曲妥珠单抗在乳腺癌辅助治疗中的临床疗效研究  

Clinical Study of Therapy by Trastuzumab for Breast Cancer

作　　者：曹华 王树滨 郑涛 许瑞莲 陈亦欣 闫茂生 

机构地区：[1]暨南大学第二临床医学院深圳市人民医院,广东深圳518020

出　　处：《黑龙江医学》2013年第7期529-533,共5页Heilongjiang Medical Journal

基　　金：深圳市科技计划项目(201003001)

摘　　要：目的通过对人表皮生长因子受体2(HER-2)阳性乳腺癌患者临床资料的分析,探讨曲妥珠单抗在乳腺癌辅助治疗中的疗效、不良反应及影响预后的因素。方法依据是否使用过曲妥珠单抗辅助靶向治疗及雌激素受体(ER)的免疫组织化学检测结果,采用回顾性方法将本院107例HER-2阳性乳腺癌患者分为治疗组和未治疗组,其中各组又分为ER-及ER+亚组。对患者的临床特征采用SPSS17.0统计软件进行分析,并用Kaplan-Meier法和Cox回归分析患者的无瘤生存情况及预后影响因素。结果在107例HER-2乳腺癌患者中,治疗组43例,未治疗组64例,未治疗组的无瘤生存低于治疗组的患者(P=0.04);再进一步分为ER+治疗组(22例,20.56%)、ER-治疗组(21例,19.63%)、ER+未治疗组(46例,42.99%)及ER-未治疗组(18例,16.82%),这4组间的无瘤生存差异明显有统计学意义(P=0.02);ER-治疗组的无瘤生存率高于ER-未治疗组(P=0.04),ER+治疗组与ER+未治疗组的无瘤生存率差异无统计学意义(P=0.25)。经Cox多因素预后分析发现淋巴结及激素受体状况是影响HER-2阳性乳腺癌预后的重要因素;淋巴结转移多、ER阴性患者的预后差较差(P<0.05)。结论 HER-2阳性的乳腺癌患者予曲妥珠单抗辅助治疗能提高其无瘤生存率,其中ER-的患者获益明显;HER-2阳性乳腺癌患者中,淋巴结及激素受体状况是影响预后的重要因素,淋巴结转移多或ER阴性的预后较差。Objective To study the effect of trastuzumab and the prognostic factors in HER-2 + breast cancer by analysis of the clinical data.Methods Based on immunohistochemical results of estrogen(ER),whether using trastuzumab or not,107 patients with HER 2 + breast cancer patients were divided into treated and untreated group,which were divided into ER-and ER + subgroups.Their clinical characteristics were retrospectively reviewed by SPSS17.0 software.The survival rate and prognosis were also analyzed by Kaplan-Meier method and Cox regression.Results Among the 107 HER-2 + breast cancer patients,43 cases were treated by trastuzumab,64 cases were not treated,which had lower survival(P = 0.04).The patients were further divided into ER + treated group(22 cases,20.56%),ER-treated group(21 cases,19.63%),ER + non-treated group(46 cases,42.99%) and ER-non-treated group(18 cases,16.82%).The survival of the 4 groups were significantly different(P = 0.02).The disease-free survival rate of ER-treated group was higher than that of untreated ER-(P = 0.04),and that of ER + treated and untreated groups was in no significant difference(P = 0.25).According to the result of the Cox multiple-factor analysis,the lymph node status and hormone receptor status were important factors for the prognosis of HER-2 + breast cancer patients.The patients with more lymph node metastasis or ER-had poorer prognosis(P < 0.05).Conclusion The disease-free survival rate of HER-2 + breast cancer patients is improved by adjuvant trastuzumab therapy,especially of ER-patients.In the HER-2 + breast cancer,the lymph node and hormone receptor status are the important prognostic factors.The patients with lymph node metastasis or ER negative have the worst prognosis.

关 键 词：乳腺癌 人表皮生长因子受体2(HER-2) 曲妥珠单抗 预后 

分 类 号：R737.9[医药卫生—肿瘤]