乳腺癌分子分型在新辅助化疗疗效和预后中的预测作用  

Predictive Role of Breast Cancer Molecular Subtype in Response and Outcome of Breast Cancer Patients Treated with Neoadjuvant Chemotherapy

作　　者：吴建南[1] 李顺荣[1] 顾然[1] 萧俏珍[1] 苏逢锡[1] 

机构地区：[1]中山大学孙逸仙纪念医院乳腺肿瘤医学部,广东广州510120

出　　处：《中山大学学报（医学科学版）》2011年第3期383-388,420,共7页Journal of Sun Yat-Sen University:Medical Sciences

摘　　要：【目的】探讨乳腺癌分子分型在表阿霉素联合多西紫杉醇方案(ET方案)化疗敏感性及预后方面的预测作用。【方法】对接受ET新辅助化疗方案治疗的244例乳腺癌患者进行回顾性分析。依据免疫组化雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(HER2)表达水平将乳腺癌分为Luminal、HER-2+和Basal-like3个分子亚型,分析3个分子亚型患者的病理疗效及远期生存的差别。【结果】244例患者中,167(68.4%)例为Luminal亚型,43(17.6%)例为HER2+亚型,34(13.9%)例为Basal-like亚型。Basal-like亚型与HER2+亚型的病理完全缓解率(pCR)分别为29.4%、25.6%,明显高于Luminal亚型的12.0%(P=0.011)。Basal-like亚型与HER2+亚型患者,特别是新辅助化疗后仍有癌残留的患者,其5年无病生存率(DFS)明显低于Luminal亚型(P<0.05)。Basal-like亚型与HER2+亚型患者,特别是新辅助化疗后仍有癌残留的患者,其5年总生存率(OS)亦明显低于Luminal亚型(P<0.05)。获得pCR的乳腺癌患者5年的DFS和OS均明显高于化疗后仍有癌残留的患者(P值分别为P<0.001,P=0.003)。【结论】乳腺癌分子分型能作为乳腺癌的病理完全缓解独立预测因子。相比于Luminal亚型,Basal-like亚型和HER2+亚型的pCR率更高,但远期生存率却较差。[Objective] To investigate the predictive role of breast cancer molecular subtype in the response and outcome of breast cancer patients treated with neoadjuvant docetaxel plus epirubicin chemotherapy.[Methods]Two hundred and forty-four patients treated with neoadjuvant chemotherapy were included in this retrospective study.Molecular subtypes were constructed from immunohistochemical results of estrogen receptor（ER）,progesterone receptor（PR） and HER2 status,which were classified as Luminal,HER2 positive and Basal-like subtype.[Results] Among all 244 cases,167（68.4%） were Luminal subtype,43（17.6%） were HER2 positive subtype and 34（13.9%） were Basal-like subtype.Compared with Luminal subtype,the pathological complete response rates of patients with basal-like and HER2 positive subtype were 29.4% and 25.6%,respectively,which were significantly higher than that of patients with Luminal subtype（P = 0.011）.Patients with Basal-like and HER2 positive subtype especially for those with residual disease after chemotherapy had decreased 5-years disease-free survival（DFS） compared with those with Luminal subtype（P〈0.05）.And similarly,patients with Basal-like and HER2 positive subtype especially for those with residual disease after chemotherapy had decreased 5-year overall survival（OS） compared with those with Luminal subtype（P〈0.05）.The 5-year DFS and OS of patients who achieve pathological complete response（pCR） were significantly higher than that of patients with residual disease after chemotherapy（P 〈0.001,P = 0.003,respectively）.[Conclusion] Molecular subtype can predict the response of breast cancer patients treated with neoadjuvant chemotherapy.Compared with luminal subtype,patients of HER2 positive or basal-like subtype had increased pCR rates,but were associated with significantly worse survival.

关 键 词：乳腺癌 分子分型 新辅助化疗 预后 

分 类 号：R737.9[医药卫生—肿瘤]