中国实用外科杂志

中国实用外科杂志

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乳腺癌新辅助治疗疗效相关因素分析

程    岩1，2，徐    玲1，刘    倩1，刘荫华1   

  1. 1北京大学第一医院乳腺疾病中心，北京100034；2河北省优抚医院，河北石家庄050051
  • 发布日期:2012-10-19

  • Published:2012-10-19

摘要：

目的    对乳腺癌新辅助治疗疗效相关因素进行分析。方法    选择2009年1月至2010年8月在北京大学第一医院乳腺疾病中心接受新辅助治疗的原发乳腺癌病人为研究对象，以蒽环类及紫杉类细胞毒药物为新辅助化疗基础方案，并对人类表皮生长因子受体2（HER2）阳性病人联合应用曲妥珠单抗。参照实体肿瘤疗效评价标准（RECIST1.1）及组织学分级系统（Miller and Payne grading system）对新辅助治疗疗效进行综合评价。结果    共105例病人入组，动态增强MRI评价临床完全缓解（CR）12例（11.4%），部分缓解（PR）68例（64.8%），疾病稳定（SD）24例（22.9%），疾病进展（PD）1例（1.0%）；组织分级系统评价: 30例（28.6%）G5（病理完全缓解，pCR），35例（33.3%）G4，17例（16.2%）G3，12例（11.4%）G2，11例（10.5%）G1。单因素分析提示，肿瘤临床T分期和N分期较早，高组织学分级、Ki67、p53 及HER2高表达与病理完全缓解率相关，且差异有统计学意义（P<0.01）；而雌激素受体（ER）、孕激素受体（PR）及CK5/6在疗效评价中差异无统计学意义（P>0.05）。结论    T分期、N分期、组织学分级、HER2、Ki67、p53与新辅助治疗疗效具有相关性 。

关键词: 乳腺癌, 新辅助治疗

Abstract:

Analysis on the factors related with the response of neoadjuvant therapy in primary breast cancer        CHENG Yan*, XU Ling, LIU Qian, et al. *Breast Disease Center, Peking University First Hospital, Beijing 100034, China 
Corresponding author：LIU Yin-hua，E-mail：liuyinhua@medmail.com.cn
Abstract    Objective    To assess the effect of neoadjuvant therapy and to investigate the factors related with the response of neoadjuvant therapy in breast cancer patients. Methods    We reviewed data of the primary breast cancer patients who had received neoadjuvant therapy with complete MRI data and who had received operation with histopathology evaluation in our center from January, 2009 to August, 2010. The neoadjuvant therapy regimens were based on anthracyclines and taxanes, and trastuzumab was used in most of the HER2 positive patients. The response of neoadjuvant therapy was comprehensively evaluated based on RECIST1.1 and Miller-Payne grading system. Results Among the 105 patients, 12（11.4%）patients had CR, 68（64.8%）patients had PR, 24（22.9%）patients had SD and 1（1.0%）patient had PD according to the MRI evaluation. While according to the Miller-Payne grading system, 30（28.6%） patients had G5，35（33.3%） patients had G4,17 （16.2%）patients had G3, 12（11.4%) patients had G2，11（10.5%）patients had G1. The analysis suggests that the smaller tumor size, fewer positive lymph nodes, and higher histological grade were correlated with pCR statistically. Meanwhile the results of IHC suggested that strong express of HER2, Ki67 and p53 are related to pCR in a statistically significant way (P＜0.01), while the express of ER、PR and CK5/6 had no correlation with pCR. Conclusion    The effect of new adjuvant therapy can be predicted. The tumor size, lymph node status, histological grade and the IHC results of HER2, Ki67 and p53 were related to the pCR of new adjuvant therapy for primary breast cancer.

Key words: breast cancer, new adjuvant therapy