HER-2阳性型浸润性乳腺癌新辅助化疗后肿瘤退缩模式及影响因素  

The pattern of tumor regression after neoadjuvant chemotherapy for HER-2 positive invasive breast cancer and its influencing factors

作　　者：杨丽 何建信 张春霞 马强 YANG Li;HE Jianxin;ZHANG Chunxia;MA Qiang(General Surgery,Beijing Shunyi Hospital,Beijing 101300,China;General Surgery,Horqin Left Middle Banner People's Hospital,Inner Mongolia Tongliao 029399,China)

机构地区：[1]北京市顺义区医院普外二科,北京101300 [2]通辽市科尔沁左翼中旗人民医院外二科,内蒙古通辽029399

出　　处：《现代肿瘤医学》2022年第2期228-231,共4页Journal of Modern Oncology

摘　　要：目的:了解人表皮生长因子受体2(HER-2)阳性型浸润性乳腺癌(IBC)新辅助化疗(NCT)后肿瘤退缩模式并分析影响因素。方法:回顾性分析63例NCT后未达到病理学完全缓解HER-2阳性型IBC患者临床病理学资料,以病理残存肿瘤情况判定肿瘤退缩模式将其分为向心性退缩(CSM)及非向心性退缩(NCSM),分析肿瘤退缩模式的影响因素。结果:本研究中CSM 41例(65.08%,41/63)。单因素分析:不同NCT前T分期、HER-2表达状态及是否联合曲妥珠单抗治疗组间CSM发生率具有统计学差异(P<0.05),而不同年龄、体质量指数、NCT前腋窝淋巴结转移状态、HR及Ki67表达状态组间肿瘤退缩模式差异无统计学意义(P>0.05);多因素分析显示:NCT前T_(2)组较T_(3)组CSM发生率更高(OR=10.542,P=0.002),NCT联合曲妥珠单抗组CSM发生率更高(OR=0.190,P=0.031),不同HER-2表达状态组间肿瘤退缩模式差异无统计学意义(P>0.05)。结论:肿瘤较大的HER-2阳性型IBC患者经NCT后拟行保乳手术者应加强术前检查评估肿瘤退缩模式,且在NCT治疗方案选择上应联合曲妥珠单抗靶向治疗,以期降低局部复发风险。Objective:To understand the pattern of tumor regression after neoadjuvant chemotherapy(NCT)for human epidermal growth factor receptor 2(HER-2)positive invasive breast cancer(IBC)and to analyze its influencing factors.Methods:The clinicopathological data of 63 patients with HER-2-positive IBC who underwent NCT were retrospectively analyzed.According to the pathological residual tumor to judge the pattern of tumor regression,it was divided into concentric shrinkage mode(CSM)and non-concentric shrinkage mode(NCSM).The influencing factors related to the tumor regression pattern were analyzed.Results:Concentric shrinkage mode(CSM)was the predominant pattern in our study(65.08%,41/63).Univariate analysis:There was significant difference in the incidence of CSM among different tumor T stages before NCT,HER-2 expression level before NCT and whether combined with trastuzumab treatment groups(P<0.05).There was no significant difference for tumor regression pattern among different ages,body mass index,axillary lymph node metastasis status before NCT,HR and Ki67 expression groups(P>0.05).Multivariate analysis showed that the incidence of CSM in T_(2) group before NCT was higher than that in T_(3) group(OR=10.542,P=0.002).The incidence of CSM was higher in the patient who treated with the NCT combined with trastuzumab group(OR=0.190,P=0.031).There was no significant difference in different HER-2 expression groups for tumor regression pattern(P>0.05).Conclusion:For patients with HER-2 positive IBC who want to have breast-conserving surgery after NCT,especially those with larger tumor,preoperative examination should be strengthened to assess the scope of residual tumors and choose the treatment combine trastuzumab targeted therapy to reduce the risk of local recurrence.

关 键 词：浸润性乳腺癌 新辅助化疗 人表皮生长因子受体2 肿瘤退缩模式 向心性退缩 曲妥珠单抗 

分 类 号：R737.9[医药卫生—肿瘤]