局部晚期乳腺癌临床病理特征与新辅助化疗效果和预后的关系

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摘要目的探讨局部晚期乳腺癌临床病理特征与新辅助化疗（NAC）效果及预后的关系。方法分析2012年1月至2015年12月湖北省十堰市太和医院181例接受NAC的乳腺癌患者临床及病理指标资料，按临床效果将其分为临床有效组（149例）和临床无效组（32例），再按病例效果将其分为病理有效组（70例）和病理无效组（111例）。分别比较不同临床效果及不同病理效果患者的临床及病理指标资料。采用多因素logistic回归分析NAC临床效果及病理效果的影响因素。采用生存曲线分析NAC后不同分子分型及不同激素受体状态患者的预后情况。结果 181例患者的临床有效率为82.3%，其中临床完全缓解率为20.4%；病理有效率为38.7%，其中病理学完全缓解率为14.4%。临床有效组与临床无效组分子分型比较，差异有统计学意义（P ＜ 0.05）。病理有效组与病理无效组分子分型分子分型比较，差异有统计学意义（P ＜ 0.05）。临床有效组孕激素受体（PR）阴性占比低于临床无效组，Ki-67阳性占比、p53阴性占比均高于临床无效组，差异有统计学意义（P ＜ 0.05）。病理有效组雌激素受体（ER）阴性占比、PR阴性占比、Ki-67阳性占比、均高于病理无效组，差异有统计学意义（P ＜ 0.05）。多因素分析结果显示Ki-67阳性、p53阴性是NAC临床有效的独立危险因素（OR ＞ 1，P ＜ 0.05），PR阴性、三阴性乳腺癌（TNBC）是NAC临床有效的保护因素（OR ＜ 1，P ＜ 0.05）。Ki-67阳性是病理有效的独立危险因素（OR ＞ 1，P ＜ 0.05），而PR阴性、TNBC是NAC临床有效的保护因素（OR ＜ 1，P ＜ 0.05）。生存分析发现不同分子分型患者NAC治疗后的总生存时间比较，差异有统计学意义（P ＜ 0.05）。NAC治疗后Luminal型患者的总生存时间长于non-Luminal型患者，差异有统计学意义（P ＜ 0.05）。结论影响NAC疗效的因素较多，且不同分子分型的乳腺癌预后存在差异。

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	艾勇彪黄军章书铭李文仿张丹峰

关键词 ：局部晚期乳腺癌, 新辅助化疗, 分子分型, 疗效, 预后

Abstract：Objective To investigate the relationship between clinical and pathological characteristics and the efficacy and prognosis of neoadjuvant chemotherapy (NAC) in locally advanced breast cancer. Methods The clinical and pathological data of 181 breast cancer patients receiving NAC in Shiyan Taihe Hospital, Hubei Province from January 2012 to December 2015 were analyzed. According to the clinical effect, they were divided into clinically effective group (149 cases) and clinically ineffective group (32 cases), and then into pathologically effective group (70 cases) and pathologically ineffective group (111 cases) according to the pathological effect. Patients with different clinical effects and different pathological effects were compared for clinical disease management index data. Multivariate logistic regression was used to analyze the influencing factors of clinical and pathological outcomes of NAC. Survival curves were used to analyze the prognosis of patients with different molecular types and different hormone receptor status after NAC. Results The clinical response rate of 181 patients was 82.3%, and the clinical complete response rate was 20.4%. The pathologic response rate was 38.7%, and the pathologic complete response rate was 14.4%. There was statistically significant difference in molecular typing between the clinically effective group and the clinically ineffective group (P ＜ 0.05). The difference of molecular typing between pathologically effective group and pathologically ineffective group was statistically significant (P ＜ 0.05). The proportion of progesterone receptor (PR) negative in the clinically effective group was lower than that in the clinically ineffective group, the proportion of Ki-67 positive and the proportion of p53 negative were higher than that in the clinically ineffective group, the difference was statistically significant (P ＜ 0.05). The percentages of estrogen receptor (ER) negative, PR negative and Ki-67 positive in pathologically effective group were all higher than those in pathologically ineffective group, with statistical significance (P ＜ 0.05). Multivariate analysis showed that Ki-67 positive and p53 negative were clinically effective independent risk factors for NAC (OR ＞ 1, P ＜ 0.05), and PR negative and triple negative breast cancer (TNBC) were its protective factors for NAC (OR ＜ 1, P ＜ 0.05). Ki-67 positive was a pathologically effective independent risk factor (OR ＞ 1, P ＜ 0.05), while PR negative and TNBC were its protective factors for NAC (OR ＜ 1, P ＜ 0.05). Survival analysis showed that the overall survival time of patients with different molecular subtypes after NAC treatment was statistically significant (P ＜ 0.05). After NAC treatment, the overall survival time of patients with Luminal type was longer than that of patients with non-luminal type, and the difference was statistically significant (P ＜ 0.05). Conclusion There are many factors affecting the efficacy of NAC, and the prognosis of breast cancer varies with different molecular types.

Key words： Locally advanced breast cancer Neoadjuvant chemotherapy Molecular typing Efficacy Prognosis

基金资助:湖北省教育厅科学技术研究项目（B2019109）。

通讯作者: 张丹峰（1982.7-），男，硕士，副主任医师，主要从事乳腺甲状腺疾病临床研究工作。

作者简介: 艾勇彪（1985.10-），男，硕士，主要从事甲状腺乳腺肿瘤临床研究工作。

引用本文:

艾勇彪黄军章书铭李文仿张丹峰. 局部晚期乳腺癌临床病理特征与新辅助化疗效果和预后的关系[J]. 中国医药导报, 2021, 18(20): 86-90.
AI Yongbiao HUANG Jun ZHANG Shuming LI Wenfang ZHANG Danfeng. Analysis of relationship between clinical and pathological characteristics and efficacy and prognosis of neoadjuvant chemotherapy in locally advanced breast cancer. 中国医药导报, 2021, 18(20): 86-90.

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https://www.yiyaodaobao.com.cn/CN/ 或 https://www.yiyaodaobao.com.cn/CN/Y2021/V18/I20/86

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