乳腺癌新辅助化疗病理缓解率与组织学及分子标志相关性分析  

Analysis of the impact of histopathology and molecular markers on pathological complete response to neoadjuvant chemotherapy in breast cancer

作　　者：曹一鸣[1] 韦长元[2] 黄平[1] 莫军扬[1] 覃庆洪[2] 杨立[1] 

机构地区：[1]柳州市人民医院乳腺外科,广西柳州545006 [2]广西医科大学附属肿瘤医院乳腺外科,广西南宁530021

出　　处：《中华肿瘤防治杂志》2015年第18期1479-1483,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：广西卫生厅重点科研课题(2010079);广西科学研究与技术开发计划课题(桂科攻1355055-3-12)

摘　　要：目的研究乳腺癌新辅助化疗后病理完全缓解(pathological complete response,pCR)的规律及其与各种生物学标志物的关系,指导临床个体化治疗。方法对2009-01-01—2014-03-20广西医科大学附属肿瘤医院(77例)及柳州市人民医院(138例)经粗针穿刺活检病理确诊为浸润性乳腺癌的215例患者的临床资料进行回顾性分析,确定组织病理分级及病理类型,并通过免疫组化检测确定分子分型。所有入组患者均采用蒽环类及紫衫类药物行新辅助化疗。应用SPSS 21.0软件分析各影响因子与pCR的相关性。结果新辅助化疗后总临床有效率为86.0%(185/215),其中临床完全缓解51例(23.7%),部分缓解134例(62.3%),疾病稳定30例(14.0%),无疾病进展病例;病理完全缓解39例(18.1%),病理部分缓解130例(60.5%),临床疗效与病理疗效的一致性欠佳。病理完全缓解与病理类型(χ2=4.544,P=0.033)、雌素受体(χ2=8.352,P=0.004)、孕激素受体(χ2=7.531,P=0.006)、HER-2(χ2=6.119,P=0.013)、Ki-67(χ2=5.714,P=0.017)及分子分型(χ2=4.255,P=0.04)相关,多因素分析显示,HER-2过表达(OR=0.191,P=0.006)及三阴性乳腺癌(OR=0.122,P=0.009)是pCR的独立影响因素。结论激素受体阴性、HER-2过表达、Ki-67高表达pCR率更高,三阴性乳腺癌pCR率更高,浸润性小叶癌pCR率更低。OBJECTIVE To research the regularity of pathological complete response（pCR）to neoadjuvant chemotherapy in breast cancer and the correlation between pCR and biological markers in order to guide the individualized therapy.METHODS We retrospectively analyzed the data of 215 patients who were diagnosed with invasive breast cancer in Liuzhou People＇s Hospital（138cases）and Cancer Hospital of Guangxi Medical University（77cases）from January 2009 to March 2014.Histological grade and pathological type were determined by core needle biopsy and molecular subtype was determined by immunohistochemistry.All patients had received anthracycline-taxane-based neoadjuvant chemotherapy.SPSS 21.0was used to analyze the correlation between influence factors and pCR.RESULTS The overall clinical response rate was 86.0% after neoadjuvant chemotherapy,including clinical complete response for 51cases（23.7%）and clinical partial response for 134cases（62.3%）,and the rate of stable disease was 14.0%（30cases）.Totally 39patients（18.1%）achieved pathological complete response and 130patients（60.5%）achieved pathological partial response.Discrepancies were found between clinical response and pathological response.Pathological complete response was related to pathological type（χ2=4.544,P=0.033）,hormone receptor status（χ2=8.352,7.531,P=0.004,0.006）,expression of HER-2（χ2=6.119,P=0.013）,expression of Ki-67（χ2=5.714,P=0.017）and molecular type（χ2=4.255,P=0.04）.Multivariate analysis showed that overexpressions of HER-2（OR=0.191,P=0.006）and triple-negative breast cancer（OR=0.122,P=0.009）were independent factors for the pathological complete response.CONCLUSIONS High pCR rates are correlated with hormone receptor negative,overexpression of HER-2and high expression of Ki-67.Triple-negative breast cancer has a hiher pCR rate while invasive lobular carcinoma is associated with a lower chance of obtaining pCR.

关 键 词：乳腺肿瘤 病理完全缓解 新辅助化疗 个体化治疗 

分 类 号：R737.9[医药卫生—肿瘤]