白蛋白结合型紫杉醇治疗不同分子亚型乳腺浸润性小叶癌效果及预后差异分析

Differences in therapeutic effect and prognosis of different molecular subtypes of invasive lobular carcinoma of the breast treated with nab-paclitaxel

目的探讨不同分子亚型乳腺浸润性小叶癌白蛋白结合型紫杉醇治疗效果及预后差异,为乳腺癌临床用药的选择提供依据。方法回顾性分析2017年1月至2020年1月在邯郸市中心医院、河北医科大学第四医院就诊的180例晚期乳腺浸润性小叶癌患者资料,包括34例Luminal A型、92例Luminal B型、21例人表皮生长因子受体2(HER2)过表达型、33例三阴性型。患者采用白蛋白结合型紫杉醇进行治疗,治疗1年后参照实体瘤疗效评价标准1.1版评估临床疗效,计算客观缓解率(ORR)(以完全缓解+部分缓解计算)和临床获益率(CBR)(以完全缓解+部分缓解+疾病稳定计算);记录患者治疗过程中不良反应发生情况。采用Kaplan-Meier法绘制各亚型患者无进展生存(PFS)和总生存(OS)曲线,用log-rank法进行检验。结果Luminal A、Luminal B、HER2过表达、三阴性4个亚型患者间ORR及CBR差异均有统计学意义(均P<0.001),其中三阴性型ORR及CBR最低[21.2%(7/33)、63.6%(21/33)],Luminal A型ORR及CBR最高[70.6%(24/34)、100.0%(34/34)],Luminal B型ORR和CBR分别为45.7%(42/92)、90.2%(83/92),HER2过表达型分别为38.1%(8/21)、90.5%(19/21)。4个亚型患者间骨髓抑制、四肢麻木、关节肌肉疼痛发生率差异均有统计学意义(均P<0.05),其中三阴性型上述不良反应发生率均最高。三阴性型PFS和OS较Luminal A、Luminal B、HER2过表达型均差,差异均有统计学意义(均P<0.05)。结论不同分子亚型浸润性小叶癌患者采用白蛋白结合型紫杉醇干预后的临床反应及预后存在明显不同,其中三阴性型患者最差,临床中可依照病理检测结果针对性指导用药。

Objective To explore the differences in therapeutic effect and prognosis of different molecular subtypes of breast invasive lobular carcinoma treated with nab-paclitaxel,so as to provide a basis for the selection of clinical drugs for breast cancer.Methods The data of 180 patients with advanced invasive lobular carcinoma of the breast who were treated in Handan Central Hospital and the Fourth Hospital of Hebei Medical University from January 2017 to January 2020 were retrospectively analyzed,including 34 cases of Luminal A type,92 cases of Luminal B type,21 cases of human epidermal growth factor receptor 2(HER2)overexpression type,and 33 cases of triple-negative type.The patients were treated with nab-paclitaxel,and the clinical curative effect was evaluated according to the solid tumor response evaluation criteria version 1.1 after 1 year of treatment,and the objective response rate(ORR)(calculated as complete remission+partial remission)and clinical benefit rate(CBR)(calculated as complete remission+partial remission+stable disease)were calculated;the occurrence of adverse reactions during the treatment was recorded.The Kaplan-Meier method was used to draw the progression-free survival(PFS)and overall survival(OS)curves for each subtype of patients,and the log-rank method was used to test them.Results The differences in ORR and CBR among patients with the four subtypes of Luminal A,Luminal B,HER2 overexpression,and triple-negative were statistically significant(all P<0.001),with the triple-negative type having the lowest ORR and CBR[21.2%(7/33)and 63.6%(21/33)]and the Luminal A type having the highest ORR and CBR[70.6%(24/34)and 100.0%(34/34)].The ORR and CBR of Luminal B type were 45.7%(42/92)and 90.2%(83/92),and the HER2 overexpression type was 38.1%(8/21)and 90.5%(19/21).The differences in the incidence of myelosuppression,numbness of limbs,joint and muscle pain among the four subtypes were statistically significant(all P<0.05),with the triple-negative type having the highest incidence of all of the above adverse reactions.The PFS and OS of triple-negative subtype were worse than those of Luminal A,Luminal B and HER2 overexpression subtypes,and the differences were statistically significant(all P<0.05).Conclusions The clinical response and prognosis of patients with different molecular subtypes of invasive lobular carcinoma is significantly different after nab-paclitaxel intervention,among which the prognosis of patients with triple-negative type is the worst,and the clinical medication can be guided according to the pathological test results.