乳腺癌新辅助化疗组织学疗效评价研究

Morphologic assessment of response to neoadjuvant chemotherapy in breast cancer

目的探讨乳腺癌新辅助化疗后根治标本的组织学疗效评价标准。方法收集2005年6月至2007年6月乳腺癌新辅助化疗154例档案，其中改良根治术139例，保乳手术15例。化疗结束后4周内实施乳腺根治术。按照Miller and Payne（MP）分级系统的标准规范进行取材、制片和按该系统组织学疗效评价标准进行分级评价，同时与既往应用的肿瘤治疗反应评价系统（既往评价系统）进行比较。对所有病例进行常规随访。应用SPSS 13．0软件进行统计学处理。结果（1）154例手术标本所获得的组织学疗效评价信息：MP分级系统1级12例（7．8％）、2级33例（21．4％）、3级64例（41．6％）、4级31例（20．1％）、5级14例（9．1％）；既往评价系统分别为轻度治疗反应51例（33．1％）、中度治疗反应71例（46．1％）、重度治疗反应32例（20．8％）。MP分级系统与既往评价系统各组病例比例之间存在统计学相关（X^2=186．660，P〈0．01）。（2）154例患者中147例获得随访信息（95．5％），随访时间16～38个月；其中14例出现术后复发、远处转移或死亡。MP分级系统5个级别组与患者生存状态均相关（X^2=11．612，P=0．020），既往评价系统3个级别组与患者生存状态均无关（X^2=0．881，P=0．644）。结论MP分级系统可以用于肿瘤化疗后的组织学疗效评价，与预后相关。

Objective To investigate the histological criteria of breast cancer response to neoadjuvant therapy. Methods One hundred and fifty-four cases of breast cancer receiving neoadjuvant therapy were collected from June, 2005 to June, 2007 and the clinical data were analysed. All patients were operated on within 4 weeks after neoadjuvant therapy. All specimens were assessed by the standard method of Miller and Payne （MP） grading system. The response to neoadjuvant therapy were assessed by two pathologists independently, using MP grading system and common grading system separately. Results The response rate using the MP grading system were grade 1 in 12 cases （7.8%）, grade 2 in 33 cases （21.4%）, grade 3 in 64 cases （41.6%）, grade 4 in 31 cases （20.1%） and grade 5 in 14 cases （9. 1% ）. Using the common grading system, the response were mild in 51 cases （33.1%）, moderate in 71 cases （46. 1% ） and severe in 32 cases （20. 8% ）. MP grading system may be related to common grading system （X^2= 186. 660, P 〈 0.01 ）. Follow up information were available in 147 cases, with 14 cases showing recurrence, metastasis or death from the disease. The MP grading system may be related to the outcome （X^2=11.612, P=0.020）, but not the common grading system （ X^2=0.881, P=0.644）. Conclusion MP grading system may be one of the prognostic factors in the neoadjuvant therapy of breast cancer.