新辅助化疗联合靶向治疗治疗HER-2阳性乳腺癌患者获得病理完全缓解的影响因素

Influencing factors of pathological complete response in patients with HER-2 positive breast cancer treated with neoadjuvant chemotherapy combined with targeted therapy

目的 探讨人表皮生长因子受体2(HER-2)阳性乳腺癌患者采用新辅助化疗联合靶向治疗获得病理完全缓解(pCR)的影响因素。方法 回顾性分析2018年1月1日至2023年4月1日深圳市人民医院乳腺外科行新辅助化疗联合靶向治疗的209例HER-2阳性乳腺癌患者的临床资料。根据是否获得pCR分为pCR组和非pCR组,分析患者年龄、绝经状态、肿瘤分期、临床分期、组织学分型、激素受体、HER-2状态、Ki-67比值、化疗方案及靶向治疗方案等因素与pCR的关系,并通过多因素logistic回归分析pCR的独立危险因素。结果 209例患者中获得pCR共93例(44.50%)。pCR组与非pCR组肿瘤HER-2表达水平、激素受体状态和靶向治疗方案比较,差异均有统计学意义(P <0.05)。多因素logistic回归分析显示HER-2表达水平(OR=7.964,95%CI:0.918~69.065,P=0.048)、激素受体状态(OR=3.859,95%CI:1.930~7.717,P <0.001)和靶向治疗方案(OR=0.432,95%CI:0.186~1.002,P=0.049)是获得pCR的独立预测因素。结论 靶向治疗方案、HER-2表达水平、激素受体状态是影响pCR的独立预测因素,其中HER-2免疫组化为+++、激素受体为阴性及联合双靶治疗的HER-2阳性乳腺癌患者更容易在新辅助化疗中获得pCR。

Objective To explore the influencing factors of pathological complete response(pCR) in patients with human epidermal growth factor receptor 2(HER-2) positive breast cancer treated with neoadjuvant chemotherapy combined with targeted therapy.Methods The clinical data of 209 patients with HER-2 positive breast cancer who underwent neoadjuvant chemotherapy combined with targeted therapy in the Department of Breast Surgery of Shenzhen People's Hospital from January 1,2018 to April 1,2023 were retrospectively analyzed.According to whether pCR was achieved or not,the patients were divided into the pCR group and the non-pCR group.The relationship between factors such as patient age,menopausal status,tumor stage,clinical stage,histological classification,hormone receptor,HER-2status,Ki-67 index,chemotherapy regimen and targeted therapy regimen and pCR was analyzed,and independent risk factors for pCR were analyzed by multifactorial logistic regression.Results pCR was achieved in 93(44.50%) of 209patients.There were significant differences in HER-2 status in tumor,hormone receptor and targeted therapy regimen between the pCR group and the non-pCR group(P < 0.05).Multiple logistic regression analysis showed that HER-2status(OR=7.964,95%CI:0.918-69.065,P=0.048),hormone receptor(OR=3.859,95%CI:1.930-7.717,P < 0.001) and targeted therapy regimen(OR=0.432,95%CI:1.930-7.717,P=0.049) were independent predictors of pCR.Conclusion Targeted therapy regimen,HER-2 expression level and hormone receptor status are independent predictors of pCR.HER-2 positive breast cancer patients with HER-2 immunohistochemistry score of +++,negative hormone receptor and combined dual-targeted therapy are more likely to achieve pCR in neoadjuvant chemotherapy.