腋窝淋巴结转移的乳腺癌患者新辅助化疗后病理完全缓解的影响因素及预后分析

The factors influencing and prognostic analysis of pathological complete response in breast cancer patients with axillary lymph node metastasis after neoadjuvant chemotherapy

目的新辅助化疗(NAC)后病理完全缓解(pCR)与伴有腋窝淋巴转移(ALNM)的乳腺癌(BC)患者生存和预后密切相关。对NAC后与pCR相关的临床病理特征进行探讨,并对术后生存情况进行分析。方法收集在本院就诊的116例伴有ALNM的BC患者。通过单因素分析患者的临床病理特征与NAC后pCR的关系,应用二元Logistic回归分析NAC后pCR的独立影响因素。采用Kaplan-Meier生存曲线分析pCR和non-pCR患者的术后无病生存时间(DFS)和总生存时间(OS)。结果116例患者中,有32例NAC后达到pCR。单因素分析显示,NAC后达到pCR和non-pCR患者比较发现年龄、Ki67指数、NAC前后Ki67差值≥30%、临床分期、NAC疗效差异有统计学意义(P<0.05)。二元Logistic回归分析结果显示年龄、临床分期(II期)、NAC前后Ki67差值≥30%是pCR的独立影响因素(P<0.05)。NAC后pCR与non-pCR患者术后5年DFS(83.10%VS.63.00%)和OS(94.10%VS.73.60%)比较差异有统计学意义(P<0.05)。结论通过分析临床病理特征与伴有ALNM的BC患者NAC后pCR的相关性,发现年龄≤50岁,临床分期(II期)、NAC前后Ki67差值≥30%有助于评估NAC后pCR。同时发现,NAC后达到pCR较non-pCR患者预后生存更好。

Objective Pathological complete response(pCR)after neoadjuvant chemotherapy(NAC)is closely related to the survival and prognosis of breast cancer(BC)patients with axillary lymph node metastasis(ALNM).To explore the clinicopathological characteristics associated with pCR after NAC,and to analyze the postoperative survival.Methods A total of 116 BC patients with ALNM in our hospital were collected.The relationship between clinicopathological characteristics and pCR after NAC was analyzed by univariate analysis,and the independent influencing factors of pCR after NAC were analyzed by binary Logistic regression.Kaplan-Meier survival curve was used to analyze the disease-free survival(DFS)and overall survival(OS)of pCR and non-pCR patients.Results Of the 116 patients,32 achieved pCR after NAC.Univariate analysis showed that age,Ki67 index,the difference of Ki67≥30%before and after NAC,clinical stage and NAC efficacy were statistically significant between patients who achieved pCR and non-pCR after NAC(P<0.05).Binary Logistic regression analysis showed that age,clinical stage,and the difference of Ki67≥30%before and after NAC were independent influencing factors for pCR(P<0.05).There was a statistically significant difference in the 5-year DFS(83.10%VS.63.00%)and OS(94.10%VS.73.60%)between patients with pCR and non-pCR after NAC.Conclusion This study analyzes the relationship between clinicopathological features and pCR after NAC in BC patients with ALNM.The results shows that age≤50 years,clinical stage,and the difference of Ki67≥30%before and after NAC are useful in evaluating pCR after NAC.Additionally,patients who achieve pCR after NAC have a better prognosis and survival compared to non-pCR patients.