乳腺癌中医辨证分型联合分子分型预测新辅助化疗疗效的应用研究

Study on Application of New Adjuvant Chemotherapy Based on Combination of TCM and Western Medicine in Treatment of Breast Cancer

目的:为解决准确预测新辅助化疗疗效的问题,设计采用中医辨证分型联合西医分子分型的方法进行前瞻性病例研究,探讨联合分型与乳腺癌新辅助化疗疗效的相关性。方法:纳入2012年7月—2013年6月间收治符合入组标准进行新辅助化疗的女性乳腺癌病例。化疗前行空芯针穿刺检查明确西医分子分型(4型:管腔A型、管腔B型、HER2过表达型和三阴性),同时由有丰富经验的资深中医师进行中医辨证分型(3型:肝郁痰凝型、冲任失调型和正虚毒炽型),每个病例同时具有一个西医分子分型和中医辨证分型(联合分型)。通过规范统一的4周期蒽环类联合紫衫类(ET)方案新辅助化疗得到化疗疗效的临床评价和病理评价。将联合分型与化疗疗效评价结果进行相关性分析。结果:共有128例女性乳腺癌符合入组要求纳入研究分析。管腔A型合并肝郁痰凝型占全体病例数比例最高(24.22%),管腔B型合并正虚毒炽型比例最低(0.78%)。管腔型(包括A和B)更倾向于中医辨证为肝郁痰凝和冲任失调型,三阴性更倾向于中医辨证为正虚毒炽型,而HER2过表达型则在三种中医辨证类型中分布较为均衡(χ~2=38.35,P=0.00)。通过联合分型与化疗疗效相关性分析比较发现,管腔A型中正虚毒炽分型较其他辨证分型有更高的完全缓解率(χ~2=16.54,P=0.002),而HER2过表达型中肝郁痰凝分型较其他辨证分型有更高的病理和完全缓解率(χ~2=10.25,P=0.036)。结论:西医分子分型联合中医辨证分型可能更加精确地预测治疗疗效,可为乳腺癌术前治疗提供更为准确的指导。

Objective：To resolve the problem of predicting the effect of neoadjuvant chemotherapy accurately, we adopted the traditional Chinese medicine syndrome differentiation and molecular subtype to have a prospective case study. Methods ：From July 2012 to June 2013, female breast cancer patients conformed to the enter criterion were brought into our study. Before neoadjuvant chemotherapy, we verified their molecular subtypes （Luminal A, Luminal B, HER2 overexpression, triple negative type） through tubular needle puncture. Simultaneously, rich experienced traditional Chinese physicians identified their traditional Chinese medicine syndromes （ stagnation of liver - qi and phlegm, deficiencies of healthy qi and exuberance of toxin, incoordination between Chong and Ren Meridians）. Every patients would have both TCM syndrome type and the united subtype. Through standard 4 - cycle neoadjuvant chemotherapy regimens and anthracycline combined with taxanes （ET）, we got the clinical and pathological evaluation. Finally, we analyzed the relationship between the evaluation and the united subtypes. Results：There were 128 cases in the study. The number of Luminal A/stagnation of liver - qi and phlegm patients was the most, accounted for 24.22%. The number of Luminal B/deficiencies of healthy qi and exuberance of toxin was the least, accounted for 0.78%. Luminal A and Luminal B patients tended to be the type of incoordination between Chong and Ren Meridians. Triple negative type patients were likely to be deficiencies of healthy qi and exuberance of toxin. Patients who were type of HER2 overexpression distributed more balanced in three types of traditional Chinese medicine syndromes（ X2 = 38.35, P = 0.00）. Through analyzing the relationship between the united subtypes and the effect of chemotherapy, we found that among type of Luminal A, compared with other traditional Chinese medicine syndromes, patients with deficiencies of healthy qi and exuberance of toxin had higher complete remission（ X2 = 16.54,P = 0. 002）. The same phenomenon also can be found in stagnation of liver - qi and phlegm patients among the HER2 overexpression type （X2 = 10.25 ,P = 0.036）. Conclusions：Traditional Chinese medicine syndromes combined with molecular subtypes can predict the effect of neoadjuvant chemotherapy accurately and can be considered as a precise guide of treatment before surgery in breast cancer.