多灶、多中心性乳腺癌新辅助化疗疗效影响因素分析

Analysis of Factors Influencing the Efficacy of Neoadjuvant Chemotherapy for Multifocal/Multicentric Breast Cancer.

目的分析多灶、多中心乳腺癌新辅助化疗的疗效及其影响因素。方法采用回顾性研究收集2018~2021年于我院确诊为多灶或多中心乳腺癌患者行新辅助化疗且手术的103例患者临床资料,使用X^(2)检验或Fisher确切概率法分析多灶型与多中心型之间的基线特征,计算病理完全缓解(PCR)组和非PCR组与临床病理特征之间的相关性,多因素采用Logistic回归分析。结果多灶型与多中心对比分析发现,两者病灶个数及PCR率差异有统计学意义(P<0.05)。多灶、多中心乳腺癌总体PCR率31%,多灶型乳腺癌新辅助化疗后PCR率高于多中心型乳腺癌,差异有统计学意义(P<0.05)。其中HER2阳性、ER低表达、Ki67高表达、分子分型、化疗方案及周期数是影响PCR率的危险因素。结论HER2阳性、ER低表达组、Ki67高表达可作为预测多灶、多中心乳腺新辅助化疗疗效的临床指标,多灶型乳腺癌新辅助化疗反应性较多中心好,多灶与多中心乳腺癌的生物学行为可能不同。

Objective To analyze the efficacy and influencing factors of neoadjuvant chemotherapy for multifocal and multicenter breast cancer.Methods A retrospective research method was used to collect relevant clinical data of patients with multi-focal/multi-center breast cancer diagnosed with neoadjuvant chemotherapy and surgery in the Affiliated Hospital of Southwest Medical University from 2018 to 2021,and finally 103 cases were included for data analysis.X^(2) test or Fisher s exact probability method was used to analyze the baseline characteristics between the multifocal and multicentric types,and the correlation between the pathological complete remission(PCR)group and the non-PCR group as well as the clinicopathological characteristics was calculated.Logistic regression analysis was used for multivariate analysis.Results The comparative analysis between multifocal and multicenter showed that there were differences in the number of lesions and PCR rate between the two(P<0.05).The overall PCR rate of multifocal and multicentric breast cancer was 31%,and the PCR rate after neoadjuvant chemotherapy for multifocal breast cancer was higher than that of multicentric breast cancer.The difference was statistically significant(P<0.05).Among them,HER2 positive,ER low expression,Ki67 high expression,molecular typing,chemotherapy regimen and number of cycles were the risk factors that affected the PCR rate.Conclusion HER2 positive,ER low expression group,Ki67 high expression can be used as clinical indicators to predict the efficacy of multifocal/multicenter breast neoadjuvant chemotherapy.Multifocal breast cancer is more responsive to neoadjuvant chemotherapy.Finally,the biological behavior of multifocal and multicentric breast cancer may be different.