新辅助化疗对中青年不同分子分型乳腺癌患者免疫标志物表达变化和预后的影响

Effect of neoadjuvant chemotherapy on the expression of immune markers and prognosis in young and middle-aged patients with different molecular typing of breast cancer

目的分析新辅助化疗对中青年不同分子分型乳腺癌患者免疫标志物表达变化和预后的影响。方法选取2016年3月至2020年3月安徽省立医院收治的251例中青年乳腺癌患者为研究对象,按照乳腺癌分子分型,将入选患者分别纳入Luminal A型组(86例)、Luminal B型组(64例)、人表皮生长因子受体-2(human epidermal growth factor receptor-2,HER-2)过表达型组(43例)、三阴性组(58例),均行新辅助化疗联合乳腺癌改良根治术治疗。检测四组患者新辅助化疗前和乳腺癌改良根治术后免疫标志物表达变化,比较各组患者预后特点。结果Luminal A型组、Luminal B型组、三阴性组患者术后病理组织免疫标志物表达阳性率与本组新辅助化疗前穿刺结果比较差异均无统计学意义(均P>0.05);HER-2过表达型组患者术后病理雌激素受体阳性、孕激素受体阳性≥20%占比均显著高于本组新辅助化疗前(均P<0.05),HER-2阳性占比显著低于本组新辅助化疗前(P<0.05)。HER-2过表达型组、三阴性组术后分别有31例、9例患者发生分子分型改变。Luminal A型组、Luminal B型组患者术后1年内局部复发率、远处转移率均显著低于HER-2过表达型组和三阴性组(均P<0.05),Luminal A型组、Luminal B型组和HER-2过表达型组患者1年生存率均显著高于三阴性组(均P<0.05);HER-2过表达型组和三阴性组中术后分子分型改变者术后1年内局部复发率、远处转移率均显著低于本组分子分型未改变者(均P<0.05),1年生存率均显著高于本组分子分型未改变者(均P<0.05)。结论新辅助化疗治疗Luminal A型、Luminal B型乳腺癌效果确切,且能够促进HER-2过表达型、三阴性乳腺癌亚型转变,有助于改善患者预后。

Objective To analyze the effect of neoadjuvant chemotherapy on the expression of immune markers and prognosis in young and middle-aged patients with different molecular typing of breast cancer.Method From March 2016 to March 2020,251 cases of young and middle-aged patients with breast cancer admitted to Anhui Provincial Hospital were selected and divided into Luminal A type group(86 cases),Luminal B type group(64 cases),human epidermal growth factor receptor-2(HER-2)overexpression type group(43 cases),and triple negative group(58 cases)according to their molecular typing.All patients were treated with neoadjuvant chemotherapy combined with modified radical mastectomy.The changes of immune markers before chemotherapy and after operation were detected in the four groups,and the prognosis of each group was compared.Result There were no significant differences in the positive rates of pathological immune markers expression after operation among Luminal A type group,Luminal B type group and triple negative group as compared with the puncture results before neoadjuvant chemotherapy in this group(all P>0.05).In HER-2 overexpression type group,the proportion of estrogen receptor positive and progesterone receptor positive rate≥20%were significantly higher than those before neoadjuvant chemotherapy(all P<0.05),while the proportion of HER-2 positive was significantly lower than that before neoadjuvant chemotherapy(P<0.05).In HER-2 overexpression type group and triple negative group,31 cases and 9 cases respectively experienced molecular typing changed after operation.The local recurrence rate and distant metastasis rate within 1-year after operation in Luminal A type group and Luminal B type group were significantly lower than those in HER-2 overexpression type group and triple negative group(all P<0.05).The 1-year survival rate of patients in Luminal A type group,Luminal B type group and HER-2 overexpression type group were significantly higher than that in triple negative group(all P<0.05).In HER-2 overexpression type group and triple negative group,the local recurrence rate within 1-year after operation in the group with changed molecular typing after operation was significantly lower than that in the group without changed molecular typing(all P<0.05),and the 1-year survival rate was significantly higher than that in the group without changed molecular typing(all P<0.05).Conclusion Neoadjuvant chemotherapy is effective in the treatment of Luminal A and Luminal B breast cancer,and can promote the transformation of HER-2 overexpression and triple negative type breast cancer subtypes,which is helpful to improve the prognosis of patients.