血清VitD、FA水平与三阴乳腺癌患者新辅助化疗敏感性关系

Relationship between serum vitamin D,folic acid and the sensitivity of neoadjuvant chemotherapy in patients with triple-negative breast cancer

目的分析血清维生素D(VitD)、叶酸(FA)水平与三阴乳腺癌(TNBC)患者新辅助化疗敏感性的关系。方法以接受新辅助化疗后病理结果为残留癌(RD)的235例患者观察组,以接受新辅助化疗后达到病理完全缓解(p CR)的235例患者为对照组。回顾性收集患者一般特征、瘤体大小、TNM分期、淋巴结、组织Ki-67表达和基底标志情况等;采用酶联免疫吸附测定法(ELISA)检测血清VitD、FA水平;用logistic回归、受试者工作特征曲线(ROC)分析法等分析血清VitD、FA水平与三阴乳腺癌患者新辅助化疗敏感性的关系。结果单因素分析显示观察组VitD和FA水平低于对照组,差异有统计学意义(均P<0.05);观察组中瘤体为T3/4、Ki-67为低表达、基底标志标记为阳性、VitD和FA具有显著降低趋势的人数比率显著高于对照组,差异有统计学意义(均P<0.05);但两组年龄水平、TNM分期和淋巴结情况方面比较,差异无统计学意义(P>0.05);logisitic回归分析显示瘤体为T3/4(OR=4.122,95%CI:2.768~7.502)、组织Ki-67低表达(OR=4.193,95%CI:1.967~8.880)、基底阳性(OR=3.459,95%CI:1.884~80.30)、VitD(OR=2.689,95%CI:1.656~4.306)和FA(OR=2.005,95%CI:1.470~3.436)有降低趋势与新辅助化疗效果不佳有关;ROC分析显示血清VitD预测TNBC患者新辅助化疗效果不佳的灵敏度0.782、特异度0.899;FA预测TNBC患者新辅助化疗效果不佳的灵敏度0.775、特异度0.862;两者联合预测敏感性为0.856,特异性0.908。结论血清VitD、FA水平降低可增加TNBC患者新辅助化疗效果不佳风险,二者水平降低可作为预测新辅助化疗敏感性有效的指标。

Objective To analyze the relationship between serum vitamin D （VitD） and folic acid （FA） levels and sensitivity of neoadjuvant chemotherapy in patients with triple-negative breast cancer（TNBC）. Methods After receiving neoadjuvant chemotherapy, 235 TNBC patientspathologically diagnosed withresidual cancer were selected as the observation group, while 235 TNBC patients diagnosed with pathological complete response served as the control group. The patients’ general characteristics, tumor size, TNM staging, lymph node, Ki-67 expression and basal marker condition were retrospectively collected, and the levels of serum VitD and FA were detected by enzyme-linked immunosorbent assay. The relationship between serum VitD and FA levels and sensitivity of neoadjuvant chemotherapy in all the TNBC patients after neoadjuvant chemotherapy was analyzed by logistic regression and receiver operating characteristic （ROC） curve. Results Single factor analysis indicated that serum VitD and FA levels were lower in the observation group than in the control group, showing statistically significant differences （both P〈0.05）. The proportions of patients with a tumor size T3/4, Ki-67 low-expession, positive basal marker and having a decreasing trend in serum VitD and FA levels in the observation group were significantly higher than those of the control group, with statistically significant differences（all P〈0.05）. However, no statistically significant differences were found in age, TNM staging and lymph node status between the two groups （all P〉0.05）. Logistic regression analysis showed that a tumor size T3/4 （OR=4.122, 95%CI：2.768-7.502）, Ki-67 low-expession （OR=4.193, 95%CI：1.967-8.880）, positive basal marker （OR=3.459, 95%CI：1.884-80.30） and having a decreasing trend in serum levels of VitD （OR=2.689, 95%CI：1.656-4.306） and FA（OR=2.005, 95%CI：1.470-3.436） were associated with poor effects of neoadjuvant chemotherapy. ROC analysis revealed that the prognostic sensitivity and specificity of poor effects of neoadjuvant chemotherapy separately predicted by serum VitD and FA were 0.782 and 0.899, 0.775 and 0.862 respectively, while the sensitivity and specificity predicted by VitD in combination with FA were 0.856 and 0.908 respectively. Conclusions The decrease of serum VitD and FA levels can increase the risk of poor response to neoadjuvant chemotherapy in patients with TNBC, and both can be used as the effective indexes for evaluating the sensitivity of neoadjuvant chemotherapy.