HP联合新辅助化疗治疗HER2阳性乳腺癌患者腋窝病理完全缓解影响因素

Influencing factors of axillary pathological complete response of HER2 positive breast cancer patients treated with HP combined with neoadjuvant chemotherapy

目的分析人表皮生长因子受体2(HER2)阳性淋巴结转移乳腺癌患者使用曲妥珠单抗和帕妥珠单抗(HP)联合新辅助化疗治疗的腋窝病理完全缓解(apCR)的影响因素。方法回顾性分析2019-03-01-2022-02-28河北医科大学第四医院乳腺中心收治的281例行HP联合新辅助化疗治疗并完成手术的HER2阳性淋巴结转移乳腺癌患者的临床资料,分析临床病理特点与apCR关联。结果281例患者中临床完全缓解(CR)165例(58.7%),部分缓解(PR)93例(33.1%),疾病稳定(SD)23例(8.2%),总有效率(CR+PR)为91.8%。HER2阳性乳腺癌患者apCR率为74.4%,乳腺病理完全缓解(bpCR)率为73.0%,总病理完全缓解(tpCR)率为63.7%。单因素分析显示,激素受体(χ2=17.078,P<0.001)、HER2状态(χ2=44.016,P<0.001)和bpCR(χ2=66.595,P<0.001)与患者apCR有统计学意义的关联。多因素分析显示,HER2状态(OR=4.439,95%CI为1.798~10.959,P=0.001)和bpCR(OR=6.136,95%CI为3.096~12.160,P<0.001)是apCR的独立预测因素。临床分期为cT1~3N1患者apCR率为73.0%(92/126)。HER2免疫组化(IHC,3+)患者apCR率(79.8%)高于IHC(2+)/FISH(+)患者(29.4%),χ2=18.964,P<0.001。获得bpCR患者apCR率(89.7%)高于未获得bpCR患者(35.9%),χ2=39.498,P<0.001。结论HP联合化疗在淋巴结转移HER2阳性患者中取得了较高的apCR率。HER2状态和bpCR是影响apCR的独立预测因素。临床分期为cT1~3N1患者有较高apCR率,该类患者适合以前哨淋巴结活检术代替腋窝淋巴结清除术。

Objective To analyze the influencing factors of axillary pathological complete response(apCR)in patients with human epidermal growth factor receptor 2(HER2)positive lymph node metastasis from breast cancer who were treated with trastuzumab and pertuzumab(HP)combined with neoadjuvant chemotherapy.Methods We retrospectively analyzed the clinical data of 281 patients with lymph node positive HER2 positive breast cancer who received HP combined neoadjuvant chemotherapy and completed surgery in the Breast Center of the Fourth Hospital of Hebei Medical University from March 1,2019 to February 28,2022,and analyzed the relationship between clinicopathological characteristics and apCR.Results Among 281 patients,165(58.7%)had complete response(CR),93(33.1%)had partial remission(PR),23(8.2%)had stable disease(SD),and the total effective rate(CR+PR)was 91.8%.The apCR rate of HER2 positive breast cancer patients was 74.4%,the breast pathological complete response(bpCR)rate was 73.0%,and the total pathological complete response(tpCR)rate was 63.7%.Single factor analysis showed that hormone receptors(χ~2=17.078,P<0.001),HER2 status(χ~2=44.016,P<0.001)and bpCR(χ~2=66.595,P<0.001)had statistically significant correlation with apCR.Multivariate analysis showed that HER2 status(OR=4.439,95%CI:1.798-10.959,P=0.001)and bpCR(OR=6.136,95%CI:3.096-12.160,P<0.001)were independent predictors of apCR.The apCR rate of patients with clinical stage of cT1-3N1was 73.0%(92/126).The apCR rate of HER2 IHC(3+)patients(79.8%)was higher than that of IHC(2+)/FISH(+)patients(29.4%),χ~2=18.964,P<0.001.The apCR rate of patients with bpCR(89.7%)was higher than that of patients without bpCR(35.9%),χ~2=39.498,P<0.001.Conclusion HP combined with chemotherapy has a high apCR rate in patients with HER2 positive lymph node metastasis.HER2 status and bpCR were independent predictors of apCR.Patients with clinical staging of cT1-3N1have a high apCR rate,and sentinel lymph node biopsy is suitable for this type of patients to replace axillary lymph node dissection.