to study the breast cancer phenotype (ER/PR, FOXA1, HER2, Ki67) and the dynamics of changes in these markers in the tumour before and after neoadjuvant chemotherapy (NAT), compare them with metastases in the regional lymph nodes (LN). Materials and methods. The subject of the study was a group of patients with breast carcinomas receiving NAT according to the TAC and TC regimens, who had metastases in regional LUs in the course of the treatment (urN1,2,3). Results. Patients were divided into three groups. The first group (n = 11, primary tumour and tumour after NAT). The conversion of hormone receptor expression was both upward (37.5%) and downward (62.5%). Expression of HER2 has only changed upward by 36.4%.

The second group (n = 32, residual tumour and regional metastases). The conversion of hormonal receptors was reported in 12.5%. Expression of HER2 has changed by 21.87%. In the third group (n = 11, the primary tumour before the onset of NAT and metastasis in LN after treatment). Conversion of ER in 18.2% in the form of a total loss, PR in 54.5%. Expression of HER2 increased by 45.5%. Expression of FOXA1 remained stable in all cases after NAT, where expression of hormonal receptors decreased or disappeared. Conclusions. In the era of personalized therapy and NAT, it is required to conduct a pathomorphological study of the immunohistochemical status of metastases in LN, since the hormone receptor status changes in almost 20% of cases, with the signal pathway for steroid hormone receptors remaining unchanged. The HER-2 oncoprotein expression status changes in almost half of cases when comparing the primary biopsy and metastasis after NAT.

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The authors declare that there are no conflicts of interest present.