浸润性乳腺癌新辅助化疗前后的代谢改变及其临床价值

Metabolic change in patients with invasive breast cancer before and after neoadjuvant chemotherapy andits clinical signifi cance

目的探讨女性浸润性乳腺癌患者新辅助化疗前后的代谢改变及其临床价值。方法回顾性分析2019年1月至2020年12月本院收治的接受新辅助化疗的女性浸润性乳腺癌患者78例。人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)阴性患者接受表柔比星+紫杉醇或表柔比星+环磷酰胺序贯紫杉醇方案新辅助化疗;HER2阳性患者接受表柔比星+环磷酰胺序贯紫杉醇方案,并给予注射用曲妥珠单抗靶向治疗。分析患者新辅助化疗前后的代谢变化情况及其与疗效的关系。结果与新辅助化疗前比较,新辅助化疗后浸润性乳腺癌患者丙氨酸氨基转移酶、天冬氨酸转移酶、碱性磷酸酶、总胆固醇、三酰甘油、低密度脂蛋白和空腹血糖水平以及体质量指数均增高(均P<0.05),白蛋白和高密度脂蛋白水平均降低(均P<0.01)。受试者工作特征(receiver operating characteristic,ROC)曲线分析显示,化疗前高密度脂蛋白水平对浸润性乳腺癌患者新辅助化疗后完全缓解具有一定的预测价值(P=0.012),曲线下面积为0.717,最佳诊断界值为1.205 mmol/L,特异度为0.786,敏感度为0.688。结论新辅助化疗可导致女性浸润性乳腺癌患者代谢功能紊乱。高密度脂蛋白水平对女性浸润性乳腺癌患者新辅助化疗后完全缓解具有一定的预测价值。

Objective To investigate the metabolic changes in female patients with invasive breast cancer before and after neoadjuvant chemotherapy and its clinical value.Methods From January 2019 to December 2020,78 female patients with invasive breast cancer receiving neoadjuvant chemotherapy in our hospital were retrospectively analyzed.Patients with negative human epidermal growth factor receptor 2(HER2)received neoadjuvant chemotherapy with epirubicin+paclitaxel or epirubicin+cyclophosphamide sequential paclitaxel regimen;HER2 positive patients received epirubicin+cyclophosphamide sequential paclitaxel regimen,and then trastuzumab for injection as targeted therapy.The metabolic changes of patients before and after neoadjuvant chemotherapy and their relationship with therapeutic efficacy were analyzed.Results The levels of alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase,total cholesterol,triglyceride,low density lipoprotein and fasting blood glucose and body mass index were all increased significantly after neoadjuvant chemotherapy(all P<0.05),while albumin and high density lipoprotein levels both decreased significantly(both P<0.05).Receiver operating characteristic(ROC)curve analysis showed that high density lipoprotein level before chemotherapy had a certain predictive value for complete remission after neoadjuvant chemotherapy in female patients with invasive breast cancer(P=0.012),the area under the curve was 0.717,the optimal diagnostic threshold was 1.205 mmol/L,the specificity was 0.786,and the sensitivity was 0.688.Conclusions Neoadjuvant chemotherapy can lead to metabolic dysfunction in patients with invasive breast cancer.High density lipoprotein level has predictive value for complete remission after neoadjuvant chemotherapy in female patients with invasive breast cancer.