不同新辅助化疗方案对人表皮生长因子受体2阳性乳腺癌患者免疫指标和肿瘤微环境的影响研究  

Effects of Different Neoadjuvant Chemotherapy Regimens on Immune Indicators and Tumor Microenvironment in HER-2-positive Breast Cancer Patients

作　　者：裴蓓 成琳 许凌云 PEI Bei;CHENG Lin;XU Lingyun(Breast Surgery,Changzhou No.2 People's Hospital Affiliated to Nanjing Medical University,Changzhou 213003,China)

机构地区：[1]南京医科大学附属常州第二人民医院乳腺外科,江苏省常州市213003

出　　处：《中国全科医学》2023年第27期3435-3440,共6页Chinese General Practice

基　　金：国家自然科学基金资助项目(81502294);常州市科技计划项目(CJ20160035);常州市卫生健康委员会重大科技项目(ZD202016)。

摘　　要：背景乳腺癌是临床常见的恶性肿瘤,严重影响女性群体的健康。尽管目前针对乳腺癌的靶向治疗体系较完善,但双靶治疗与单靶治疗的临床疗效差异尚不明确。目的探究不同新辅助化疗方案对人表皮生长因子受体2(HER-2)阳性乳腺癌患者免疫指标和肿瘤微环境的影响。方法收集2017年9月—2021年9月南京医科大学附属常州第二人民医院收治的HER-2阳性乳腺癌患者92例,随机分为研究组(曲妥珠单抗+帕妥珠单抗+多西紫杉醇治疗,n=46)和对照组(曲妥珠单抗+多西紫杉醇治疗,n=46),比较两组患者临床治疗有效率及有效控制率、炎症因子水平、免疫学指标改变情况等。结果治疗后研究组患者的临床有效率、有效控制率均高于对照组(P<0.05)。研究组患者治疗后外周血CD_(3)^(+)、CD_(4)^(+)及CD_(4)^(+)/CD_(8)^(+)水平均高于对照组,CD_(8)^(+)水平低于对照组(P<0.05);研究组患者治疗后肿瘤坏死因子α、干扰素γ、白介素6、白介素8水平均低于对照组(P<0.05)。研究组患者治疗后程序性死亡配体1(PD-L1)的阳性细胞百分比≥25%、程序性死亡受体1(PD-1)的阳性细胞百分比≥65%均高于对照组(P<0.05),叉头框蛋白P3(FoxP3)阳性细胞百分比≥0.45%低于对照组(P<0.05)。结论曲妥珠单抗+帕妥珠单抗+多西紫杉醇的新辅助化疗可有效改善HER-2阳性乳腺癌患者免疫指标和肿瘤微环境。Background Breast cancer is a common clinical malignant tumor,which seriously affects the health of women.Although the current targeted therapy system for breast cancer is well established,the difference in clinical efficacy between double-target therapy and single-target therapy remains unclear.Objective To explore the effects of different neoadjuvant chemotherapy regimens on the immune indicators and tumor microenvironment in HER2-positive breast cancer patients.Methods A total of 92 patients with HER-2-positive breast cancer admitted to Changzhou No.2 People's Hospital Affiliated to Nanjing Medical University from September 2017 to September 2021 were collected and randomly divided into the study group(trastuzumab+patuzumab+docetaxel therapy,n=46)and the control group(trastuzumab+docetaxel therapy,n=46).The clinical efficiency rate and control rate,the changes of inflammatory factors levels and immunological indicators were compared between the two groups.Results The clinical efficiency rate and control rate after treatment of the study group were higher than those of the control group(P<0.05).The peripheral blood CD_(3)^(+),CD_(4)^(+)and CD_(4)^(+)/CD_(8)^(+)levels were higher and CD_(8)^(+)levels was lower in the study group than those in the control group after treatment(P<0.05),the levels of TNF-α,IFN-γ,IL-6 and IL-8 in the study group were lower than those in the control group(P<0.05).The percentages of PDL1-positive cells≥25%and PD-1-positive cells≥65%in the study group were higher than those in the control group,while the percentage of FoxP3-positive cells≥0.45%in the study group was lower than that in the control group.Conclusion Neoadjuvant chemotherapy of trastuzumab+patuzumab+docetaxel can effectively improve the immune indicators and tumor microenvironment of HER-2 positive breast cancer patients.

关 键 词：乳腺肿瘤 HER-2阳性 抗肿瘤联合化疗方案 分子靶向治疗 双靶治疗 肿瘤微环境 免疫指标 

分 类 号：R737.9[医药卫生—肿瘤]