乳腺癌分子分型与新辅助化疗效果的关系  

Correlation between molecular subtypes and efficacy of neoadjuvant chemotherapy in breast cancer patients

作　　者：朱坤兵[1] 徐灿[2] 李晓霞[3] 刘启龙[1] 张仁亚[3] 马姝[1] 石朋[1] 

机构地区：[1]济宁医学院附属医院乳腺甲状腺外科,272029 [2]济宁医学院附属医院健康体检中心,272029 [3]济宁医学院附属医院病理科,272029

出　　处：《中华乳腺病杂志（电子版）》2016年第3期166-169,共4页Chinese Journal of Breast Disease(Electronic Edition)

摘　　要：目的研究乳腺癌分子分型与新辅助化疗效果的关系。方法回顾性分析2008年6月至2013年6月在济宁医学院附属医院乳腺甲状腺外科确诊的136例原发性乳腺癌并行新辅助化疗的患者资料，以多西他赛＋吡柔比星十环磷酰胺（TAC）方案为新辅助化疗方案。分析基于免疫组织化学的乳腺癌分子分型、临床病理特点与新辅助化疗效果的关系。影像学疗效评价采用实体瘤疗效评价标准（RECIST）1．1。不同年龄、腋窝淋巴结状态、Ki67表达水平、分子分型组间的pCR率比较采用χ^2检验，不同肿瘤大小组间的pCR率比较采用Fisher精确概率法。多因素分析采用Logistic回归分析。结果新辅助化疗后临床总体缓解率为84．6％（115／136），其中pCR率为16．2％（22／136），疾病进展（PD）率为2．9％（4／136）。luminal A型、luminal B型、HER-2过表达型、三阴性乳腺癌的pCR率分别为5．4％（3／56）、10．0％（3／30）、30．0％（9／30）、35．0％（7／20），差异有统计学意义（χ^2=15．132，P=0．002），其中HER．2过表达型及三阴性乳腺癌新辅助化疗pCR率显著高于luminNA型（χ^2=9．880、11．333，P均〈0．008）。单因素分析显示，年龄、分子分型、Ki67表达水平与新辅助化疗pCR率有关（χ^2=15．648、15．132、6．278，P均〈0．050）。多因素Logistic回归分析显示，年龄和分子分型与新辅助化疗pCR率有关（OR=0．025，95％CI：0．005～0．136，P〈0．001；OR=3．644，95％CI：1．851—7．174，P〈0．001）。结论乳腺癌新辅助化疗效果与基于免疫组织化学的乳腺癌分子分型有关，三阴性和HER-2过表达型乳腺癌新辅助化疗更易获得pCR。Objective To explore the correlation between the immunohistochemistry-based molecular subtypes and the efficacy of neoadjuvant chemotherapy in primary breast cancer patients. Methods We retrospectively studied the records of 136 patients with primary breast cancers who received neoadjuvant chemotherapy （TAC： docetaxel ＋ pirarubiein ＋ cyclophosphamide ） in Department of Breast and Thyroid Surgery, Affiliated Hospital of Jining Medical College from June 2008 to June 2013. The correlation of the immunohistochemistry-based molecular subtypes, clinicopathological characteristics with efficacy of neoadjuvant chemotherapy was analyzed. The response of neoadjuvant chemotherapy was comprehensively evaluated based on Response Evaluation Criteria in Solid Tumors （RECIST） 1.1. The pCR rate in groups of different ages, axillary node status, Ki67 expressions and molecular types were processed using χ^2 test and the pCR rate in groups of different tumor diameters were using Fisher exact test. Multivariate analysis was performed using Logistic regression analysis. Results After neoadjuvant chemotherapy, the overall response rate was 84. 6% （115/136）, including pCR in 22 patients （16. 2%, 22/136） and disease progression in 4 patients （2. 9%, 4/136）. The pCR rates of luminal A, luminal B, HER-2 overexpression and triple-negative subtype were 5.4% （ 3/56 ）, 10. 0% （ 3/30 ）, 30. 0% （ 9/30 ） and 35.0% （7/20） respectively, indicating a significant difference among them（ χ^2= 15. 132, P= 0. 002）. The pCR rate of HER-2 overexpression or triple-negative subtype was significantly higher than that of luminal A subtype （ χ^2= 9. 880, 11. 333, both P〈0. 008 ）. Univariate analysis showed that pCR rate of patients after neoadjuvant chemotherapy was correlated with patients＇ age, molecular subtype and Ki67 expression （χ^2= 15. 648, 15. 132, 6. 278, all P 〈 0. 050 ）. In multivariate Logistic regression analysis, pCR rate of patients after neoadjuvant chemotherapy was correlated with

关 键 词：乳腺肿瘤 药物疗法 联合 分子分型 KI67抗原 

分 类 号：R737.9[医药卫生—肿瘤]