目的

研究乳腺癌分子分型与新辅助化疗效果的关系。

方法

回顾性分析2008 年6 月至2013 年6 月在济宁医学院附属医院乳腺甲状腺外科确诊的136 例原发性乳腺癌并行新辅助化疗的患者资料,以多西他赛+吡柔比星+环磷酰胺(TAC)方案为新辅助化疗方案。 分析基于免疫组织化学的乳腺癌分子分型、临床病理特点与新辅助化疗效果的关系。 影像学疗效评价采用实体瘤疗效评价标准(RECIST)1.1。 不同年龄、腋窝淋巴结状态、Ki67 表达水平、分子分型组间的pCR 率比较采用χ² 检验,不同肿瘤大小组间的pCR 率比较采用Fisher 精确概率法。 多因素分析采用Logistic 回归分析。

结果

新辅助化疗后临床总体缓解率为84.6%(115/136),其中pCR 率为16.2% (22/136),疾病进展(PD)率为2.9%(4/136)。 luminal A 型、luminal B 型、HER-2 过表达型、三阴性乳腺癌的pCR 率分别为5.4%(3/56)、10.0%(3/30)、30.0%(9/30)、35.0%(7/20),差异有统计学意义(χ²=15.132,P=0.002),其中HER-2过表达型及三阴性乳腺癌新辅助化疗pCR 率显著高于luminal A 型(χ²=9.880、11.333,P 均＜0.008)。单因素分析显示,年龄、分子分型、Ki67 表达水平与新辅助化疗pCR 率有关(χ²=15.648、15.132、6.278,P 均＜0.050)。 多因素Logistic 回归分析显示,年龄和分子分型与新辅助化疗pCR 率有关(OR=0.025,95%CI:0.005 ～0.136,P＜.001;OR=3.644,95%CI:1.851 ～7.174,P＜.001)。

结论

乳腺癌新辅助化疗效果与基于免疫组织化学的乳腺癌分子分型有关,三阴性和HER-2 过表达型乳腺癌新辅助化疗更易获得pCR。

Objective

To explore the correlation between the immunohistochemistry-based molecular subtypes and the efficacy of neoadjuvant chemotherapy in primary breast cancer patients.

Methods

We retrospectively studied the records of 136 patients with primary breast cancers who received neoadjuvant chemotherapy (TAC: docetaxel + pirarubicin + cyclophosphamide) in Department of Breast and Thyroid Surgery, Affiliated Hospital of Jining Medical College from June 2008 to June 2013. The correlation of the immunohistochemistry-based molecular subtypes, clinicopathological characteristics with efficacy of neoadjuvant chemotherapy was analyzed. The response of neoadjuvant chemotherapy was comprehensively evaluated based on Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. The pCR rate in groups of different ages,axillary node status, Ki67 expressions and molecular types were processed using χ² test and the pCR rate in groups of different tumor diameters were using Fisher exact test. Multivariate analysis was performed using Logistic regression analysis.

Results

After neoadjuvant chemotherapy, the overall response rate was 84.6%(115/136), including pCR in 22 patients (16.2%,22/136) and disease progression in 4 patients (2.9%,4/136). The pCR rates of luminal A, luminal B, HER-2 overexpression and triple-negative subtype were 5.4%(3/56), 10.0% (3/30), 30.0% (9/30) and 35.0% (7/20) respectively, indicating a significant difference among them(χ² =15.132, P=0.002). The pCR rate of HER-2 overexpression or triple-negative subtype was significantly higher than that of luminal A subtype (χ² =9.880, 11.333, both P＜0.008).Univariate analysis showed that pCR rate of patients after neoadjuvant chemotherapy was correlated with patients' age, molecular subtype and Ki67 expression(χ² = 15.648, 15.132, 6.278,all P＜0.050). In multivariate Logistic regression analysis, pCR rate of patients after neoadjuvant chemotherapy was correlated with patients' age and molecular subtype (OR=0.025,95%CI:0.005-0.136,＜0.001;OR=3.644,95%CI:1.851-7.174,P＜0.001).

Conclusion

The efficacy of neoadjuvant chemotherapy is correlated with immunohistochemistry-based molecular subtype,and the patients with triple-negative and HER-2 overexpression breast cancer are more likely to obtain pCR after neoadjuvant chemotherapy.