铂类化疗药物对进展期三阴性乳腺癌的临床疗效及与BRCA基因突变的关系

Relationship between the efficacy of platinum-based regimens in advanced triple-negative breast cancer and BRCA gene mutations

目的观察铂类化疗药物一线治疗进展期三阴性乳腺癌的临床疗效,分析其与乳腺癌易感基因(BRCA)突变的关系。方法回顾性分析210例进展期三阴性乳腺癌患者的临床资料,依据是否接受铂类化疗药物治疗分为治疗组(n=86)和对照组(n=124)。比较两组患者的临床获益率(CBR)和无进展生存时间(PFS);采用二代测序法检测患者BRCA基因的突变情况,比较两组患者中BRCA基因野生型和突变型患者的CBR和PFS;按转移部位对三阴性乳腺癌患者进行分层,比较含铂类和不含铂类化疗方案的CBR和PFS。结果治疗组与对照组患者CBR和中位PFS比较,差异均无统计学意义(P﹥0.05)。按转移部位分层分析结果显示,含铂类和不含铂类化疗方案治疗后不同转移部位三阴性乳腺癌患者的CBR和中位PFS比较,差异均无统计学意义(P﹥0.05)。210例三阴性乳腺癌患者中59例检测过BRCA基因,治疗组中,BRCA基因野生型患者CBR低于突变型(P﹤0.05),中位PFS短于突变型(P﹤0.05);对照组中,BRCA基因野生型患者的CBR低于突变型(P﹤0.05),但BRCA基因野生型和突变型患者的中位PFS比较,差异无统计学意义(P﹥0.05)。结论铂类化疗药物一线治疗进展期三阴性乳腺癌的临床疗效与其他治疗方案无明显差异,但在有BRCA基因突变的患者中疗效较好。

Objective To observe the efficacy of platinum-based regimens as first-line treatment of advanced triplenegative breast cancer, and to analyze the relationship between the efficacy and the breast cancer susceptibility gene (BRCA) gene mutations. Method A retrospective analysis was performed for the clinical data of 210 patients pathologically diagnosed as advanced triple- negative breast cancer, who were stratified as treatment group (n=86) and control group (n=124) according to whether they were treated with platinum- based regimens or not. The clinical benefit rate (CBR) and progress-free survival (PFS) of the two groups were compared;and the BRCA gene mutations were detected using next generation sequencing to assess the CBR and PFS in the two groups of patients with BRCA wild-type and mutations;furthermore, triple-negative breast cancer patients were stratified by metastasis sites to compare the CBR and PFS of platinum-based regimens versus non-platinum-based regimens. Result The CBR and median PFS in the treatment group and control group showed no evident difference (P>0.05). By metastasis sites, the analysis indicated that, there was no significant difference regarding the CBR and PFS among the triple-negative breast cancer patients administered with platinum-based and non-platinum-based regimens (P>0.05). Of the 210 patients of triple-negative breast cancer, 59 were detected for BRCA gene, in treatment group, the BRCA wild-type patients had lower CBR and lower median PFS than those with BRCA mutations (P<0.05);while in control group, BRCA wild-type was associated with lower CBR compared with those with mutations (P<0.05), while there was no marked difference in respect to the median PFS of patients with BRCA wild-type and mutations (P>0.05). Conclusion The efficacy of platinum-based regimens as first-line treatment of advanced triple-negative breast cancer is not significantly different from that of the non-platinum-based therapy, notwithstanding, platinum-based regimens are more effective in patients with BRCA gene mutations.