三阳性与HER2过表达型乳腺癌患者新辅助化学药物治疗的疗效对比

Comparison of efficacy of neoadjuvant chemotherapy in treatment of patients with triple positive breast cancer and HER2 overexpression breast cancer

目的对比三阳性乳腺癌(triple positive breast cancer,TPBC)与人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)过表达型乳腺癌患者的临床病理特征以及接受新辅助化学药物治疗(neoadjuvant chemotherapy,NACT)后的疗效差异。方法回顾性收集2019年1月至2021年7月期间西南医科大学附属医院收治的符合本研究入组条件的TPBC和HER2过表达型乳腺癌患者,比较二者的临床病理特征及接受NACT后的疗效差异,同时采用logistic回归多因素分析影响NACT疗效的风险因素。HER2过表达型乳腺癌为HER2阳性、雌激素受体(estrogen receptor,ER)和孕激素受体(progesterone receptor,PR)阴性,TPBC为HER2、ER和PR均为阳性。疗效评价指标采用病理完全缓解(pathological complete response,pCR),即原发灶及腋窝淋巴结均无乳腺浸润性癌细胞成分但允许乳腺内有导管内癌的成分存在(ypT0/isypN0)。结果本研究共收集符合入组条件的患者105例,其中TPBC患者57例,HER2过表达型乳腺癌患者48例;NACT后达到pCR患者50例,未达到pCR即非pCR患者55例。(1)与TPBC患者比较,HER2过表达型乳腺癌患者中Miller-Payne系统分级4~5级、临床疗效评估为部分缓解、达p CR、中性粒细胞-淋巴细胞比率(neutrophil-lymphocyte ratio,NLR)>2.77者占比均更高(均P<0.05),二者在其他特征如年龄、乳腺癌家族史、组织学分级、T和TNM分期、淋巴结转移、淋巴细胞-单核细胞比率、Ki-67表达、手术方式等方面比较差异无统计学意义(P>0.05)。(2)将单因素分析有统计学意义的指标以及结合与临床有关的特征指标进行logistic回归多因素分析影响pCR的风险因素发现,T分期越晚、Ki-67低表达、NLR低、ER和PR状态阳性者在NACT后不易达到pCR(P<0.05)。结论从本研究结果看,HER2过表达型乳腺癌患者接受NACT的疗效较TPBC患者更好,激素受体(ER和PR)阳性、T分期晚(3~4期)、Ki-67低表达及NLR低(≤2.77)是乳腺癌患者NACT疗效的风险因素。

Objective To compare the clinicopathologic characteristics and the difference of efficacy after neoadjuvant chemotherapy(NACT)between the patients with triple positive breast cancer(TPBC)and human epidermal growth factor receptor 2(HER2)overexpression breast cancer.Methods The patients with TPBC and HER2overexpression breast cancer admitted to the Affiliated Hospital of Southwest Medical University from January 2019 to July 2021 who met the inclusion conditions of this study were retrospectively collected,and the differences of clinicopathologic characteristics and the efficacy after NACT were compared between the patients with TPBC and HER2overexpression breast cancer.Meanwhile the risk factors affecting the efficacy of NACT were analyzed by logistic regression according to the risk factors of pCR based on the statistically significant indicators of univariate analysis and the indicators related to clinical characteristics.The HER2 overexpressing breast cancer was positive HER2,negative estrogen receptor(ER)and progesterone receptor(PR),and the TPBC was positive HER2,ER,and PR.The pathological complete response(pCR)was used to evaluate the efficacy,which was defined as ypT0/isypN0.Results A total of 105patients were enrolled in this study,including 57 patients with TPBC and 48 patients with HER2 overexpression breast cancer,as well as 50 patients with pCR and 55 patients with non-pCR.(1)Compared with patients with TPBC,the patients with HER2 overexpression breast cancer had the higher proportions of Miller-Payne system grade 4–5,partial response,pCR,and neutrophil-lymphocyte ratio(NLR)>2.77(P<0.05).There were no statistical differences in other characteristics such as age,family history of breast cancer,histological grade,T and TNM stages,lymph node metastasis,lymphocyte-monocyte ratio,Ki-67 expression,and surgical method between them(P>0.05).(2)The results of logistic multivariate analysis showed that the later T stage,the lower Ki-67 expression,the lower NLR,and the positive ER and PR statuses were not easy to achieve pCR after NACT(P<0.05).Conclusions According to the results of this study,the efficacy of patients with HER2 overexpression breast cancer receiving NACT is more likely to achieve pCR than that of patients with TPBC.Positive hormone receptors(ER and PR),later T stage(stage 3–4),lower Ki-67 expression,and lower NLR(≤2.77)might be a worse efficacy after NACT for patients with breast cancer.