乳腺癌新辅助化疗疗效影响因素研究及预测模型构建  

Influencing Factors and Prediction Model of Neoadjuvant Chemotherapy for Breast Cancer

作　　者：钱贝 辛玥 史薇 朱俊玲 郭爽 屈新才[1] 刘春萍[1] 张守鹏[1] Qian Bei;Xin Yue;Shi Wei(Department of Breast and Thyroid Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院乳腺甲状腺外科,武汉430022 [2]华中科技大学同济医学院附属协和医院病理科,武汉430022

出　　处：《华中科技大学学报（医学版）》2022年第1期72-77,共6页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

摘　　要：目的探究乳腺癌患者病理、临床资料中与新辅助化疗效果相关的影响因素,并构建乳腺癌新辅助化疗病理完全缓解的预测模型。方法回顾性分析华中科技大学同济医学院附属协和医院2018年1月到2020年6月期间收治的215例行新辅助化疗的女性乳腺癌患者临床资料。根据术后病理Miller-Payne(MP)分级评分进行分组(G1~G5),分析各组新辅助化疗前的临床资料及术前空芯针穿刺标本的病理信息,探究乳腺癌新辅助化疗疗效的影响因素;根据是否达到病理完全缓解进行分组,Logistic回归分析重要影响因素并利用R语言制作列线图预测模型。结果在215例纳入的病例中,77例获得病理完全缓解(pathologic complete response, pCR),完全缓解率为35.8%。HER2过表达型患者pCR率高于三阴性亚型和Luminal亚型,其中Luminal A亚型pCR率最低;多因素Logistic分析显示,T分期(P=0.001)、ER/PR状态(P<0.001)、HER2(P=0.003)状态和治疗前Ki-67指数(P=0.017)是乳腺癌新辅助化疗疗效的影响因素;本研究构建的列线图预测模型C指数为0.75。结论 T分期、ER/PR状态、HER2状态以及Ki-67指数是乳腺癌新辅助化疗疗效的影响因素;本研究构建的预测模型具备良好的预测乳腺癌新辅助化疗患者获得pCR概率的能力。Objective To explore factors affecting therapeutic efficacy of neoadjuvant chemotherapy(NAC)for breast cancer and establish a prediction model of pathologic complete response(pCR).Methods The clinical data of 215 female breast cancer patients who received NAC in Wuhan Union Hospital from January 2018 to June 2020 were retrospectively analyzed.Study sujects were scored and grouped according to Miller-Payne postoperative pathology grading(G1-G5).Clinical data before NAC and preoperative pathological information from anterior hollow needle puncture specimen were analyzed to determine the factors affecting the efficacy of NAC for breast cancer.Logistic regression was used to analyze the influencing factors, and R Studio software was applied to draw a nomogram prediction model for pCR.Results Seventy-seven out of the 215 enrolled cases achieved pCR,the pCR rate was 35.8%.The pCR rate of HER2 overexpression patients was higher than that of triple negative and Luminal subtype.Among all subtypes, Luminal A subtype had the lowest pCR rate(P<0.05).Multivariate Logistic analysis showed that T stage(P=0.001),ER/PR expression level(P<0.001),HER2 status(P=0.003),and Ki-67 index before NAC(P=0.017)were the influencing factors of the efficacy of NAC for breast cancer(P<0.05).The C index of the nomogram prediction model constructed in this study was 0.75.Conclusion T stage, ER/PR expression levels, HER2 status and Ki-67 index are the influencing factors of the efficacy of NAC for breast cancer.The predictive model established in this study has a satisfying ability to predict the pCR probability of breast cancer patients receiving NAC.

关 键 词：乳腺癌 新辅助化疗 疗效 影响因素 预测模型 

分 类 号：R737.9[医药卫生—肿瘤]