乳腺癌新辅助治疗前HER2表达与术后残余肿瘤负荷分级相关性分析

Correlation between HER2 expression before neoadjuvant treatment and RCB classification after surgical treatment in breast cancer

目的对乳腺癌新辅助治疗前粗针穿刺活检标本中HER2的表达与残余肿瘤负荷(RCB)分级的相关性进行初步探讨。方法收集河北医科大学第四医院2013年1月至2014年1月间150例经术前粗针穿刺病理确诊为乳腺浸润性癌,行新辅助治疗后进行手术切除的患者。应用免疫组织化学(IHC)或荧光原位杂交(FISH)检测HER2在术前穿刺标本中的表达情况,根据RCB计算患者术后新辅助治疗反应分级。采用SPSS 21.00及GraphPad Prism 8.0.1进行数据统计,卡方检验及Fisher确切概率法进行相关性分析,Cox回归进行生存分析。结果150例乳腺浸润癌患者经新辅助治疗后达到病理完全缓解(PCR)即RCB-038例,RCB-Ⅰ级12例,RCB-Ⅱ级61例,RCB-Ⅲ级39例。统计学结果示:乳腺癌新辅助治疗前HER2表达与术后是否达到PCR及RCB分级均相关(r1=-0.217,r2=-0.282;P<0.05)。进一步分析发现,在HER2阳性组,PCR与总生存期(OS)、无病生存期(DFS)相关,PCR患者OS及DFS更长,差异有统计学意义(P<0.05);与HER2阴性组比较,HER2阳性组的RCB不同分级与OS、DFS差异更加明显(P<0.05)。结论新辅助治疗前HER2表达与术后是否达到PCR及RCB分级具有相关性。HER2阳性患者,PCR与预后的关系更密切,且RCB分级之间的预后分层更为明显,提示新辅助治疗前HER2过表达联合术后RCB分级更能精准地预测预后。

Objective To explore the relationship between the expression of human epidermal growth factor receptor 2(HER2)in core needle biopsy(CNB)specimens before neoadjuvant chemotherapy(NAC)and post NAC Residual Cancer Burden(RCB)classification in breast cancer.Methods This retrospective study included 150 patients with CNB proven invasive breast carcinoma in the Fourth Hospital of Hebei Medical University from January 2013 to January 2014.Immunohistochemistry(IHC)or fluorescence in situ hybridization(FISH)was used to detect the expression of HER2 in the CNB specimens.RCB was used to assess the chemotherapy response of patients.SPSS 21.00 and GraphPad Prism 8.0.1 were used for data statistics;Chi square test and Fisher's exact test for correlation analysis,and Cox regression for survival analysis.P<0.05 was considered statistically significant.Results Among the 150 patients,there were 38 RCB-0,12 RCB-Ⅰ,61 RCB-Ⅱ and 39 RCB-Ⅲ post NAC.RCB-0 meant pathological complete response(PCR).Statistical analysis found that the pre NAC HER2 expression was related to PCR and RCB classification after surgery(r1=‒0.217,r2=‒0.282;P<0.05).Further analysis demonstrated that in the HER2-positive group,PCR was associated with prolonged OS and DFS(HR=2.939,2.359;P<0.05);the differences of OS and DFS in RCB classifications were more significant(P<0.05)in the HER2 positive than HER2 negative groups.Conclusion There is a correlation between pre NAC HER2 expression and PCR and RCB classification after treatment.In HER2-positive patients,the prognostic stratification of RCB classification is more obvious,suggesting that pre NAC HER2 overexpression combined with RCB classification after surgery can more accurately predict the prognosis.