三阴性乳腺癌中HER-2低表达与HER-2不表达的新辅助化疗疗效评估

Evaluation of Neoadjuvant Chemotherapy for Triple Negative Breast Cancer with HER-2-low Expression and HER-2-zero Expression

目的 探讨三阴性乳腺癌(triple negative breast cancer, TNBC)患者中HER-2低表达和HER-2不表达在新辅助化疗(neoadjuvant chemotherapy, NAC)疗效方面的差异。方法 回顾性收集2018年1月~2020年1月就诊于南阳市中心医院的120例TNBC患者的临床病理资料,初诊行NAC治疗,其中HER-2低表达组57例,HER-2不表达组63例。采用双侧χ^(2)检验分析比较两组患者的临床病理特征。3年术后复发率或转移率。二元Logistic回归分析评价临床病理因素对病理完全缓解(pathological complete response, pCR)的影响。采用生存曲线比较两组患者的无病生存率。结果 相较于HER-2不表达组,HER-2低表达组患者T_(3~4)期的患者比例显著增高(P<0.05),腋窝淋巴结有转移的患者比例也显著增高(P<0.05),而组织学分级显著更低(P<0.05)。腋窝淋巴结状态(P<0.05)和HER-2表达水平(P<0.05)是TNBC患者pCR的独立影响因素,腋窝淋巴结有转移和HER-2低表达的TNBC患者,在NAC治疗后更不容易达到pCR状态,另外,HER-2低表达组相较HER-2不表达组,3年复发率或转移率明显升高(28.1%vs 11.1%,P<0.05),无病生存率显著降低(P<0.05)。结论 在TNBC患者中,相较于HER-2不表达,HER-2低表达患者腋窝淋巴结转移率更高,在NAC后更不容易达到pCR,预后结果也更差。

Objective To investigate the efficacy difference between HER-2-low expression and HER-2-zero expression in neoadjuvant chemotherapy(NAC)of patients with triple negative breast cancer(TNBC).Methods The clinicopathologic data of 120 patients with TNBC treated in Nanyang Central Hospital from January 2018 to January 2020 were retrospectively collected.They were initially treated with NAC,including 57 patients with HER-2-low expression,and 63 patients with HER-2-zero expression.Bilateralχ^(2) test was used to compare the clinicopathologic features,3-year recurrence rate or metastasis rate of the two groups.The influence of clinicopathologic factors on pathological complete response(pCR)was analyzed by binary Logistic regression analysis.Survival curves were used to compare the disease-free survival rates between the two groups.Results Compared with the HER-2-zero expression group,the proportion of patients with T _(3-4) stage in the HER-2-low expression group was significantly higher(P<0.05),the proportion of patients with axillary lymph node metastasis was also significantly higher(P<0.05),and the histological grade was lower(P<0.05).Axillary lymph node status(P<0.05)and HER-2 expression level(P<0.05)were independent influencing factors for pCR in patientswith TNBC.TNBC patients with axillary lymph node metastasis and HER-2-low expression were less likely to reach pCR status after NAC treatment.In addition,compared with the HER-2-zero expression group,the 3-year recurrence rate or metastasis rate in the HER-2-low expressio group was significantly increased(28.1%vs 11.1%,P<0.05),and the disease-free survival rate was significantly decreased(P<0.05).Conclusion In TNBC patients,compared with HER-2-zero expression,patients with HER-2-low expression had a higher rate of axillary lymph node metastasis,were less likely to achieve pCR after NAC,and had poorer prognosis.