残余肿瘤负荷评估乳腺癌新辅助治疗疗效的影响因素及其预后价值  

Factors influencing the efficacy of neoadjuvant therapy in breast cancer assessed by RCB as well as the prognostic value of RCB in neoadjuvant therapy

作　　者：鞠仙莉 阎红琳 柯晓康 管枫 黄奥玲 袁静萍[1] Ju Xianli;Yan Honglin;Ke Xiaokang;Guan Feng;Huang Aoling;Yuan Jingping(Department of Pathology,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院病理科,武汉430060

出　　处：《中华内分泌外科杂志》2023年第5期518-523,共6页Chinese Journal of Endocrine Surgery

基　　金：湖北省卫生健康科研基金资助(WJ2021M151)。

摘　　要：目的采用残余肿瘤负荷(residual cancer burden,RCB)评估系统分析乳腺癌新辅助治疗疗效的影响因素,并探讨RCB评估在新辅助治疗中的预后价值。方法收集武汉大学人民医院2019年11月至2022年11月364例行新辅助治疗的乳腺癌患者的临床病理资料及术后RCB分级,采用χ^(2)检验分析RCB分级与临床病理参数的关系,Spearman相关性分析法分析RCB分级与临床病理特征的相关性,Logistic回归分析病理完全缓解(pathologic complete response,pCR)的影响因素,Kaplan-Meier生存分析和log-rank检验方法评估累积生存期。结果364例经新辅助治疗患者中,术后获得RCB 0级者129例、RCBⅠ级46例、RCBⅡ级109例、RCBⅢ级80例。新辅助治疗前患者的组织学分级(χ^(2)=21.757,P=0.000)、雌激素受体(estrogen receptor,ER)(χ^(2)=52.837,P=0.000)、孕激素受体(progesterone receptor,PR)(χ^(2)=55.658,P=0.000)、人类表皮生长因子受体2(human epidermal growth factor receptor-2,HER2)(χ^(2)=89.040,P=0.000)的表达情况,Ki67表达(χ^(2)=12.927,P=0.005),分子分型(χ^(2)=80.793,P=0.000)及术前淋巴结状态(χ^(2)=25.764,P=0.000)均显示与患者术后的RCB分级相关;进一步相关性分析显示组织学分级(r=-0.229,P=0.000)、HER2表达情况(r=-0.465,P=0.000)及Ki67表达量(r=-0.179,P=0.000)与RCB分级呈负相关,而ER(r=0.352,P=0.000)、PR(r=0.379,P=0.000)及淋巴结转移情况(r=0.214,P=0.000)与RCB分级呈正相关。Logistic回归分析显示患者术前高组织学分级,ER、PR、AR阴性表达,HER2阳性表达,Ki67高增殖指数,淋巴结未发生转移是术后获得pCR的有利因素,且PR、AR、HER2是术后获得pCR的独立预测因素。Kaplan-Meier生存分析显示不同RCB分级患者术后的累积生存期差异有统计学意义(P=0.004)。结论乳腺癌的术后RCB分级与其新辅助治疗前诸多临床病理特征及生存预后密切相关,与RCB分级密切相关的临床病理因素同时也是影响新辅助治疗pCR的重要影响因�Objective The residual cancer burden(RCB)evaluation system was used to analyze the influencing factors of the efficacy of neoadjuvant therapy in breast cancer,and to explore the prognostic value of RCB evaluation in neoadjuvant therapy.Methods Clinicopathologic data and postoperative RCB grading of 364 breast cancer patients who underwent neoadjuvant therapy in Renmin Hospital of Wuhan University from Nov.2019 to Nov.2022 were collected.Chi-square test was used to analyze the relationship between RCB grading and clinicopathological parameters,and Spearman’s rank correlation analysis was performed to evaluate the correlation between RCB grading and clinicopathological characteristics.Factors influencing pathologic complete response(pCR)were analyzed by Logistic regression.Kaplan-Meier survival analysis and log-rank test were used to evaluate cumulative survival.Results Among the 364 patients who underwent neoadjuvant therapy,129 cases of RCB grade 0 and 235 cases of RCB gradeⅠ-Ⅲ(including 46 cases of RCB gradeⅠ,109 cases of RCB gradeⅡand 80 cases of RCB gradeⅢ)were obtained after surgery.Histological classification(χ^(2)=21.757,P=0.000),estrogen receptor(ER)(χ^(2)=52.837,P=0.000),progesterone receptor(PR)(χ^(2)=55.658,P=0.000),human epidermal growth factor receptor-2(HER2)(χ^(2)=89.040,P=0.000),Ki67 expression(χ^(2)=12.927,P=0.005),molecular typing(χ^(2)=80.793,P=0.000)and preoperative lymph node status(χ^(2)=25.764,P=0.000)were all associated with postoperative RCB grading.Further correlation analysis showed that histological grade(r=-0.229,P=0.000),HER2 expression(r=-0.465,P=0.000)and Ki67 expression(r=-0.179,P=0.000)were negatively correlated with RCB grading,while ER(r=0.352,P=0.000),PR(r=0.379,P=0.000)and lymph node metastasis(r=0.214,P=0.000)were positively correlated with RCB grading.Logistic regression analysis showed that high histological grade,negative expression of ER,PR and AR,positive expression of HER2,high proliferation index of Ki67 and no lymph node metastasis were favorable fa

关 键 词：乳腺癌 新辅助治疗 残余肿瘤负荷 病理完全缓解 

分 类 号：R737.9[医药卫生—肿瘤]