不同亚型乳腺癌患者新辅助化疗治疗及预后影响因素分析

The analysis of prognostic factors of neoadjuvant chemotherapy in different subtypes of breast cancer

目的探究新辅助化疗在治疗不同分子亚型乳腺癌患者的临床疗效及预后影响因素。方法对135例行TEC方案(多西紫杉醇+表阿霉素+环磷酰胺)方案进行新辅助化疗的乳腺癌患者进行免疫组织化学检测,根据其雌激素受体(ER)、孕激素受体(PR)以及人表皮生长因子受体-2(Her-2)表达的不同将其分为Luminal A型41例,Luminal B型47例,Her-2+型28例,三阴型19例。对比不同亚型患者的近期临床疗效、临床病理特征及预后情况,并就新辅助化疗后影响其预后的因素进行单因素分析。结果不同亚型乳腺癌患者在年龄、化疗周期、TNM分期、原发肿瘤直径、组织学分级以及淋巴结状态上比较差异无统计学意义(P>0.05),而不同亚型乳腺癌患者在近期临床疗效上差异有统计学意义(P<0.05)。Luminal A型、Luminal B型、HER-2+型以及三阴型乳腺癌患者的总有效率分别为63.4%、53.2%、82.1%、89.5%,其肿瘤控制率分别为78.0%、76.6%、96.4%和100.0%,四种亚型患者的3年无病生存率分别为85.4%、76.6%、57.1%、52.6%,其3年总生存率分别为90.2%、87.2%、67.9%、68.4%,组间比较差异有统计学意义(P<0.05)。不同年龄、TNM分期、组织学分级、淋巴结状态以及不同分子分型的乳腺癌患者,其3年无病生存率及总生存率比较差异有统计学意义(P<0.05);在化疗周期及原发肿瘤直径上则差异无统计学意义(P>0.05)。结论新辅助化疗在治疗不同亚型乳腺癌上效果良好,以ER、PR、Her-2为依据的乳腺癌分子分型是乳腺癌患者预后生存的预测指标。此外,年龄、TNM分期、组织学形态、淋巴结状态的不同也对乳腺癌患者新辅助化疗治疗效果及预后造成一定影响。

Objective To investigate the clinical efficacy and prognostic factors of neoadjuvant chemotherapy in patients with breast cancer with different molecular subtypes.Methods Immunohistochemical tests were performed on 135 patients with breast cancer who underwent neoadjuvant chemotherapy with TEC scheme.According to the different expressions of ER,PR and Her-2,they were divided into Luminal A(41 cases),luminal B(47 cases),Her-2+(28 cases),and triple negative(19 cases).The short-term clinical efficacy,clinicopathological features and prognosis of patients with different subtypes were compared,and the factors influencing prognosis after neoadjuvant chemotherapy by single factor were analyzed.Results There were no differences in age,chemotherapy cycle,TNM staging,diameter of primary tumor,histological grade,and lymph node status in patients with different subtypes of breast cancer(P>0.05).However,there was significant differences in patients with different subtypes of breast cancer(P<0.05).The total effective rates in the breast cancer patients of Luminal A,Luminal B,HER-2+and triple negative were 63.4%,53.2%,82.1% and 89.5% respectively.The tumor control rates were 78.0%,76.6%,96.4% and 100.0%,respectively.Four subtypes of patients with 3 year disease-free survival rates were 85.4%,76.6%,57.1%,52.6%,3 year overall survival rates were 90.2%,87.2%,67.9%,68.4%,the differences were statistically significant(P<0.05).The 3 year disease-free survival rate and overall survival rate in breast cancer patients with different age,TNM stage,histological grade,lymph node status and different molecular subtypes were statistically significant(P<0.05),and there were no significant differences between the duration of chemotherapy and the diameter of the primary tumor(P>0.05).ConclusionNeoadjuvant chemotherapy is effective in the treatment of different subtypes of breast cancer.The molecular classification of breast cancer based on ER,PR and Her-2 is a predictor of survival in patients of breast cancer.In addition,the differences in age,TNM stage,histological morphology,and lymph node status also have some effects on neoadjuvant chemotherapy and prognosis in patients with breast cancer.