乳腺癌分子分型与新辅助化疗疗效关系的研究

Research on relationship between the molecular subtypes and neoadjuvant chemotherapy curative effect

目的探讨乳腺癌分子分型与环磷酰胺联合表柔比星及多西他赛方案(TEC方案)新辅助化疗(NCT)疗效的关系。方法选择2011年6月～2012年7月接受过4周期TEC方案NCT治疗的乳腺癌患者66例进行回顾性分析,根据免疫组化检测的雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(HER2)表达水平,将这些患者分为4种亚型,分别为:Luminal A、Luminal B、HER2+和Basal-like型。分析不同亚型乳腺癌患者的病理完全缓解率(pCR率)及临床病理的关系。结果在66例患者中,3例(4.5%)为Luminal A亚型,43例(65.3%)为Luminal B亚型,19例(28.8%)为HER2+亚型,1例(1.5%)为Basal-like型;HER2+亚型的pCR率(66.7%)明显高于Luminal A亚型(11.1%)、LuminalB亚型(22.2%)及Basal-like型(0),差异有统计学意义(P=0.026)。结论HER2+亚型相对Luminal A型,Luminal B和Basal-like型亚型对NCT治疗更敏感,pCR率更高。治疗时需根据患者不同的分子亚型来选用特定的治疗方案、增加化疗周期数或是更换其他新的治疗方案。

Objective To investigate research on relationship between the molecular subtypes and neoadjuvant chemotherapy with TEF （docetaxel, epirubicin, and fluorouracil）. Methods 66 patients with breast cancer who received 4 cycles of TEF - based neoadjuvant chemotherapy from June 2011 to July 2012 were comprised. The patients were classified into 4 subtypes： luminal A, luminal B, HER2~ and Basal-likes subtype according to the detection of ER, PR and HER by immunohistochemistry. The relationship between pathological complete response （pCR） rate and treatment outcome according to these subtypes were analyzed. Results Of a total of 66 patients, 3 cases （4.5%） of luminal A were found; 43 cases （65.3%） of Luminal B were found, 19 cases （28.8%） of HER2 were found, 1 （1.5%） case of Basal-like was found; the pCR rate of luminal A （11.1%） were better than those in luminal B （22.2%）, HER2＋ （66.7%） and Basal-like （0）, the differences were statistically significant （P = 0.026）, which showed that the rate of neoadjuvant chemotherapy in patients with HER2~ subtype were significantly higher than that of patients with Luminal A ,Luminal B and Basal-like subtype. Conclusion HER2~ subtypes are more sensitive to neoadjuvant chemotherapy compared with Luminal A, Luminal B and Basal-like subtype. It is right to select and use specific treatment plan to increase the cycles of chemotherapy or choose other new treatments.