非特殊型浸润性乳腺癌新辅助化疗后RCB分级与MP分级在预后分析中的比较研究  

Comparison of RCB grading and MP grading for prognosis of non-specific breast invasive cancer after neoadjuvant chemotherapy

作　　者：葛志文 连渊娥[1] 郑巧灵[1] 杨映红[1] GE Zhiwen;LIAN Yuan’e;ZHENG Qiaoling;YAN Yinghong(Department of Pathology,Affiliated Union Hospital of Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院病理科,福州350001

出　　处：《临床与实验病理学杂志》2024年第9期947-954,共8页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的 分析新辅助化疗后非特殊型浸润性乳腺癌患者的临床病理学相关因素对残余肿瘤负荷(residual cancer burden, RCB)分级系统和Miller-Payne(MP)分级系统的影响,并探讨两种分级系统对患者生存的预测价值。方法 收集术前穿刺确诊为非特殊型浸润性乳腺癌,并施行新辅助化疗的177例患者临床资料进行回顾性分析。分别研究RCB分级系统及MP分级系统与无病生存期(disease-free survival, DFS)和总生存期(overall survival, OS)的关系,分析比较两者对预后判断的价值。结果 RCB分级与月经状态、治疗前组织学分级、治疗后淋巴结转移情况相关,而MP分级与治疗前组织学分级、治疗后淋巴结转移情况、治疗前分子分型相关。通过观察复发与生存的ROC曲线图,比较曲线下面积(AUC),可以得出RCB分级系统对于复发和生存的预测优于MP分级系统。单因素及多因素生存分析显示治疗前临床分期、治疗后淋巴结转移情况及RCB分级为DFS的独立影响因素,治疗前临床分期、治疗前分子分型、RCB分级为OS的独立影响因素,而MP分级不是DFS及OS的独立影响因素。结论 RCB分级系统较MP分级系统对患者生存的预测价值更高,推荐将RCB分级评估系统作为非特殊型浸润性乳腺癌新辅助化疗后的首选评估体系。Purpose To analyze the impact of clinicopathological factors on residual tumor burden(RCB)grading system and Miller-Payne(MP)grading system in non-specific invasive breast cancer patients after neoadjuvant chemotherapy,and to explore the predictive value of the two grading systems for patient survival.Methods The clinical data of 177 patients with non-specific invasive breast cancer diagnosed by preoperative puncture and treated with neoadjuvant chemotherapy were retrospectively analyzed.The relationship of RCB grading system or MP grading system with disease free survival(DFS)and overall survival(OS)was studied,and the value of the two systems in predicting prognosis was analyzed and compared.Results RCB grading was related to menstrual status,histological grading before treatment,and lymph node metastasis after treatment;MP grading was related to pre-treatment histological grading,post-treatment lymph node metastasis,and pre-treatment molecular typing.By evaluating the ROC curve of recurrence and survival and comparing the area under curve(AUC),it was shown that RCB grading system was superior to MP grading system in predicting recurrence and evaluating survival.Univariate and multivariate survival analysis showed that pre-treatment clinical staging,post-treatment lymph node metastasis,and RCB grading were independent factors for DFS.Pre-treatment clinical staging,pre-treatment molecular typing,and RCB grading were independent factors for OS,while MP grading was not an independent factor for DFS and OS.Conclusion RCB grading system has a higher predictive value for patient survival than MP grading system.RCB grading evaluation system is recommended as evaluation system for non-specific invasive breast cancer after neoadjuvant chemotherapy.

关 键 词：乳腺肿瘤 新辅助化疗 MP分级 RCB分级 

分 类 号：R730.21[医药卫生—肿瘤]