原发性乳腺癌分子分型与新辅助化疗疗效及预后的相关性

Relationship of Molecular Subtypes with Responses and Outcome of Primary Breast Cancer Patients Treated with Neoadjuvant Chemotherapy

目的探讨原发性乳腺癌分子分型与新辅助化疗疗效及预后之间的相关性。方法回顾性分析河南省肿瘤医院收治的204例接受新辅助化疗患者的临床病理资料,分为Luminal A、Luminal B、HER2阳性和三阴乳腺癌4种亚型,分析乳腺癌分子分型对新辅助化疗疗效及预后的预测作用。结果 204例患者中,40例(19.6%)为Luminal A亚型,46例(22.5%)为Luminal B亚型,36例(17.6%)为HER2阳性亚型,82例(40.2%)为三阴乳腺癌亚型。HER2阳性(22.2%)及三阴乳腺癌亚型(22.4%)的病理完全缓解(p CR)率明显高于Luminal A亚型(2.5%)及Luminal B亚型(6.5%),差异有统计学意义(P=0.03)。与Luminal亚型相比,HER2阳性及三阴乳腺癌亚型具有更差的无病生存期(DFS)(P=0.001)和OS(P=0.002);剔除获得p CR的患者,单独评价存在肿瘤残留的患者,我们发现HER2阳性及三阴乳腺癌亚型比Luminal亚型具有更差的DFS(P<0.001)和OS(P<0.001)。获得p CR的乳腺癌患者的5年DFS和总生存期(OS)均明显高于化疗后仍有癌残留的患者(P=0.002,P=0.012)。结论相对于Luminal亚型,HER2阳性和三阴乳腺癌亚型对新辅助化疗更为敏感,更易达到p CR;但是HER2阳性和三阴乳腺癌亚型预后反而更差。

Objective To explore the relationship of molecular subtypes with the responses and outcome of primary breast cancer patients treated with neoadjuvant chemotherapy. Methods We included 204 patients with primary breast cancer treated with neoadjuvant chemotherapy in He'nan Tumor Hospital in this retrospective study. The patients were classified into 4 subtypes: Luminal A, Luminal B, HER2 positive and triple-negative. The predictive role of molecular subtype in the response and outcome of breast cancer patients treated with neoadjuvant chemotherapy were analyzed. Results Among all 204 patients, 40(19.6%) patients were Luminal A subtype, 46(22.5%) were Luminal B subtype, 36(17.6%) were HER2 positive subtype and 82(40.2%) were triple-negative subtype. The p CR rates of HER2 positive(22.2%) and triplenegative(24.4%) subtypes were higher than those of Luminal A(2.5%) and Luminal B(6.5%), with significant difference(P=0.03). Despite initial chemosensitivity, the patients with HER2 positive and triple-negative subtypes had worse disease-free survival(DFS)(P=0.001) and overall survival(OS)(P= 0.002) than those with Luminal subtypes in the whole population, and especially worse in patients with residual disease after neoadjuvant chemotherapy with decreased DFS(P<0.001) and OS(P<0.001). The 5-year DFS and OS of patients who achieved pathological complete response(p CR) were significantly higher than those of patients with residual disease after chemotherapy(P=0.002, P=0.012, respectively). Conclusion We have found that breast cancer patients with HER2 positive and triple-negative subtypes have higher sensitivity to neoadjuvant chemotherapy and with higher rates of p CR but worse prognosis than those with Luminal subtypes.