乳腺癌新辅助化学治疗后微钙化的变化与治疗反应及病理的相关性分析

Correlation analysis between mammography microcalcification and molecular pathological classification and tumor response after neoadjuvant chemotherapy

目的探讨乳腺癌内微钙化与病理类型、新辅助化学治疗(NACT)反应的相关性,微钙化的改变模式与治疗反应的相关性。方法回顾性分析接受NACT的103例患者共106例局部晚期乳腺癌,分为微钙化组与无微钙化组,比较2组病例的乳腺密度、病灶大小,X线片内是否腋下淋巴结增大、肿瘤的分期、组织学类型、组织学分级、病理分子分型以及对NACT反应间的差异。结果106例乳腺癌中,含有微钙化49例(46.2%),无微钙化57例(53.8%)。微钙化组与无微钙化组在乳腺密度、X线片内是否腋下淋巴结增大、肿瘤分期、组织学类型、病理分子分型[雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(HER2)]、组织学分级比较差异均无统计学意义(P均>0.05)。微钙化组乳腺癌患者的病灶直径大于无微钙化组,2组对NACT的治疗反应比较差异有统计学意义,无微钙化组的完全缓解率较高(P均<0.05)。微钙化组乳腺癌患者中,不同病理分子分型如ER阳性者与阴性者、PR阳性者与阴性者、HER2阳性者与阴性者以及不同治疗反应者在NACT前后微钙化的范围与分布密度变化比较差异均无统计学意义(P均>0.05)。结论有微钙化与无微钙化的乳腺癌病例对于NACT反应有差异,无微钙化者较易获得完全缓解。NACT后微钙化的范围和分布密度会出现变化,但该变化与治疗反应及乳腺癌病理分子分型可能无关。

Objective To investigate the correlation between the presence of microcalcification on mammography,pathological pattern and tumor response after neoadjuvant chemotherapy(NACT)and explore the correlation between the changing patterns of microcalcification before and after NACT and tumor response.Methods Clinical data of 103 patients(106 cases)who received mammography before and after NACT were retrospectively analyzed.All patients were divided into the microcalcification and non-microcalcification groups.The breast density,lesion size,the presence of axillary lymph node enlargement or not on X-ray,tumor staging,histological type,histological grade,molecular pathological classification and tumor response to NACT were statistically compared between two groups.Results Among 106 breast cancer cases,49(46.2%)cases presented with microcalcification and 57(53.8%)cases had no microcalcification.The breast density,lesion size,axillary lymph node enlargement on X-ray,tumor stage,histological type,histological grade and molecular pathological classification(estrogen receptor(ER),progesterone receptor(PR)and human epidermal growth factor receptor 2(HER2))did not significantly differ between two groups(all P>0.05).In the microcalcification group,the lesion size was significantly larger than that in the non-microcalcification group(P<0.05).The tumor response to NACT significantly differed between two groups(P<0.05).The complete remission rate in the non-microcalcification group was higher compared with that in the microcalcification group.Changes in the range and distribution density of microcalcification before and after NACT did not significantly differ among breast cancer patients with different molecular pathological classification(positive and negative ER,positive and negative PR,positive and negative HER2)and different tumor responses to NACT in the microcalcification group(all P>0.05).Conclusions Breast cancer patients with and without microcalcification show different responses to NACT.Patients without microcalcification are likely to achieve complete remission.The range and distribution density of microcalcification may change after NACT,which are probably not associated with NACT response or molecular pathological classification.