摘要
目的对乳腺癌新辅助治疗后病理完全缓解（pCR）的预测因素进行分析。方法选择2009年1月至2011年12月确诊为原发性乳腺癌并接受新辅助治疗的159例患者为研究对象进行前瞻性分析，年龄28—70岁，中位年龄50岁。以紫杉类及蒽环类药物为基础方案，同时对人类表皮生长因子受体2阳性患者联合应用曲妥珠单抗。分析组织病理免疫组化结果及分子分型对pCR的预测价值。影像学疗效评价采用RECIST1．1标准，组织学评估采用Miller—Payne标准。结果新辅助治疗影像学评价原发病灶临床总体缓解率75．5％（120／159），其中临床完全缓解10．1％（16／159），部分缓解65．4％（104／159），疾病稳定24．5％（39／159），无疾病进展病例。病理组织学评价G5（pCR）27．7％（44／159），G428．3％（45／159），G318．9％（30／159），G212．6％（20／159），G112．6％（20／159）。组织病理检查免疫组化高组织学分级（Z=-2．820，P=0．005）、Ki67高表达（Z=-1．989，P=0．047）、p53高表达（Z=-2．457，P=0．014）的肿瘤pCR率更高；在分子分型中三阴型乳腺癌pCR率高于非三阴型乳腺癌（P=0．000）。结论组织学分级、Ki67、p53与pCR密切相关，三阴型乳腺癌pCR率更高。
Objective To assess the effect of neoadjuvant chemotherapy and the factors related with pathological complete response （pCR） of neoadjuvant chemotherapy in breast cancer. Methods The data of 159 primary breast cancer patients who had received neoadjuvant chemotherapy and operation with complete MRI data and histopathology evaluation in this center from January 2009 to December 2011 was analyzed. All the patients were female, aging from 28 to 70 years with a median of 50 years. The neoadjuvant chemotherapy regimens were based on anthracyclines or taxanes, and trastuzumab was used in almost half of the human epidermalgrowth factor receptor 2 positive patients. The response of neoadjavant chemotherapy was comprehensively evaluated based on RECIST 1.1 and Miller-Payne grading system. SPSS 18.0 was used for statistical analysis. Results Among the 159 patients, 10. 1% patients had achieved complete response according to the MRI evaluation, and the rate of partial response, stable disease, and progressive disease was 65.4% , 24. 5% , and 0 respectively. According to the Miller-Payne grading system, 27.7% patients had pathological response evaluated as G5 （pCR）, and the response evaluated as G4, G3, G2,and G1 were 28.3% , 18.9% , 12.6%, and 12.6% respectively. The higher histological grade were correlated with pCR statistically （ Z = - 2. 820, P = 0. 005 ）. Meanwhile strong expression of Ki67 （ Z = - 1. 989, P =0. 047） and p53 （Z = -2. 457, P =0. 014） were related to pCR in a significant statistically way. Conclusions The response of neoadjuvant chemotherapy can be predicted. The histological grade and the immunohistochemistry results of Ki67 and p53 are related to pCR of neoadjuvant chemotherapy for primary breast cancer. Basal-like breast cancer had a higher pCR statistically.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2013年第4期339-343,共5页
Chinese Journal of Surgery
基金
首都医学发展科研基金资助项目（2009-1011）
北京市科委科技计划资助项目（D090507043409010）
关键词
乳腺肿瘤
抗肿瘤联合化疗方案
预测
免疫表达分型
Breast neoplasms
Antineoplasticconlbinedchemotherapyprotocols
Forecasting
hnmunophenotyping
