血清CTC联合临床特征对乳腺癌新辅助治疗效果的预测价值

Predictive value of serum CTC combined with clinical characteristics on neoadjuvant therapy for breast cancer

目的探讨血清循环肿瘤细胞(CTC)联合临床特征对乳腺癌新辅助治疗效果的影响因素分析。方法回顾性分析2019年4月—2022年4月甘肃省妇幼保健院收治的80例乳腺癌患者的临床资料,根据患者治疗效果分为pCR获得组30例和p CR未获得组50例。比较两组的年龄、体质量指数(BMI)、绝经状态、哺乳史、糖尿病史、高血压史、乳腺疾病史、家族史、肿瘤大小、T分期、N分期、临床分期、组织学分级、腋窝淋巴结状态、雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(HER-2)、细胞增殖指数Ki-67、分子分型、CTC等临床资料。采用非条件Logistic逐步回归分析乳腺癌患者新辅助治疗效果的影响因素,分析血清CTC联合临床特征预测乳腺癌患者新辅助治疗效果的价值。结果pCR获得组ER阴性、PR阴性、HER-2阳性、Ki-67高表达、HER-2过表达型、CTC阴性患者的占比高于pCR未获得组(P<0.05)。非条件Logistic逐步回归分析结果显示,ER阴性[OR=3.113(95%CI:1.524,6.359)]、PR阴性[OR=3.242(95%CI:1.431,7.345)]、HER-2阳性[OR=2.756(95%CI:1.135,6.692)]、Ki-67高表达[OR=2.895(95%CI:1.074,7.804)]、HER-2过表达型[OR=2.957(95%CI:1.247,7.012)]及CTC阴性[OR=3.688(95%CI:1.752,7.763)]是乳腺癌患者新辅助治疗效果良好的影响因素(P<0.05)。血清CTC联合临床特征预测乳腺癌患者新辅助治疗效果的敏感性为93.3%(28/30)(95%CI:1.611,8.047)、特异性为94.0%(47/50)(95%CI:1.336,7.823),准确性为93.8%(75/80)(95%CI:1.288,8.112)。结论血清CTC联合临床特征对乳腺癌新辅助治疗效果有较好的预测价值。

Objective To investigate the predictive value of serum circulating tumor cells(CTC)combined with clinical features on the prognosis of breast cancer neoadjuvant therapy.Methods The clinical data of 80 breast cancer patients admitted to our hospital from April 2019 to April 2022 were retrospectively analyzed.According to the short-term prognosis of the patients,they were divided into good prognosis group(n=30)and poor prognosis group(n=50).The age,body mass index(BMI),menopausal status,breast feeding history,diabetes history,hypertension history,breast disease history,family history,tumor size,T stage,N stage,clinical stage,histological grade,axillary lymph node status,estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor receptor 2(HER-2),cell proliferation index Ki-67,molecular typing,CTC,and other clinical datas of the two groups were compared.The prognostic factors of breast cancer patients after neoadjuvant therapy were identified by multivariate Logistic regression analysis.Introduce inspection levelα=0.05,exclude inspection levelα=0.10.The value of serum CTC combined with clinical features in predicting the prognosis of breast cancer patients after neoadjuvant therapy was analyzed by consistency.Results The proportion of patients with ER negative,PR negative,HER-2 positive,Ki-67 high expression,HER-2 overexpression,and CTC negative in the good prognosis group were significantly higher than that in the poor prognosis group(P<0.05).Multivariate Logistic regression analysis showed that ER negative[OR=3.113(95%CI:1.524,6.359)],PR negative[OR=3.242(95%CI:1.431,7.345)],HER-2 positive[OR=2.756(95%CI:1.135,6.692)],KI-67 overexpression[OR=2.895(95%CI:1.074,7.804)],molecular typing HER-2 overexpression[OR=2.957(95%CI:1.247,7.012)],and CTC negative[OR=3.688(95%CI:1.752,7.763)]were prognostic factors of breast cancer patients after neoadjuvant therapy(P<0.05).The sensitivity of serum CTC combined with clinical characteristics in predicting the prognosis of breast cancer patients after neoadjuvant therapy was 0.933(95%CI:1.611,8.047),the specificity was 0.940(95%CI:1.336,7.823),and the accuracy was 0.938(95%CI:1.288,8.112).Conclusion Serum CTC combined with clinical features have good predictive value in the prognosis of breast cancer after neoadjuvant therapy.