TCbHP新辅助化疗治疗HER-2阳性乳腺癌的临床疗效及其相关因素研究

Study of complete pathological remission in HER-2-positive breast cancer patients after neoadjuvant chemotherapy regimen with TCbHP and related factors

目的:探究紫杉类+铂类(TCbHP)新辅助化疗方案治疗人表皮生长因子受体-2(HER-2)阳性乳腺癌的临床疗效,并分析其影响因素。方法:根据新辅助治疗方案不同将80例HER-2阳性乳腺癌患者分为对照组及观察组,每组各40例。对照组采用紫杉类单药(THP)新辅助化疗方案治疗;观察组采用TCbHP新辅助化疗方案治疗。记录并比较两组患者一般资料、病理完全缓解率及不良反应发生情况,采用Logistic回归分析影响患者病理完全缓解率的相关因素,制作受试者工作曲线(ROC),并以曲线下面积(AUC)分析各指标对患者病理完全缓解率的预测价值。结果:观察组病理完全缓解率高于对照组(P<0.05)。两组患者不良反应发生率无统计学差异(P>0.05)。Logistic分析显示,有并发症、激素受体为阴性、Ki67表达率≥30%、HER-2表达为+++及采用THP治疗均为影响患者病理完全缓解率的独立危险因素。经ROC曲线分析发现,是否有并发症、激素受体状况、Ki-67表达率、HER-2表达及治疗方式均对预测患者病理完全缓解情况具有较高敏感度及特异度,且各指标联合诊断的AUC为0.817,敏感度为0.667,特异度为0.860。结论:相较于THP治疗,HER-2阳性乳腺癌患者采用TCbHP治疗后病理完全缓解率较高,有并发症、激素受体为阴性、Ki67表达率≥30%、HER-2表达为+++及治疗方式为THP均是病理完全缓解率的影响因素,且该类指标可对病理是否完全缓解具有预测价值。

Objective:To investigate the complete pathological remission after neoadjuvant chemotherapy regimen of paclitaxel+platinum(TCbHP)in patients with human epidermal growth factor receptor-2(HER-2)-positive breast cancer and analyze the corresponding influencing factors.Methods:80 patients with HER-2 positive breast cancer were divided into a control group and an observation group of 40 cases each according to the different neoadjuvant treatment regimens used.The control group was treated with paclitaxel single-agent(THP)neoadjuvant chemotherapy regimen and the observation group was treated with TCbHP neoadjuvant chemotherapy regimen.The baseline data,pathological complete remission rate and adverse reactions of patients in the two groups were recorded and compared.Logistics regression was used to analyze the relevant factors affecting the pathological complete remission rate of the patients,to produce the working curve(ROC)of the subjects,and to analyze the predictive value of each index for the pathological complete remission rate of the patients by the area under the curve(AUC).Results:The rate of complete pathological remission was higher in the observation group than that in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups of patients compared with each other(P>0.05).Logistic analysis results concluded that having comorbidities,being negative for hormone receptors,Ki67 expression rate≥30%,HER-2 expression of+++,and treatment modality of THP were all relevant factors affecting the rate of complete pathological remission in patients.The ROC curve analysis revealed that the presence of comorbidities,hormone receptor status,Ki-67 expression rate,HER-2 expression,and treatment modality all had high sensitivity and specificity in predicting patients pathological complete remission,and the combined AUC of each index was 0.817,with a sensitivity of 0.667 and a specificity of 0.860.Conclusion:Compared with THP treatment,HER-2-positive breast cancer patients treated with TCbHP have a higher rate of complete pathological remission,and it is also found that having comorbidities,hormone receptor negative,Ki67 expression rate≥30%,HER-2 expression of+++and treatment mode of THP will reduce the rate of complete pathological remission in the patients,and this type of index can be a certain prediction of whether the pathological complete remission is somewhat predictive.