HR阴性HER2低表达与HR阴性HER-2(0)乳腺癌的临床病理特征及新辅助化疗疗效对比分析研究

Study on clinicopathological characteristics of HR negative breast cancer patients with low HER2 expression or HER-2(0)negative and efficacy comparison of neoadjuvant chemotherapy

目的探讨HR阴性HER2低表达与HR阴性HER-2(0)乳腺癌的临床病理特征,以及HER2状态与乳腺癌新辅助化疗疗效的相关性。方法回顾性分析2017年1月—2023年7月本院甲乳外科收治的HR阴性HER2低表达与HR阴性HER-2(0)乳腺癌患者的临床资料,依据治疗方案分为确诊后直接行手术及辅助治疗和确诊后行新辅助治疗两个部分。统计分析确诊后直接行手术及辅助治疗患者的临床病理特征差异。采用单因素和多因素分析评估乳腺癌新辅助化疗患者治疗后达病理学完全缓解(pathological complete response,pCR)的独立影响因素,评估HER2状态与乳腺癌新辅助化疗疗效的相关性。结果本研究纳入符合标准的乳腺癌患者共356例,其中确诊后直接行手术及辅助治疗(未行新辅助治疗)患者共267例,确诊后行新辅助治疗89例。与HR阴性HER-2(0)组相比,HR阴性HER2低表达组患者年龄大于50岁比例更高(58.7%vs 44.9%,P=0.027),已绝经比例更高(56.9%vs 43.7%,P=0.034),肿瘤大小>2 cm比例更高(80.7%vs 63.9%,P=0.003),脉管癌栓比例更低(39.4%vs 55.7%,P=0.009)。多因素Logistic回归分析结果显示,临床T分期(OR为0.353,95%CI为0.140~0.894,P=0.028)和临床TNM分期(OR为0.123,95%CI为0.040~0.379,P<0.001)为新辅助化疗获得pCR的独立预测因子,而HER2状态并非新辅助化疗pCR的预测因子。结论HR阴性HER2低表达与HR阴性HER-2(0)乳腺癌的临床病理特征具有一定差异性。HER2状态并非是乳腺癌新辅助化疗pCR的独立预测因子。

Objective To investigate the clinicopathological characteristics of HR negative breast cancer patients with HER2 negative or low HER2 expression and the correlation between the HER2 expression and therapeutic effect of neoadjuvant chemotherapy.Methods The clinical data of HR negative breast cancer patients with HER2 negative or low HER2 expression who were admitted to department of thyroid gland breast surgery of the First Affiliated Hospital of Wannan Medical College from January 2017 to July 2023 were retrospectively analyzed.According to the therapeutic schedules,the patients were divided into the surgery and adjuvant chemotherapy group and the neoadjuvant chemotherapy group.The differences in clinical characteristics of the two groups were analyzed.The independent influencing factors of pathological complete response(pCR)after neoadjuvant chemotherapy were evaluated by univariate and multivariate logistic regression.The association between HER2 status and the efficacy of neoadjuvant chemotherapy in breast cancer was evaluated.Results 356 cases of patients suffering from breast cancer were enrolled in this study,among them,267 cases of patients underwent surgery directly and received adjuvant therapy(did not adopt neoadjuvant therapy)and 89 cases of patients adopted neoadjuvant therapy.Compared with the HR negative HER2(0)patients,the HR negative HER2 low expression patients had a higher proportion of patients over 50 years old(58.7%vs 44.9%,P=0.027),a higher proportion of postmenopausal state(56.9%vs 43.7%,P=0.034),a higher proportion of tumor size over 2 cm(80.7%vs 63.9%,P=0.003),and a lower proportion of lymphovascular invasion(39.4%vs 55.7%,P=0.009).Multivariate analysis of logistic regression model showed that clinical tumor staging(OR=0.353,95%CI:0.140~0.894,P=0.028)and clinical TNM staging(OR=0.123,95%CI:0.040~0.379,P<0.001)were independent predict indicators of pCR.The HER2 expression was not an independent predictor for pCR in breast cancer patients undergoing neoadjuvant chemotherapy.Conclusions There are significant differences in clinicopathological characteristics between the HR negative HER-2(0)patients and the HR negative HER2 low expression patients.The HER2 expression is not an independent predictor for pCR in breast cancer patients undergoing neoadjuvant chemotherapy.