乳腺癌新辅助治疗病理完全缓解影响因素及预后分析

Analysis of the predicted factors of pathological complete response(pCR) after neoadjuvant systemic therapy in primary breast cancer and the prognostic value of pCR

目的分析乳腺癌新辅助治疗病理完全缓解（pCR）的影响因素，并探讨pCR对预后的意义。方法回顾性分析2008年1月至2014年12月北京大学第一医院乳腺疾病中心接受新辅助治疗的324例女性乳腺癌病例资料，分析临床病理信息及预后随访数据，探讨pCR的预测因素及其对预后的意义。结果新辅助治疗pCR率为21．9％；不同分子分型pCR率差异具有统计学意义（P〈0．001），其中Luminal B[人类表皮生长因子受体（HER2）阳性]型、HER2过表达型、三阴型更易获得pCR，pCR率分别为30．6％、37．5％、32．4％；pCR对于不同分子分型预后的意义存在差异，HER2过表达型[无病存活率（DFS）：P=0．048；总存活率（OS）：P=0．050]及三阴型乳腺癌（DFS：P=0．040；OS：P=0．045）pCR预后优于非pCR。治疗前肿瘤孕激素受体（OR=O．297，95％CI=O．167-0．530，P〈0．001）、HER2（OR=2．351，95％CI=1．340-4．125，P=0．003）、Ki67表达（OR=6．870，95％CI=0．885-53．303，P=0．065）是pCR的独立影响因素。结论治疗前肿瘤孕激素受体和HER2表达状态、Ki67表达水平是pCR的独立影响因素；pCR可作为HER2过表达型和三阴型乳腺癌远期预后的预测指标之一。

Objective To explore the predicted factors and the prognostic value of pathological complete response （pCR）. Methods The clinical data of patients with primary breast cancer received neoadjuvant systemic therapy （NST）, subsequent surgery between January 2008 and December 2014 in Breast Disease Center, Peking University First Hospital were analyzed retrospectively. Data of the pathological characteristics and events in follow-up were analyzed to explore the predicted factors and the prognostic value of pCR. Results The pCR rate was 21.9%, and the patients achieved a pCR had better survival than the patients who didn＇ t （DFS： P=0.003; OS： P=0.009）. Different subtypes differed in pCR rate （P〈 0.001）, Luminal B-like（HER2 negative）, HER2 positive （non-luminal） and triple-negative breast cancer （TNBC） were easier to achieve a pCR （30.6%, 37.5% and 32.4% respectively）. The predicted factors of pCR in the multivariate model are the PR status before NST（OR=0.297,95%CI = 0.167-0.530, P〈 0.001）, the HER2 status before NST（OR=2.351,95% CI=1.340-4.125, P=0.003）, the Ki67 status before NST （OR=6.870, 95% CI= 0.885-53.303, P=0.065）. Conclusion The predicted factors of pCR are the PR, HER2 and Ki67 expression before NST. PCR could be a predictor of DFS and OS, but its values differ in subtypes, and the correlationships have statistical significance in HER2 positive （non-luminal） and TNBC.