乳腺癌分子分型对多西他赛联合表阿霉素新辅助化疗疗效和预后的预测价值

Predictive value of molecular subtype in curative effect and prognosis of elderly breast cancer with docetaxel plus epirubicin neoadjuvant chemotherapy

目的探讨乳腺癌分子分型对多西他赛＋表阿霉素新辅助化疗的临床疗效及预后的预测价值。方法对126例行多西他赛＋表阿霉素新辅助化疗的老年乳腺癌患者的肿瘤组织行免疫组织化学检测,依据雌激素受体（ER）、孕激素受体（PR）、人类表皮生长因子受体2（HER2）表达情况及Ki67水平,将乳腺癌分三阴型、HER2过表达型、Luminal A型、Luminal B型,分析不同分子分型患者病理完全缓解率（p CR）的差异,比较不同分子分型患者术后无病生存时间（DFS）和总生存时间（OS）。结果乳腺癌分子分型各组p CR依次为三阴型（42.1%）、HER2过表达型（30.8%）、Luminal A型（13.2%）和Luminal B型（4.7%）,三阴型和HER2过表达型者的临床总有效率分别为94.7%和80.8%,高于Luminal A型的63.7%和Luminal B型的55.9%（P〈0.05）。Cox回归分析显示,分子亚型为影响乳腺癌临床疗效的独立因素,以三阴型为对照,Luminal A型、Luminal B型的OR值分别为1.885和2.317。Luminal A型患者的OS、DFS均高于三阴型（χ~2=3.176,P=0.032;χ~2=3.743,P=0.029）。结论以ER、PR、HER2、Ki67为依据的乳腺癌分子分型可能是老年乳腺癌多西他赛＋表阿霉素新辅助化疗后p CR、OS、DFS的预测指标。

Objective To investigate the predictive value of of molecular subtype in curative effect and prognosis of elderly breast cancer with docetaxel plus epirubicin neoadjuvant chemotherapy. Methods Totally 126 elderly patients with breast cancer treated with Docetaxel ＋ epirubicin neoadjuvant chemotherapy were enrolled in the study,the cancer tissue specimens were detected by immunohistochemistry,the molecular subtypes were constructed from estrogen receptor（ ER）,progesterone receptor（ PR）,human epidermal growth factor receptor 2（ HER2） and Ki67 expression,which were classified as the triple-negative subtype,HER2 ＋ subtype,Luminal A subtype and Luminal B subtype. The correlation of molecular subtype and pathologic complete response rate（ p CR） were analyzed,and the disease-free survival time（ DFS） and overall survival time（ OS） in different molecular subtype were compared. Results The p CR in different molecular subtype ranked as triple negative（ 42. 1%）,HER2 positive（ 30. 8%）,Luminal A type（ 13. 2%）and Luminal B type（ 4. 7%）,the total clinical effective rates in triple-negative subtype and HER2 positive subtype repectively were 94. 7%,80. 8%,which were higher than that in Luminal A subtype（ 63. 2%）and Luminal B subtype（ 55. 9%）（ P〈0. 05）. Cox regression analysis showed that molecular subtypes of breast cancer was an independent risk factor for clinical efficacy,with triple-negative subtype for control,OR of Luminal A subtype,Luminal B subtype were 1. 885,2. 317; Log-rank test showed the OS and DFS of Luminal A subtype were higher than those in the triple negative type（ χ~2= 3. 176,P = 0. 032; χ~2= 3. 743,P = 0. 029）. Conclusion The molecular subtype based on ER,PR,HER2,ki67 expression may be the predictors of p CR,OS,DFS after Docetaxel ＋ epirubicin neoadjuvant chemotherapy in elderly patients with breast cancer.