吉西他滨治疗HER-2阴性转移性乳腺癌疗效的影响因素

Factors Influencing the Efficacy of Gemcitabine in the Treatment of HER-2 Negative Metastatic Breast Cancer

目的研究HER-2阴性转移性乳腺癌患者临床特征、病理特征及其与吉西他滨疗效的相关性。方法收集2015年5月~2020年5月在安徽省立医院接受吉西他滨治疗的HER-2阴性转移性乳腺癌患者97例。收集患者初次使用吉西他滨的年龄,原发肿瘤的激素受体表达情况、Ki-67指数,患者既往治疗史中蒽环、紫杉、辅助放疗应用情况,远处转移部位,吉西他滨治疗线数以及单药或联合用药等信息。研究终点是无进展生存期(PFS),分析吉西他滨疗效的影响因素,比较不同特征患者间PFS的差异。结果患者的中位PFS为139 d。单因素和多因素分析结果表明,吉西他滨治疗前患者存在骨转移和吉西他滨在一、二线应用(三线及以后方案)是较长PFS的独立预测因素(P<0.05);吉西他滨单药治疗与联合用药的PFS无显著差异,仅在内脏转移的患者中联合组相比单药组PFS较长(P<0.05)。结论HER-2阴性转移性乳腺癌患者中,存在骨转移和吉西他滨早期应用是吉西他滨疗效的独立预测因素。单药与联合用药在一线治疗方案以及骨转移患者的亚组分析中疗效相似,仅在内脏转移的患者中联合用药能有效延长吉西他滨治疗的PFS。

Objective To study the clinical and pathological characteristics of patients with HER-2 negative metastatic breast cancer and their correlation with the efficacy of gemcitabine.Methods A total of 97 patients with HER-2 negative metastatic breast cancer who received gemcitabine treatment in Anhui Provincial Hospital from May 2015 to May 2020 were collected.Collecting the age of the patients when they first used gemcitabine,the expression of hormone receptors in the primary tumor,Ki-67 index,the application of anthracycline,taxane,and adjuvant radiotherapy in the patient's previous treatment history,the location of distant metastases,the number of gemcitabine treatment lines,and the number of treatments.Information about drugs or combination drugs.The endpoint of the study is progression-free survival(PFS).The factors affecting the efficacy of gemcitabine were analyzed and the differences in PFS between patients with different characteristics were compared.Results The median PFS of the patient was 139 d.The results of univariate and multivariate analysis showed that patients with bone metastases before gemcitabine treatment and gemcitabine first-line and second-line application(third-line and later regimens)were independent predictors of longer PFS(P<0.05);There was no significant difference in PFS between gemcitabine monotherapy and combination therapy.In patients with visceral metastases,the combination group had a longer PFS than the monotherapy group(P<0.05).Conclusion In patients with HER-2 negative metastatic breast cancer,the presence of bone metastasis and early use of gemcitabine are independent predictors of the efficacy of gemcitabine.The efficacy of single-drug and combination drugs was similar in the first-line treatment plan and subgroup analysis of patients with bone metastases.Only the combination of drugs in patients with visceral metastasis can effectively prolong the PFS of gemcitabine treatment.