表皮生长因子受体-2和雌激素受体对晚期乳腺癌应用紫杉类药物疗效的预测分析

目的 研究表皮生长因子受体-2（HER-2）和雌激素受体（ER）对乳腺癌应用紫杉类药物化疗疗效的预测作用。方法 268例晚期乳腺癌应用紫杉类药物化疗,其中单药紫杉醇71例,单药泰索帝32例,紫杉醇联合组110例,泰索帝联合组55例。应用免疫组化的方法对患者的ER和HER-2生物学指标在蛋白水平进行检测。268例中,行HER-2检测201例,行ER检测242例,行HER-2和ER两项检测者200例。结果 HER-2过表达有效率为56．7％,低表达有效率为33．3％,两组差异有统计学意义（P=0．003）。ER阳性有效率为33．3％,ER阴性患者有效率为48．9％,两组差异有统计学意义（P=0．015）。在HER-2过表达同时ER阴性患者的有效率高达67．6％,其他组各组均在35％左右,HER-2过表达同时ER阴性与其他3组进行两两比较,差异有统计学意义（P〈0．01）;而其他3组之间差异无统计学意义。多因素分析显示HER-2过表达仍有统计学意义（P=0．007）。而ER受体以及KPS评分、葸环类药物、转移部位均不具有统计学意义。结论 HER-2过表达和（或）ER阴性,尤其HER-2过表达对紫杉类药物的疗效可能有预测作用,HER-2过表达可能是乳腺癌紫杉类化疗效果好的分子指标。     

HER-2和Topo-Ⅱ蛋白表达对乳腺癌新辅助化疗疗效的预测价值

目的 探讨HER-2、Topo-Ⅱ蛋白表达对紫杉联合葸环类的新辅助化疗方案治疗乳腺癌的疗效预测价值.方法 采用免疫组化法检测86例乳腺癌术前肿瘤穿刺组织HER-2和Tope-Ⅱ蛋白表达,了解其与临床及病理疗效的关系.结果 本组临床有效率为84.9%,临床完全缓解占36.0%(31/86),部分缓解占48.8%(42/86);病理完全缓解15例(17.4%).HER-2与Topo-II阳性率分别为31.1%和51.4%.HER-2过表达与临床及病理疗效明显相关(P＜0.05),Tope2 Ⅱ过表达与化疗疗效无关(P＞0.05).HER-2与Tope-Ⅱ共表达者疗效更好(P＜0.05).结论 HER-2过表达者对紫杉联合蒽环类的新辅助化疗方案更敏感,HER-2有可能成为该方案的疗效预测指标.     

生存素乳腺癌耐药蛋白和人表皮生长因子受体2基因的表达与乳腺癌新辅助化疗疗效的关系

目的 探讨生存素(Survivin)、乳腺癌耐药蛋白(BCRP)以及人表皮生长因子受体2(HER-2)基因表达对乳腺癌TE方案新辅助化疗疗效的预测价值.方法 对56例乳腺癌患者行TE方案新辅助化疗,应用RT-PCR法检测TE方案化疗前后Survivin、BCRP和HER-2 mRNA的表达差异,并结合化疗疗效进行相关性分析.结果 56例乳腺癌患者经TE方案新辅助化疗后的总有效率为71.4％.全组完全缓解5例,病理完全缓解4例,部分缓解35例,稳定13例,进展3例.Survivin mRNA的阳性表达率由化疗前的60.7％降至化疗后的35.7％ (P =0.008);BCRP mRNA的阳性表达率由化疗前的37.5％降至化疗后的19.6％(P=0.036);HER-2 mRNA的阳性表达率由化疗前的41.1％降至化疗后的21.4％ (P =0.025).Survivin或BCRP单独阴性表达的患者化疗的有效率均较阳性表达者高(均P＜0.05).HER-2 mRNA的单独表达状况与化疗疗效无关(P =0.144).Survivin、BCRP和HER-2 mRNA均为阴性表达的患者化疗疗效高于其他各组(P =0.003).在乳腺癌组织中,Survivin、BCRP和HER-2 mRNA的表达之间不存在相关关系(P＞0.05).结论 联合检测Survivin、BCRP和HER-2的表达可作为预测乳腺癌TE方案新辅助化疗敏感性的分子生物学指标.     

以吉西他滨为主的联合化疗方案治疗难治性乳腺癌的临床观察

目的观察以吉西他滨为主的联合化疗方案治疗对葸环类和紫杉类均耐药的转移性乳腺癌的疗效和不良反应。方法我院从2006年1月～2008年12月分别采用吉西他滨联合顺铂（GP）、异环磷酰胺（GI）或希罗达（GX）方案治疗蒽环类和紫杉类均耐药的转移性乳腺癌74例,21天为1个周期,中位化疗周期数为4个。结果本组完全缓解（CR）1例（1％）,部分缓解（PR）21例（30％）,稳定（SD）35例（50％）,进展（PD）13例（19％）,总有效率（RR=CR＋PR）为31％,临床获益率（CR＋PR＋SD〉6个月）为53％,中位疾病进展时间（TTP）5个月,1年生存率为56．6％,2年生存率为34．8％,中位生存期为15个月。三组化疗方案间疗效无统计学差异。无化疗相关死亡病例,主要不良反应为骨髓抑制及胃肠道反应。结论以吉西他滨为主,联合顺铂、异环磷酰胺或希罗达方案对蒽环类和紫杉类均耐药的转移性乳腺癌有较好的疗效,不良反应可耐受,为有效的解救方案。     

新辅助化疗TE与CEF方案治疗乳腺癌的临床效果比较

目的比较新辅助化疗TE（紫杉类联合蒽环类）及CEF（环磷酰胺、表阿霉素、氟尿嘧啶）方案治疗乳腺癌的疗效，不良反应及其与组织病理学的关系；探讨新辅助化疗对ER、PR、HER-2、P53表达状况的影响。方法收集天津肿瘤医院2001年1月至2006年12月临床分期Ⅱ～Ⅲ期的行TE新辅助化疗患者167例，行CEF新辅助化疗患者256例。化疗皆以21d为1个周期。所有患者均完成3个周期以上的化疗后对两组患者临床效果的差异进行评价。结果乳腺癌原发肿瘤的总缓解率（RR），TE组为86％（144／167），CEF组为67％（172／256），两组间比较差异无统计学意义（P〈0．01）。临床完全缓解率（cCR），TE组为32％（54／167），CEF组为23％（59／256），两组间比较差异有统计学意义（P〈0．05）。病理完全缓解率（pCR），TE组为19％（32／167），CEF组为14％（36／256），两组间比较差异无统计学意义（P〉0．05）。两组各有2例患者出现疾病进展（PD）。主要不良反应为白细胞下降、胃肠道反应，TE组脱发较严重。两组化疗方案对ER、PR、HER-2、P53表达的差异均无统计学意义。结论新辅助化疗TE与CEF方案对乳腺癌均有较高的缓解率，且TE方案优于CEF方案。化疗的不良反应均在可耐受范围之内，而TE组患者的脱发等副反应要高于CEF组。两组新辅助化疗对ER、PR、HER-2、P53表达的影响无统计学意义。     

40例乳腺癌新辅助化疗的疗效观察

目的评价含紫杉类或葸环类药物在乳腺癌术前化疗中的疗效及副作用。方法2005年7月～2007年11月在我院治疗的40例Ⅰ～Ⅲ期原发乳腺癌患者,采用含紫杉类（TP或TE／TEC方案）或葸环类（EC／FEC方案）联合方案,术前化疗2～4个周期,33例患者接受手术,术后完成规定化疗,应用B超结合触诊判断临床疗效,观察近期疗效及毒副作用,应用x^2检验及单因素分析判定相关因素与疗效的关系。结果化疗前后中位肿瘤最大径分别为3．5厘米和2．0厘米（P=0．01）,临床有效率82．5％（33／40）,其中cCR7．5％（3／40）、cPR75％（30／40）、cSD15％（6／40）、cPD2．5％（1／40）。手术治疗33例,术后pCR9．1％（3／33）,tpCR6．1％（2／33）。这些病例中,不同肿瘤大小、受体状况、CerbB-2表达、不同分化程度以及化疗方案之间的肿瘤缓解率并无统计学差异。化疗毒副作用主要为脱发、骨髓抑制、消化道反应、口腔溃疡及外周神经毒性,心脏毒性主要表现为心律增快、心电图改变,肝功损害少见。结论紫杉类及蒽环类药物联合方案用于浸润性乳腺癌的术前化疗,可有效控制肿瘤,毒副作用可耐受。     

蒽环类联合紫杉类方案在乳腺癌新辅助化疗中的有效性及安全性评价

目的探讨蒽环类联合紫杉类方案在乳腺癌新辅助化疗中的有效性及安全性。方法收集2005年6月至2014年10月接受蒽环类联合紫杉类方案新辅助化疗的早期或局晚期乳腺癌192例患者的临床资料,探讨化疗方案的疗效以及安全性,并分析影响病理完全缓解的相关因素。结果 192例患者均可评价疗效,有效率为84.9%(163/192),病理完全缓解率为20.3%(39/192),其中HR(+)/HER-2(-)组为8.5%(10/118)、HR(-)/HER-2(+)组为42.8%(6/14)、HR(+)/HER-2(+)组为25.0%(5/20)、HR(-)/HER-2(-)组为45.0%(18/40)。HR(-)组病理完全缓解率显著高于HR(+)组(P<0.001);在HR(-)组中,HR(-)/HER-2(+)与HR(-)/HER-2(-)组之间病理完全缓解率的差异无统计学意义(P>0.05)。Logistic回归分析显示,ER状态是影响病理完全缓解率的独立因素。主要的剂量限制性毒性为3、4级中性粒细胞减少(94.8%);非血液学毒性包括2、3级呕吐(6.2%),骨骼肌肉疼痛、麻木(14.1%),中性粒细胞缺乏性发热(16.7%),黏膜炎(2.1%)以及心脏毒性(5.7%)等。结论蒽环类联合紫杉类方案在乳腺癌新辅助化疗疗效确切,不良反应可耐受,可作为乳腺癌新辅助化疗的优选方案。     

69例年轻乳腺癌新辅助化疗的疗效和影响因素分析

[目的]探讨年轻局部晚期乳腺癌的临床病理特点、新辅助治疗的疗效和影响疗效的相关因素。[方法]回顾性分析中国医学科学院肿瘤医院2005年1月至2009年1月收治的年龄小于40岁的接受术前化疗的局部晚期乳腺癌患者资料。[结果]全组患者病理完全缓解9例（13.0%）,有效率76.8%（53/69）;1例病情进展。5例在化疗后接受了保乳手术。单因素分析发现,含紫杉类方案（TE）是影响新辅助化疗疗效因素（P〈0.05）,而组织学分级,肿瘤大小,淋巴结状况,ER、PR、HER-2表达和分子分型与新辅助化疗疗效无关。[结论]年轻局部晚期乳腺癌对术前化疗敏感,含紫杉类药物的方案有助于提高化疗疗效。     

乳腺癌肝转移的临床病程与预后分析

目的 探讨乳腺癌肝转移的临床病程、治疗效果及预后因素。方法 采用SPSS 11.5统计软件对152例乳腺癌肝转移患者的生存及预后因素进行回顾性分析。结果 全组中位无病生存期（DFS）为21个月,转移后中位生存期（MSR）为16个月,中位至疾病进展时间（TTP）为7．4个月。肝转移后一线化疗的有效率为54．5％,高于介入治疗（37．7％,P=0．039）。含紫杉类方案化疗组的有效率为63．3％,高于不含紫杉类方案化疗组（40．O％,P=0．04）;含紫杉类方案化疗组的TTP为10个月,亦高于不含紫杉类方案化疗组（7个月,P=0．048）。无论介入治疗（TACE）,还是化疗,治疗有效者的MSR（18个月）均长于无效者（14个月,P=0．002）。对于单发肝转移瘤患者,单纯介入治疗的MSR（30个月）长于单纯化疗（16个月,P=0．0052）;对于多发肝转移瘤患者,单纯介入治疗与单纯化疗的MSR差异无统计学意义。原发肿瘤大小、腋窝淋巴结转移数、雌激素受体状态、肝转移后转氨酶异常程度、肝转移灶大小是影响预后的重要因素。结论 有效的化疗（尤其是含紫杉类方案化疗）和介入治疗能明显改善乳腺癌肝转移患者的预后。     

TTC及FTC方案新辅助化疗治疗乳腺癌的疗效分析

目的比较新辅助化疗方案TTC及FTC治疗乳腺癌的疗效。方法收集325例乳腺癌新辅助化疗患者的资料,其中TTC方案138例、FTC方案187例,并采用免疫组织化学法检测所有患者化疗前活组织检查标本TopoⅡa的表达状况。结果TTC组、FTC组乳腺癌总缓解率（RR）分别为87．7％、67．4％,两组差异有统计学意义（P=0．000）;而分层分析显示：在TopoⅡa（-）组,TTC、FTC两组患者RR差异均有统计学意义,而TopoⅡa（＋）Her-2（-）组,FTC组为79．4％,TTC组为87．8％,差异无统计学意义（P=0．266）;TTC组、FTC组患者的病理完全缓解率分别为13．7％、11．2％,差异无统计学意义（P=0．491）。结论新辅助化疗TTC较FTC方案有较高的缓解率;而对于TopoⅡa（-）患者,应用或联合紫杉类药物治疗可能取得更好的疗效。     

Clinical Implications of HER-2 and P53 in Taxane-Based and Anthracycline-Based Neoadjuvant Chemotherapy in Breast Cancer

Objective  To evaluate the predictive value of human epidermal growth factor receptor-2 (HER-2) and P53 in taxanebased and anthracycline-based neoadjuvant chemotherapy (NAC) in breast cancer. Methods  Sixty-two patients with breast cancer were included in this study. Twenty-two patients were treated with taxane-based (taxane group) and 40 with anthracycline-based (anthracycline group). ER, PR, c-erbB2 and P53 were detected by immunohistochemistry staining before NAC, and Fluorescence In Situ Hybridization(FISH) was used to detect the HER-2 gene amplification for the cases with the expression of c-erbB2 protein as (++) or (+++). The efficacy of the regimens was evaluated a er NAC. Results  In the anthracycline group, objective response (OR) was observed in 30 out of 40 patients (75%), whereas no response (NR) was observed in 10 patients (25%). In the taxane group, OR was observed in 15 patients out of 22 patients (68.2%), whereas NR was observed in 7 patients (31.8%). HER-2-negative status was correlated with a high OR in both taxane-based and anthracycline-based NAC (P = 0.023 and P = 0.029), whereas P53-negative status was correlated with high OR rate in anthracycline-based NAC (P = 0.041). The significant difference of the CR rates was observed between the patients took < 4 cycles and ≥ 4 cycles NAC (4.65% vs. 21.05%, P < 0.05). Conclusion  The patients with HER-2 gene non-amplication may be sensitive to both taxane-based and anthracycline-based chemotherapy; the patients without P53 overexpression may suitable to select anthracycline-based chemotherapy; and proper increased NAC cycles may increase CR rates. This work was supported by a grant from the Ministry of Public Health Scientific Research Foundation of China (No.WKJ2007-3-001).     

体重指数与HER-2阳性乳腺癌新辅助化疗病理完全缓解的关系

目的:探讨体重指数(BMI)与HER-2阳性乳腺癌新辅助化疗病理完全缓解(pCR)的关系。方法:回顾性分析2013年1月1日至2014年12月31日间哈尔滨医科大学附属肿瘤医院196例接受了新辅助化疗并进行了手术的HER-2阳性乳腺癌患者的临床资料,分析BMI与不同临床病理特征的关系。使用Logistic回归模型进行单因素和多因素分析。结果:BMI各组之间年龄及pCR率差异具有统计学意义(分别为P=0.008,0.045);单因素分析显示:与cT1/cT2组相比,cT3/cT4组较难达到pCR(P=0.039);与N/U组相比,OW组pCR率更高(P=0.019);多因素分析显示:与N/U组及OB组相比,OW组pCR率更高(P=0.026)。结论:超重是HER-2阳性乳腺癌新辅助化疗患者pCR的独立预测因素。     

乳腺癌新辅助化疗后病理完全缓解的因素分析

目的:研究代谢综合征（metabolic syndrome,MS）与乳腺癌新辅助化疗（neoadjuvant chemotherapy,NAC）病理完全缓解（pathological complete response,pCR）的关系。方法:收集2014年01月至2020年06月在哈尔滨医科大学附属肿瘤医院接受NAC后进行手术的女性乳腺癌患者526例,并收集患者的临床病理资料,根据MS诊断标准分为MS组99例与非MS组427例。采用Logistic回归模型进行单因素和多因素分析MS与pCR的关系。结果:105例患者NAC后获得pCR,其中MS组10例,非MS组95例。单因素分析显示:非MS组较MS组更易获得pCR（P=0.008）,激素受体（hormone receptor,HR）阴性、人类表皮生长因子受体2（human epidermal growth factor receptor-2,HER-2）阳性、Ki-67＞14%者更易获得pCR（P＜0.001、P＜0.001、P=0.002）。多因素分析显示:与HR阴性者相比,HR阳性者较难获得pCR（P＜0.001）;与HER-2阴性者相比,HER-2阳性者pCR率更高（P=0.033）;与非MS患者相比,合并MS患者更难获得pCR（P=0.041）。亚组分析显示:非MS组中HR阴性患者更易获得pCR（P＜0.001）。结论:HR状态、HER-2状态及MS是乳腺癌NAC后pCR的独立预测因素,合并代谢综合征的乳腺癌患者接受新辅助化疗后更难获得病理完全缓解,与长期预后相关性有待进一步研究。     

Response and Long-Term Effect of Patients with Triple-Negative Breast Cancer Receiving Neo-Adjuvant Anthracycline-Based

OBJECTIVE The breast cancer lack of expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER-2) is defined as the Triple-negative breast cancer (TNBC). Our purpose is to compare the response and long-term effect of the TNBC and non-TNBC patients receiving neo-adjuvant anthracycline-based chemotherapy, and to investigate the mechanisms of TNBC affecting the survivals. METHODS Data of long-term follow-up (median, 5.4 years) of 326 patients who received neo-adjuvant chemotherapy with anthracycline-based regimen, during a period from 2000 to 2003, were analyzed. Expressions of ER, PR, HER-2, P53, Ki-67 and E-cadherin were determined using immunohistochemical staining method. A multivariate Cox regression analysis was used to analyze independent prognostic factors affecting the relapse-free survival (RFS) and overall survival (OS) rates. Clinical effects of the neo-adjuvant anthracycline-based chemotherapeutic regimen and the RFS and OS rates were compared between the patients with TNBC and non-TNBC, and the correlations among the triple- negative phenotype (TNP), tumor grading and the expressions of P53, Ki-67 and E-cadherins were analyzed. RESULTS TNP, TNM staging, histological grades, clinical response of the neo-adjuvant chemotherapy and pathological complete remission (pCR) rate were the independent prognostic factors affecting the survival rates. Furthermore, 70 (21.5%) of the 326 patients suffered TNBC. Compared with the subjects in non- TNBC group, the patients with TNBC had a significantly higher pCR rate (P=0.046) and clinical response rate (P＝0.037), but also decreased 5-year RFS (P=0.001) and OS (P=0.004) rates. The RFS and OS rates were not improved in the TNBC patients who achieved a clinical remission after the neo-adjuvant chemotherapy. The triple-negative phenotype was positively correlated with the level of P53, Ki-67 expression (P＝0.007, P＝0.028), but negatively correlated with level of E-cadherin (P＝0.034).CONCLUSION Both clinical remission rate and pCR rate of the TNBC patients receiving neo-adjuvant anthracycline-based chemotherapy are high, however, the long-term effect is poor.The mechanism may relate to a strong potential of proliferation and invasive metastasis, as well as lack of an effective therapeutic target in the TNBC patients.     

BRCA1和APC基因异常甲基化与乳腺癌蒽环类新辅助化疗疗效的相关性

目的 探讨原发性乳腺癌肿瘤组织中BRCA1和APC基因启动子区甲基化状况与新辅助化疗疗效的相关性.方法 应用甲基化特异PCR方法,对140例原发性乳腺癌患者术前穿刺样本进行BRCA1和APC基因启动子甲基化状态检测,分析其与新辅助化疗疗效的相关性.结果 140例原发性乳腺癌患者接受蒽环类新辅助化疗后,病理完全缓解(pCR)率为21.4%(30/140),BRCA1和APC基因启动子甲基化率分别为21.4%(30/140)和18.3%(24/131).在110例BRCA1基因非甲基化患者中,pCR率为25.5%(28/110);在30例BRCA1基因甲基化患者中,pCR率为6.7%(2/30),差异有统计学意义(χ2=4.94,P=0.026).APC基因甲基化状态与患者的pCR率之间无显著相关性(P>0.05).结论 在原发性乳腺癌患者中,BRCA1基因非甲基化者更容易获得pCR,检测BRCA1基因甲基化状态对评判原发性乳腺痛新辅助化疗疗效可能具有一定的指导意义.     

术前新辅助短程密集化疗疗效与乳腺癌受体亚型及组织学类型的关系

目的评价不同组织学类型和受体亚型的乳腺癌患者对新辅助短程密集化疗疗效反应的差异。方法 对2004年1月至2006年12月期间在西南医院乳腺疾病中心接受新辅助短程密集化疗的223例可手术乳腺癌患者资料进行回顾性分析。根据术前粗针穿刺结果,将患者的肿瘤分为雌激素受体（ER）阳性[人表皮生长因子受体（HER-2）阴性]、三阴性以及HER-2阳性。新辅助短程密集化疗为4个周期,化疗方案均为TE（多西紫杉醇75mg/m2d1＋表柔比星75mmg/m2d1）,14d为1个周期。采用χ2检验分析乳腺癌组织学分类和受体亚型与病理学完全缓解率和化疗有效率的关系。结果 总的化疗有效率和病理完全缓解（pCR）率分别为59%（132/223）和9%（21/223）。浸润性导管癌和浸润性小叶癌的化疗有效率分别为70%（122/175）和24%（8/33）（P〈0.01）,pCR率分别为11%（20/175）和3%（1/33）。ER阳性、三阴性和HER-2阳性乳腺癌患者的化疗有效率分别为46%（57/123）、84%（43/51）和65%（32/49）（χ2=22.49,P=0.00）,pCR率分别为2%（3/123）、23%（12/51）和12%（6/49）（χ2=19.39,P=0.00）。结论 浸润性小叶癌患者从新辅助化疗中获益较小,新辅助化疗后ER阳性乳腺癌的pCR率很低     

Response and long-term effect of patients with triple-negative breast cancer receiving neo-adjuvant anthracycline-based chemotherapy

OBJECTIVE The breast cancer lack of expression of estrogen receptor （ER）, progesterone receptor （PR）, and human epidermal growth factor receptor 2 （HER-2） is defined as the Triple-negative breast cancer （TNBC）. Our purpose is to compare the response and long-term effect of the TNBC and non-TNBC patients receiving neo-adjuvant anthracycline-based chemotherapy, and to investigate the mechanisms of TNBC affecting the survivals. METHODS Data of long-term follow-up （median, 5.4 years） of 326 patients who received neo-adjuvant chemotherapy with anthracycline-based regimen, during a period from 2000 to 2003, were analyzed. Expressions of ER, PR, HER-2, P53, Ki-67 and E-cadherin were determined using immunohistochemical staining method. A multivariate Cox regression analysis was used to analyze independent prognostic factors affecting the relapse-free survival （RFS） and overall survival （OS） rates. Clinical effects of the neo-adjuvant anthracycline-based chemotherapeutic regimen and the RFS and OS rates were compared between the patients with TNBC and non-TNBC, and the correlations among the triplenegative phenotype （TNP）, tumor grading and the expressions of P53, Ki-67 and E-cadherins were analyzed. RESULTS TNP, TNM staging, histological grades, clinical response of the neo-adjuvant chemotherapy and pathological complete remission （pCR） rate were the independent prognostic factors affecting the survival rates. Furthermore, 70 （21.5%） of the 326 patients suffered TNBC. Compared with the subjects in non-TNBC group, the patients with TNBC had a significantly higher pCR rate （P = 0.046） and clinical response rate （P = 0.037）, but also decreased 5-year RFS （P = 0.001） and OS （P = 0.004） rates. The RFS and OS rates were not improved in the TNBC patients who achieved a clinical remission after the neo-adjuvant chemotherapy. The triple-negative phenotype was positively correlated with the level of P53, Ki-67 expression （P = 0.007, P = 0.028）, but negatively correlated with level of E-cadherin （P = 0.034）. CONCLUSION Both clinical remission rate and pCR rate of the TNBC patients receiving neo-adjuvant anthracycline-based chemotherapy are high, however, the long-term effect is poor. The mechanism may relate to a strong potential of proliferation and invasive metastasis, as well as lack of an effective therapeutic target in the TNBC patients.     

HER-2/CEP17信号比与乳腺癌新辅助化疗后病理完全缓解的相关性研究

  目的  评价HER-2/CEP17信号比与乳腺癌新辅助化疗后病理完全缓解的相关性及其预测作用。  方法  收集中山大学孙逸仙纪念医院2013年1月至2017年12月635例临床分期为ⅡB~Ⅲ期浸润性乳腺癌行新辅助化疗患者的临床资料。根据患者新辅助化疗后手术病理标本,分为病理完全缓解组117例和非病理完全缓解组518例。统计分析HER-2/CEP17信号比是否为全体患者以及联合和非联合靶向治疗亚组病理完全缓解的独立预测因子,并且分析HER-2/CEP17信号比是否与病理完全缓解率具有相关性。  结果  635例乳腺癌患者中,总体病理完全缓解率为18.4%（117/635）,多因素Logistic回归分析结果显示T分期（OR为0.500,95%CI为0.350~0.712,P < 0.001）、Ki-67表达（OR为3.461,95%CI为1.891~6.333,P < 0.001）、分子分型（OR为1.458,95% CI为1.188~1.791,P < 0.001）、HER-2基因拷贝数（OR为6.173,95%CI为2.110~17.857,P=0.001）及HER-2/CEP17信号比（OR为9.076,95%CI为3.142~26.215,P < 0.001）为乳腺癌新辅助化疗获得病理完全缓解的独立预测因子。分析显示HER-2/CEP17信号比也是新辅助化疗联合靶向治疗和非联合靶向治疗亚组的独立预测因子。Spearman秩相关性分析显示HER-2/CEP17信号比与乳腺癌新辅助化疗病理完全缓解率具有相关性（r=0.235,P < 0.001）。  结论  HER-2/CEP17信号比与乳腺癌新辅助化疗后病理完全缓解具有相关性,是其独立预测因子。      

HER2 and response to anthracycline-based neoadjuvant chemotherapy in breast cancer

BackgroundThe predictive role of human epidermal growth factor receptor 2 (HER2) to adjuvant anthracycline-based chemotherapy remains controversial. Here, we investigated the association between HER2 status and pathological response in breast cancer patients who received neoadjuvant anthracycline-based regimens.Patients and methodsWomen (n = 538) with operable primary breast cancer received neoadjuvant anthracycline-based chemotherapy. Pathological complete response (pCR) was defined as no invasive breast tumor cells in breast after completion of neoadjuvant chemotherapy. HER2 status was determined by immunohistochemistry and/or by fluorescence in situ hybridization in core biopsy breast cancer tissue obtained before initiation of neoadjuvant chemotherapy.ResultsIn this cohort of 538 patients, 23.9% of patients achieved a pCR in their breast. HER2-positive tumors had a lower rate of pCR than did HER2-negative tumors (14.7% versus 25.7%, P = 0.013); negative HER2 status remained as an independent favorable predictor of pCR after adjusted for age, estrogen receptor, progesterone receptor, tumor size, chemotherapy cycles, and tumor grade in a multivariate analysis (odds ratio = 3.14; 95% confidence interval = 1.60–6.16, P = 0.001). Furthermore, patients with a pCR had a higher 3-year disease-free survival (DFS) rate than did patients without a pCR (P = 0.007).ConclusionWomen with HER2-negative breast cancers rather than HER2-positive tumors benefit from anthracycline-based neoadjuvant chemotherapy.     

MRI evaluation of pathologically complete response and residual tumors in breast cancer after neoadjuvant chemotherapy

BACKGROUND: This study investigated the role of magnetic resonance imaging (MRI) in evaluation of pathologically complete response and residual tumors in patients who were receiving neoadjuvant chemotherapy (NAC) for both positive and negative HER-2 breast cancer. METHODS: Fifty-one individuals, comprised of 25 HER-2 positive and 26 HER-2 negative patients, were included in the study. Serial MRI studies were acquired before, during, and after NAC. On the basis of the final MRI, response was determined to be a clinically complete response ([CCR], no enhancement), probable CCR (residual enhancement equal to or less than that of glandular tissue), or residual tumor. All patients received surgery. Pathological outcomes were categorized as 1) no residual cancer, 2) no residual invasive cancer but ductal carcinoma in situ (DCIS) present, or 3) residual invasive cancer. The pathologically complete response (pCR) was defined as no invasive cancer. RESULTS: Complete clinical response as seen through MRI, including CCR and probable CCR, was identified in 35 (35 of 51, 69%) patients. MRI correctly diagnosed pCR in 26 (26 of 35, 74%) patients, including 18 of 19 (95%) patients in the HER-2 positive group and 8 of 16 (50%) patients in the HER-2 negative group (P < .005). The accuracy of MRI in identifying pCR varied according to the chemotherapy agent that was administered. MRI was more accurate in identifying pCR in patients who were receiving trastuzumab and less accurate in patients receiving bevacizumab. The high false-negative rate found in HER-2 negative patients was associated with residual disease that presented as scattered cells or small foci. In cases with residual bulk tumor, the lesion size, determined by MRI, correlated highly with that found in histopathological measurements (r = 0.93). CONCLUSIONS: MRI may predict pCR with high accuracy in HER-2 positive patients, but it has a high false-negative rate in HER-2 negative patients, particularly in patients who are receiving antiangiogenic agents. Results indicate that the chemotherapy agent should be taken into consideration when using MRI to interpret therapeutic outcomes. More studies are needed to establish the role of MRI in managing, especially surgical planning, patients who are receiving NAC.