乳腺癌分子亚型在预测新辅助化疗疗效及患者预后中的作用

目的 本研究旨在探讨乳腺癌的分子亚型与乳腺癌的病理完全缓解及患者预后的关系.方法 收集2007年1月-2010年1月在芜湖市第二人民医院接受新辅助治疗的101例乳腺癌患者的病例资料,按照ER、PR及Her-2的免疫组化的结果将其分为4型,单因素与多因素分析临床病理因素与病理完全缓解的关系.结果 19例(18.8％)患者取得病理完全缓解,三阴性乳腺癌是病理完全缓解的独立预测因素(OR=3.35,95％CI:1.25 ～ 9.79,P=0.012),而Her-2丰富型乳腺癌相比较于luminal A型乳腺癌则取得更高的病理完全缓解率(OR =3.11,95％CI:1.09 ～ 10.89,P=0.021).而病理缓解率与无病生存率密切相关(P =0.002).但三阴性乳腺癌的总生存期和无病生存期更短(P =0.008,P=0.0006).结论 三阴性乳腺癌和Her-2丰富型乳腺癌较luminal A型乳腺癌更容易获得新辅助化疗后的病理完全缓解,但三阴性乳腺癌的预后仍然较差,可能与其在治疗后仍有肿瘤残留有关.

Effect of molecular subtype on chemosensitivity and survival in patients with breast cancer following neoadjuvant chemotherapy

Objective Pathologic complete response (pCR) has been suggested as a surrogate prognostic indicator in breast cancer patients treated with neoadjuvant chemotherapy.We assessed whether the likelihood of pCR and survival is associated with the immunohistochemistry-based molecular subtypes.Methods We retrospectively analyzed the records of l01 patients with breast cancer who received neoadjuvant chemotherapy between January 2007 and January 2010.Patients were dassified into four molecular subtypes based on the immunohistochemistry prnfiles of estrogen receptor,progesterone receptor,and HER2.Logistic regression was used to analyze variables associated with pCR.Results The pCR was achieved in 19 patients (18.8％).The triple negative subtype was an independent predictive factor for pCR (odds ratio,3.35,95％ confidence interval,1.25-9.79,P =0.012),and the Her-2 subtype showed a trend for higher pCR rates (odds ratio,3.11;95％ confidence interval,1.09-10.89,P =0.021) compared with the luminal A subtype.The pCR was significantly associated with prolonged disease-free survival (P =0.002).The triple negative subgroup had shorter disease-free survival (P =0.0006) and overall survival (P =0.008) than the other subgroups.Conclusions We demonstrated that the triple negative and Her-2 subtypes are more likely to obtain pCR when neoadjuvant chemotherapy is given,compared to the luminal A subtype.Despite the high pCR rate,the triple negative subtype showed worse survival outcomes,paradoxically,primarily due to patients who had residual disease.