三阴乳腺癌对含蒽环类方案新辅助化疗的反应及远期疗效  

Efficacy of Neoadjuvant Anthracycline-based Regimen Chemotherapy on Triple-negative Breast Cancer

作　　者：孙正魁[1] 马行天[1] 吴毓东[1] 樊帆[1] 万向华[1] 付爱荣[1,2] 

机构地区：[1]江西省肿瘤医院乳腺外科,南昌市330029 [2]江西省肿瘤医院病理科,南昌市330029

出　　处：《中国肿瘤临床》2009年第3期126-130,共5页Chinese Journal of Clinical Oncology

摘　　要：目的：本文分析三阴乳腺癌（缺乏ER、PR、HER-2表达）对含蒽环类方案新辅助化疗的反应、远期疗效和探讨可能的机制。方法：对2000年1月至2003年12月间用含蒽环类方案新辅助化疗的有长期随访资料（中位随访期5．4年）的326例乳腺癌患者进行分析，用免疫组化检测ER、PR、HER-2、p53、Ki67、E钙粘素的表达，采用Cox风险回归模型分析影响无复发生存率（relapse—freesurvival rate，RFS）和总生存率（overallsurvival rate，0S）的预后因素，比较三阴乳腺癌和非三阴乳腺癌对含蒽环类方案新辅助化疗的反应，RFS和OS，分析三阴表型与肿瘤分级、p53、Ki67、E钙粘素表达的关系。结果：三阴表型、肿瘤分期、组织学分级、对新辅助化疗的临床反应及pCR是影响乳腺癌预后的独立因素；三阴乳腺癌占全组病例的21．5％，与非三阴乳腺癌比较，三阴乳腺癌组有较高的pCR率（P=0．046）和临床反应率（P=0．037），但RFS及OS低于非三阴组（P=0．001，P=O．004）；新辅助化疗后达到临床缓解的三阴乳腺癌RFS和OS并未得到改善；三阴乳腺癌与p53和Ki67的表达呈正相关（P=0．007，P=0．028），与E钙粘素的表达呈负相关（P=0．034）。结论：三阴乳腺癌对含蒽环类药物方案新辅助化疗的临床反应率和pCR率均较高，但远期疗效却较差。其机制可能与三阴乳腺癌具有较高的增殖、侵袭转移能力和缺乏有效的治疗靶点有关。Objective： Triple-negative breast cancer （TNBC） is defined by the lack of estrogen receptor （ER）, progesterone receptor （PR）, and human epidermal growth factor receptor 2 （HER-2） expression. This study was to compare response to neoadjuvant chemotherapy with anthracycline-based regimen and prospective efficacy between patients with TNBC and those without TNBC, and to investigate the mechanisms of the effect of TNBC on patient survival. Methods： A total of 326 patients who received neoadjuvant chemotherapy with anthracycline-based regimen between 2000 and 2003 and had complete data about long-term clinical follow-up （5.4 years on average） were reviewed. Expressions of ER, PR, HER-2, P53, Ki67 and E-cadherin were detected by immunohistochemical staining. A multivariate Cox regression analysis was carried out to evaluate independent predictive factors for relapse-free survival rate （RFS） and overall survival rate （OS）. Clinical response rate, pathologic complete response （pCR） rate, and expression of P53, Ki67, and E-cadherin were compared between TNBC patients and non-TNBC patients. Results： TNBC, stage, histologic grade, clinical response and pCR were independent prognostic factors associated with survival rates. Seventy （21.5%） of the 326 patients had TNBC. Compared with non-TNBC patients, TNBC patients had significantly higher pCR rate （P=0.046） and clinical response rate （P=0.037） and lower 5-year RFS rate （P=0.001） and 5-year OS （P=0.004）. RFS and OS were not improved in TNBC patients after neoadjuvant chemotherapy. Levels of P53 and Ki67 were positively correlated with triple-negative phenotype （P=0.007 and P=0.028, respectively）. E-cadherin level was inversely associated with triple-negative phenotype （P=0.034）. Conclusion： Neoadjuvant anthracycline-based regimen chemotherapy has poorer efficacy in TNBC patients than in non-TNBC patientsl The poor prognosis of TNBC may be attributed to its growth potential, aggressive biological behavior and

关 键 词：乳腺癌 三阴表型 新辅助化疗 预后 

分 类 号：R737.9[医药卫生—肿瘤] R186[医药卫生—临床医学]