T_1期HER-2阳性乳腺癌靶向治疗预后分析

Prognostic analysis of targeted therapy on patients with T_1 stage HER-2 positive breast cancer

目的随着人们健康意识的增强和诊断技术的提高,越来越多的小肿块乳腺癌被确诊和治疗。本研究初步探讨T_1期HER-2阳性乳腺癌患者的临床病理学特征及抗HER-2靶向治疗对预后的影响。方法收集新疆医科大学第三附属肿瘤医院2009-06-01-2014-12-31,218例T_1期HER-2阳性乳腺癌患者的临床病理学、治疗及预后信息并进行回顾性分析。结果在218例T_1期HER-2阳性乳腺癌患者中,T_1a期15例(6.9%),T_1b期43例(19.7%),T_1c期160例(73.4%)。肿瘤直径越大,肿瘤的组织学分级越高、Ki-67表达越活跃,更易发生脉管浸润和腋窝淋巴结转移,P<0.05。中位随访42(4~75)个月。16例(7.3%)患者发生复发转移,3年无病生存(disease-free survival,DFS)率和总生存(overall survival,OS)率分别为90.4%和99.5%。Kaplan-meier法生存曲线显示,T_1期HER-2阳性乳腺癌3年DFS与脉管浸润(P=0.020)、腋窝淋巴结转移(P=0.011)和抗HER-2靶向治疗(P=0.048)有关。Cox多因素比例风险模型分析显示,发生腋窝淋巴结转移将T_1期乳腺癌的复发转移风险提高了3.433(95%CI=1.247~9.454,P=0.017)倍,腋窝淋巴结转移是T_1期HER-2阳性乳腺癌患者的独立风险因素。47例(21.6%)患者完成了了标准1年抗HER-2靶向治疗。在激素受体(hormone receptor,HR)阴性、发生脉管浸润或伴有腋窝淋巴结转移患者中抗HER-2靶向治疗可以有效提高患者预后,3年DFS分别提高15.9%、26.2%和25.6%。结论腋窝淋巴结转移是影响T_1期HER-2阳性乳腺癌患者预后的独立风险因素,抗HER-2靶向治疗可显著改善伴有HR阴性、脉管浸润或腋窝淋巴结转移患者的预后。

OBJECTIVE Along with the enhancement of people＇s health awareness and improvement of diagnostic techniques, more and more small lump breast cancer has been diagnosed and treated. This article attempted to study the relationship between clinicopathological features of T1 HER-2 positive breast cancer patients and the effect of anti HER-2 targeted therapy on prognosis. METHODS From 1st June 2009 to 31st December 2014,date of clinicopathological,treat- ment and prognosis of T1 HER2 positive breast carcinoma were collected and retrospectively analyzed. RESULTS In 218 T1 HER-2 positive breast cancer patients, 15 cases （6.9%） were T1a, 43 cases （19.7%） were T1b, 160 cases （73.4%） were T1c. With the increasing of tumor size, the histological grade was higher, the Ki 67 expression was more active, vas cular invasion and axillary lymph node metastasis were more likely to occur（P〈0.05）. After a 42 months（4--75 months） median follow-up, 16 （7. 3%） patients suffered from recurrence and metastasis. 3-year disease free survival （DFS）was 90.4% ,3-year overall survival （OS） was 99. 5%. Kaplan-meier survival curves indicated that vascular invasion （P= 0. 020）, axillary lymph node metastasis （P=0. 011） and anti HER-2 targeted therapy were significantly associated with 3 year survival rate. Multivariate analysis showed that the risk of recurrence and metastasis was increased 3. 433 （95%CI=1. 247 -9. 454,P =0. 017）times in patients with axillary lymph node metastasis. Axillary lymph node metasta sis was an independent risk factor of T1 HER 2 positive breast cancer patients. A total of 47 patients （21.6 %） completed the standard 1 year anti HER 2 targeted therapy. Those patients with hormone receptor （receptor HR, hormone）-nega tive, vascular invasion and axillary lymph node metastasis would benefit more from anti HER-2 targeted therapy, with 3 year of DFS rate increased hy 15.9 %, 26.2 % and 25.6 %, respectively. CONCLUSIONS Axillary lymph node metastasis is an independent risk factor for T1 stage HER-2 positive breast cancer. Anti HER-2 targeted therapy can significantlyimprove 3 year DFS rate and clinical outcomes of those patients with HR negative, vascular invasion or axillary lymph node metastasis.