新辅助化疗对Luminal B型乳腺癌各亚组的疗效观察及预后分析

目的：观察新辅助化疗（NAC）对Luminal B型乳腺癌各亚组疗效及预后的差异，探讨不同亚组的临床治疗特点。方法：选择完成预计NAC疗程及手术治疗的Luminal B型乳腺癌患者246例，所有治疗前活检标本中雌激素受体（ER）均为阳性，根据孕激素受体（PR）、人表皮生长因子2（Her-2）及细胞增殖核抗原Ki-67的表达又将其分为3个亚组，即A亚组（PR低表达组），Her-2阴性，且PR阴性或<20%，Ki-67任何水平；B亚组（PR高表达组），Her-2阴性，PR≥20%且Ki-67≥14%；C亚组（Her-2阳性组），Her-2阳性，Ki-67和PR任何水平；收集所有患者的临床病理资料并随访复发转移事件。结果：Luminal B型乳腺癌患者3个亚组间年龄、原发肿瘤大小和肿瘤TNM分期比较差异均无统计学意义（P>0.05）；3个亚组患者淋巴结转移率比较差异有统计学意义（P=0.018），其中A亚组患者淋巴结转移率最高。3个亚组患者临床疗效和病理疗效比较差异均无统计学意义（P=0.123，P=0.06）。8.5%（21/246）患者达到病理完全缓解（pCR），3个亚组患者pCR率比较差异有统计学意义（P=0.009），C亚组pCR率最高，B亚组pCR率最低。3个亚组患者生存曲线经Log-Rank检验差异无统计学意义（P=0.216），但B亚组3年和5年无病生存率（DFS）均稍高于其他2组。C亚组患者的DFS比同时期单纯Her-2过表达型乳腺癌长（P=0.047）。结论：NAC中Her-2阳性型Luminal B型乳腺癌更易达到pCR，预后比单纯Her-2过表达型乳腺癌好；Luminal B型乳腺癌中PR高表达者同PR低表达及Her-2阳性者比较有预后相对较好的趋势。

Observation on curative effects of neoadjuvant chemotherapy for different subtypes of Luminal B breast cancer and analysis on its prognosis

Objective:To investigate the differences in the curative effects of neoadjuvant chemotherapy(NAC) for different subtypes of Luminal B breast cancer and its prognosis,and to discuss the clinical treatment characteristics of different subgroups.Methods:A total of 246 cases of Luminal B like breast cancer patients who completed the projected NAC courses and surgical treatment were selected.All the biopsy specimens before treatment were positive for estrogen receptot(ER).According to the expressions of progesterone receptor(PR), human epidermal growth factor-2(Her-2)and cell proliferation nuclear antigen Ki-67,246 cases of Luminal B breast cancer patients were divided into 3 subgroups.A subgroup(PR low expression group),Her-2 negative and PR< 20% or negative,Ki-67 any levels;B subgroup(PR high expression group),Her-2 negative,PR≥20% and Ki-67 ≥14%;C subgroup(Her-2 positive group),Her-2 positive,Ki-67 and PR any levels.The clinical pathological materials and follow-up recurrence events of the patients were collected.Results:Among the three subtypes of Luminal B breast cancer,there were no significant differences in the age,the size of primary tumor and the stage of TNM(P>0.05).There were significant differences in the lymph node metastasis rate among three subgroups(P=0.018),and the lymph node metastasis rate was the highest in A subgroup among three subgroups. There were no significant differences in the clinical response and pathological response among three subgroups(P=0.123,P=0.06).8.5%(21/246)patients achieved the pathological complete response(pCR);the rates of pCR in three subgroups had statistically significant difference(P=0.009);the rate of pCR in C subgroup was the highest, and the rate of pCR in B subgroup was the lowest.The Log-Rank test of the survival curves of three subgroups had not statistically significant difference(P=0.216),but the 3-year disease-free survival(DFS)and 5-year DFS of the patients in B subgroup were slightly higher than those in other two groups.The DFS of the patients in C subgroup was longer than that of the patients with Her-2 overexpression breast cancer at the same period,and the difference was statistically significant(P=0.047).Conclusion:Her-2 positive Luminal B breast cancer is more likely to achieve pCR in NAC and the prognosis is better than Her-2 overexpressing breast cancer.The patients with high expression of PR in Luminal B breast cancer patients have a tend of overall survival advantage compared with the patients with PR low expression and Her-2 positive expression.