人表皮生长因子受体2阳性乳腺癌患者新辅助治疗后病理学完全缓解的影响因素  

Influencing factors of pathologic complete response after neoadjuvant therapy in human epidermal growth factor receptor 2 positive breast cancer patients

作　　者：刘寿贵 蔡钦东 林舜国[1,2,3] LIU Shougui;CAI Qindong;LIN Shunguo(Department of Breast Surgery,Fujian Medical University Union Hospital,Fuzhou 350001,Fujian,China;Department of General Surgery,Fujian Medical University Union Hospital,Fuzhou 350001,Fujian,China;Breast Cancer Institute,Fujian Medical University,Fuzhou 350001,Fujian,China)

机构地区：[1]福建医科大学附属协和医院乳腺外科,福州350001 [2]福建医科大学附属协和医院普通外科,福州350001 [3]福建医科大学乳腺肿瘤研究所,福州350001

出　　处：《癌症进展》2024年第8期858-862,共5页Oncology Progress

摘　　要：目的探讨人表皮生长因子受体2(HER2)阳性乳腺癌新辅助治疗后病理学完全缓解(pCR)的影响因素,并建立列线图预测模型。方法将171例接受新辅助治疗的HER2阳性乳腺癌患者根据术后病理结果分为pCR组和非pCR组,并通过单因素和多因素Logistic回归分析获得pCR的影响因素,并构建列线图预测模型。利用受试者工作特征(ROC)曲线和Hosmer-Lemeshow检验对模型的预测能力进行评估和内部验证。结果171例HER2阳性乳腺癌患者中,110例患者达到pCR,pCR率为64.3%。pCR和非pCR HER2阳性乳腺癌患者激素受体(HR)状态、HER2状态比较,差异均有统计学意义(P﹤0.01)。多因素分析结果显示,HR状态、HER2状态、Ki-67均是新辅助治疗后pCR的影响因素(P﹤0.05)。将上述因素构建列线图预测模型,ROC曲线下面积为0.707(95%CI:0.629~0.784),表明该列线图预测模型有良好的区分度,Hosmer-Lemeshow检验结果χ^(2)=0.054,P=1,表明该列线图模型预测的pCR概率与实际发生概率的一致性良好,提示该列线图模型有良好的校准度。结论HR状态、HER2状态、Ki-67均是HER2阳性乳腺癌新辅助治疗后pCR的独立影响因素,以此构建的列线图预测模型效果良好,可作为预测HER2阳性乳腺癌新辅助治疗后pCR的工具,有助于指导临床个体化治疗策略。Objective To investigate the influencing factors of pathologic complete response(pCR)after neoadjuvant therapy in human epidermal growth factor receptor 2(HER2)positive breast cancer,and to establish nomogram prediction model.Method A total of 171 patients with HER2 positive breast cancer who received neoadjuvant therapy were divided into pCR group and non-pCR group according to postoperative pathological results,and the influencing factors of pCR were obtained by univariate and multivariate Logistic regression analysis,and the nomogram prediction model was constructed.The predictive ability of the model was evaluated and internally validated using receiver operating characteristic(ROC)curve and Hosmer-Lemeshow test.Result Among 171 patients with HER2 positive breast cancer,110 patients achieved pCR,the pCR rate was 64.3%.There were significant differences in hormone receptor(HR)status and HER2 status between pCR and non-PCR HER2 positive breast cancer patients(P<0.01).The univariate analysis showed that HR status,HER2 status and Ki-67 were influencing factors of pCR after neoadjuvant therapy(P<0.05).A nomogram prediction model was constructed based on the above factors,and the area under the curve was 0.707(95%CI:0.629-0.784),which showed that the nomogram prediction model had good differentiation.The results of the Hosmer-Lemeshow test was χ^(2)=0.054,P=1,which showed that the pCR predicted by the nomogram prediction model was in good agreement with the actual occurrence probability,indicating that the nomogram prediction model had good calibration degree.Conclusion HR status,HER2 status,Ki-67 are independent influencing factors of pCR after neoadjuvant therapy in HER2 positive breast cancer.The nomogram predictive model has good effect,and can be used as a tool to predict pCR after neoadjuvant therapy in HER2 positive breast cancer,which is helpful to guide clinical individualized treatment strategies.

关 键 词：人表皮生长因子受体2阳性 乳腺癌 新辅助治疗 靶向治疗 病理学完全缓解 列线图 

分 类 号：R737.9[医药卫生—肿瘤]