乳腺癌分子分型在新辅助化疗疗效和预后中的预测作用  

The Predicting Value of Molecular Subtype in Response and Prognosis for Breast Cancer Patients with NeoadjuvantChemotherapy

作　　者：雷蕾[1] 王晓稼[1] 杨红健[1] 谢尚闹[1] 孟旭莉[1] 陈占红[1] 许沈华[1] 

机构地区：[1]浙江省肿瘤医院,浙江杭州310022

出　　处：《中国肿瘤》2012年第11期868-873,共6页China Cancer

基　　金：浙江省医药卫生科技计划项目(2010KYA041);浙江省公益性技术应用研究计划项目(2010C33017)

摘　　要：[目的]探讨乳腺癌分子分型在新辅助化疗疗效及预后预测中的作用。[方法]对接受新辅助化疗方案治疗的157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 A、Luminal B、Her2阳性和三阴性4个分子分型,分析4个分子分型与临床病理因素、新辅助化疗疗效及3年生存率的相关性。[结果]157例患者中,分子分型与肿瘤大小、淋巴结转移相关,T3～4期的三阴性型的比例高于T1～2期(P=0.003);N0、N1、N2、N3期的三阴性型的比例分别为44.4%、23.8%、25.6%和22.2%(P=0.014)。不同分子分型间新辅助化疗有效率无明显差异(P=0.632),而T分期(P=0.014)、N分期(P=0.031)与有效率明显相关。不同分子分型间新辅助化疗3年生存率有明显差异,Luminal A型最高,三阴性型最低(P=0.049)。乳腺癌预后影响因素Cox回归模型分析提示分子分型(P=0.003)、年龄(P=0.007)、T分期(P=0.013)、N分期(P=0.000)是乳腺癌患者的独立预后因素。[结论]乳腺癌分子分型与肿瘤大小、淋巴结转移状态相关,能作为新辅助化疗远期疗效的独立预测因子。[Purpose] To investigate the predicting value of molecular subtype in the response and outcome of breast cancer patients received neoadjuvant chemotherapy.[Methods] One hundred and fifty-seven patients undergoing neoadjuvant chemotherapy were enrolled retrospectively.Bosed on the expression of estrogen receptor（ER）,progesterone receptor（PR）,human epidermal growth factor receptor 2（Her2） expression level,the cases were divided into 4 subtypes,Luminal A,Luminal B,Her2＋ and triple-negative phenotype.The correlation between molecular subtypes and clinic pathologic factors,efficacy of neoadjuvant chemotherapy and 3-year survival were analyzed.[Results] Of the 157 patients,molecular subtypes correlated with tumor size and lymph node metastasis.The cases with T3 ~4 had a higher proportion than those with T1~2 in triple-negative phenotype（P=0.003）.The proportion of triple-negative phenotype in cases with N0,N1,N2 and N3 was 44.4%,23.8%,25.6% and 22.2% respectively with significant difference（P=0.014）.No significant difference between the molecular subtypes and the efficacy of neoadjuvant chemotherapy（P = 0.632）.However,T stage（P=0.014） and N stage（P=0.031） related to the efficacy.Obvious difference were found among 4 molecular subtypes in 3-years survival,Luminal A was the highest,triple-negative phenotype was the lowest（P=0.049）.Cox regression showed that molecular subtype（P=0.003）,age（P=0.007）,T stage（P=0.013）,N stage（P=0.000） were the independent prognostic factors in patients with breast cancer.[Conclusion] The breast cancer molecular subtypes relate to the tumor size and lymph node metastasis,those could be used as the independent predictor for the efficacy of neoadjuvant chemotherapy.

关 键 词：乳腺癌 分子分型 新辅助化疗 预测因子 

分 类 号：R737.9[医药卫生—肿瘤]