影响局部晚期乳腺癌患者新辅助化疗后病理完全缓解因素的10年回顾性分析  

Influencing factors of pathologic complete response after neoadjuvant chemotherapy in locally advanced breast cancer patients： results of a single-center lO-year retrospective study

作　　者：乔江华[1] 焦得闯[1] 卢振铎[1] 朱久俊 崔树德[1] 刘真真[1] 

机构地区：[1]郑州大学附属肿瘤医院,河南省肿瘤医院乳腺科,450050

出　　处：《中华医学杂志》2014年第18期1401-1404,共4页National Medical Journal of China

摘　　要：目的分析局部晚期乳腺癌患者行术前新辅助化疗后病理完全缓解的相关影响因素。方法回顾性分析河南省肿瘤医院自2003年4月至2013年2月期间行术前新辅助化疗的局部晚期患者620例，其中病理完全缓解患者94例。统计分析影响PCR的临床因素及病理因素。结果新辅助化疗后PCR率与患者年龄、月经状态、治疗前淋巴结状态无关；而增加化疗周期数可以提高患者的PCR率（14．1％与19．5％），但未达到统计学差异；蒽环类联合紫杉类化疗方案的PCR为20．1％，蒽环类为主的化疗方案PCR率仅为12．7％，两者之间差异有统计学意义；在生物学指标方面，新辅助化疗后PCR率与Ki-67指数、表皮生长因子受体的状态无关，而与雌激素受体或孕激素受体相关；Logistic多因素分析显示，肿瘤直径〈5cm的患者更易达到PCR。在HER-2扩增的患者中，加用曲妥珠单抗可以明显提高PCR率（15．7％与41．7％），达到统计学差异（P=0．031）。结论蒽环类联合紫杉类的化疗方案可以提高患者的PCR率，患者年龄、月经状态、治疗前淋巴结状态与PCR无关；而在病理因素方面，ER或PR阴性的患者新辅助化疗后PCR率高于阳性的患者，在HER-2扩增的乳腺癌患者中，加用曲妥珠单抗可以明显提高PCR；肿瘤直径〈5cm是影响PCR的显著因素。Objective To analyze the influencing factors of pathologic complete response （PCR） to neoadjuvant chemotherapy in locally advanced breast cancer patients. Methods A retrospective study was conducted to analyze the clinical data of 620 locally advanced breast cancer patients at Henan Cancer Hospital between April 2003 to February 2013. After neoadjuvant chemotherapy, 94 patients achieved PCR. The correlation between clinicopathological factors and PCR was analyzed. Results No significant correlations existed between PCR with patient age, menstrual status or pretherapeutic lymph node status. Increased chemotherapeutic cycles could improve the rate of PCR （ 14. 1% or 19.5 % ） , but it had no statistical difference. The rate of PCR achieved by regimens of anthracycline plus taxane was higher （20. 1% ）than that by anthracycline-based regimens （12. 7% ）. And the rate of PCR had significant difference between two regimens. In terms of biological indicators, PCR rate after neoadjuvant chemotherapy was associated with estrogen/progesterone receptor, but it had no correlation with Ki-67 index or the status of epidermal growth factor receptor. Logistic multifactorial analysis showed that tumor size ~〈 5 cm were significantly correlated with PCR. Trastuzumab could obviously increase the PCR rate （ 15. 7% or 41.7 % ） and there was statistical difference （ P = 0. 031 ）. Conclusion The regimens of anthracycline plus taxane can achieve a higher PCR rate. Patient age, menstrual status and pretherapeutic lymph node have no significant correlation with PCR. PCR rate is associated with the expression of ER/PR negative in breast cancer. Trastuzumab increase the PCR rate in the HER-2 positive patients. Tumor size ≤ 5 cm is a significant influencing factor of PCR rate.

关 键 词：乳腺肿瘤 新辅助化疗 病理完全缓解 回顾性分析 

分 类 号：R737.9[医药卫生—肿瘤]