TCH新辅助化疗方案治疗HER-2阳性乳腺癌的疗效及对患者ER、PR、HER-2及Ki67表达的影响

Efficacy of TCH neoadjuvant chemotherapy for HER-2 positive breast cancer and its influence on the expression of ER,PR,HER-2,and Ki67.

目的探讨TCH新辅助化疗方案治疗人表皮生长因子受体2(HER-2)阳性乳腺癌的疗效以及对患者雌激素受体(ER)、孕激素受体(PR)、HER-2、细胞核相关抗原(Ki67)表达的影响。方法选取2017年12月至2018年11月宝鸡市中心医院乳腺科收治的110例HER-2阳性乳腺癌患者作为研究对象。采用随机数表法分观察组和对照组各55例。对照组采用TAC辅助化疗,观察组采用TCH辅助化疗,21 d为一个周期,共治疗6个周期。比较两组患者的临床治疗效果,治疗前后的ER、PR、HER-2、Ki67、血清转化生长因子-β1(TGF-β1)、血管内皮生长因子(VEGF)水平,以及世界卫生组织生存质量评分表(WHOQOL-100)评分和治疗期间的不良反应情况。结果观察组患者的治疗总有效率为85.45%,明显高于对照组67.27%,差异有统计学意义(P<0.05);与治疗前比较,两组患者的ER、PR表达水平升高,且观察组[(48.12±3.56)pmol/L、(37.14±3.19)pmol/L]明显高于对照组[(42.12±4.07)pmol/L、(32.12±3.08)pmol/L],而Ki67、HER-2表达水平降低,且观察组[(51.02±3.21)ng/mL、(40.17±3.18)pmol/L]明显低于对照组[(56.12±3.20)ng/mL、(45.21±3.65)pmol/L],差异均有统计学意义(P<0.05);治疗后,两组患者的TGF-β1、VEGF水平均下降,且观察组[(54.12±4.10)pg/mL、(31.41±4.78)ng/mL]明显低于对照组[(68.17±5.02)pg/mL、(42.15±4.60)ng/mL],差异均有统计学意义(P<0.05);治疗后,两组患者的WHOQOL-100评分均升高,且观察组为(72.15±4.78)分,明显高于对照组的(62.38±5.02)分,差异有统计学意义(P<0.05);观察组患者的不良反应发生率为9.09%,明显低于对照组的23.64%,差异有统计学意义(P<0.05)。结论TCH新辅助化疗方案治疗HER-2阳性乳腺癌的临床效果明显,能有效抑制Ki67、HER-2水平,上调ER、PR水平,改善血清TGF-β1、VEGF水平,提高患者的生存质量。

Objective To explore the efficacy of TCH neoadjuvant chemotherapy in the treatment of human epidermal growth factor receptor 2(HER-2)positive breast cancer and its influence on estrogen receptor(ER),progesterone receptor(PR),HER-2,and nuclear-related antigen(Ki67).Methods A total of 110 patients with HER-2 positive breast cancer admitted to the Department of Breast Cancer,Baoji Central Hospital from December 2017 to November 2018 were selected as the research objects.They were randomly divided into observation group and control group with 55 patients in each group according the random number table.The control group was treated with TAC adjuvant chemotherapy,and the observation group was treated with TCH adjuvant chemotherapy,with 21 days as a cycle,for a total of 6 cycles.The clinical treatment effects of the two groups were compared,as well as ER,PR,HER-2,Ki67,serum transforming growth factor-β1(TGF-β1),vascular endothelial growth factor(VEGF)levels,and theWorld Health Organization quality of life(WHOQOL-100)scores before and after treatment,and adverse reactions during treatment were compared between the two groups.Results The total effective rate of treatment in the observation group was 85.45%,which was significantly higher than 67.27%in the control group(P<0.05).Compared with before treatment,the expression levels of ER and PR after treatment in the two groups were increased,and the levels in the observation group were significantly higher than those in the control group:ER,(48.12±3.56)pmol/L vs(42.12±4.07)pmol/L;PR,(37.14±3.19)pmol/L vs(32.12±3.08)pmol/L;the expression levels of Ki67 and HER-2 after treatment in the two groups decreased,and the levels in the observation group were significantly lower than those in the control group(P<0.05):Ki67,(51.02±3.21)ng/mL vs(56.12±3.20)ng/mL;HER-2,(40.17±3.18)pmol/L vs(45.21±3.65)pmol/L;TGF-β1 and VEGF after treatment in both groups decreased,and the levels in the observation group were significantly lower than those in the control group(P<0.05):TGF-β1,(54.12±4.10)pg/mL vs(68.17±5.02)pg/mL;VEGF,(31.41±4.78)ng/mL vs(42.15±4.60)ng/mL;the WHOQOL-100 scores after treatment in the two groups all increased,and the score of the observation group after treatment was(72.15±4.78)points,which was significantly higher than(62.38±5.02)points of the control group(P<0.05).The incidence of adverse reactions in the observation group was 9.09%,which was significantly lower than 23.64%in the control group(P<0.05).Conclusion TCH neoadjuvant chemotherapy has significant clinical effect in the treatment of HER-2 positive breast cancer,which can effectively inhibit the levels of Ki67 and HER-2,up-regulate the levels of ER and PR,improve the levels of serum TGF-β1 and VEGF,and improve the quality of life of patients.