乳腺癌分子分型在新辅助化疗疗效和预后中的预测作用

目的]探讨乳腺癌分子分型在新辅助化疗疗效及预后预测中的作用.方法]对接受新辅助化疗方案治疗的157例乳腺癌患者进行回顾性分析.依据免疫组化雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(Her2)表达水平将乳腺癌分为Luminal A、Luminal B、Her2阳性和三阴性4个分子分型,分析4个分子分型与临床病理因素、新辅助化疗疗效及3年生存率的相关性.结果] 157例患者中,分子分型与肿瘤大小、淋巴结转移相关,T3～4期的三阴性型的比例高于T1～2期(P=0.003)；N0、N1、N2、N3期的三阴性型的比例分别为44.4％、23.8％、25.6％和22.2％ (P=0.014).不同分子分型间新辅助化疗有效率无明显差异(P=0.632),而T分期(P=0.014)、N分期(P=0.031)与有效率明显相关.不同分子分型间新辅助化疗3年生存率有明显差异,Luminal A型最高,三阴性型最低(P=0.049).乳腺癌预后影响因素Cox回归模型分析提示分子分型(P=0.003)、年龄(P=0.007)、T分期(P=0.013)、N分期(P=0.000)是乳腺癌患者的独立预后因素.结论]乳腺癌分子分型与肿瘤大小、淋巴结转移状态相关,能作为新辅助化疗远期疗效的独立预测因子.

The Predicting Value of Molecular Subtype in Response and Prognosis for Breast Cancer Patients with Neoadjuvant Chemotherapy

Purpose] To investigate the predicting value of molecular subtype in the response and outcome of breast cancer patients received neoadjuvant chemotherapy.Methods] One hundred and fifty-seven patients undergoing neoadjuvant chemotherapy were enrolled retrospectively.Bosed on the expression of estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor receptor 2(Her2) expression level,the cases were divided into 4 subtypes,Luminal A,Luminal B,Her2+ and triple-negative phenotype.The correlation between molecular subtypes and clinic pathologic factors,efficacy of neoadjuvant chemotherapy and 3-year survival were analyzed.Results] Of the 157 patients,molecular subtypes correlated with tumor size and lymph node metastasis.The cases with T3 ~4 had a higher proportion than those with T1~2 in triple-negative phenotype(P=0.003).The proportion of triple-negative phenotype in cases with N0,N1,N2 and N3 was 44.4%,23.8%,25.6% and 22.2% respectively with significant difference(P=0.014).No significant difference between the molecular subtypes and the efficacy of neoadjuvant chemotherapy(P = 0.632).However,T stage(P=0.014) and N stage(P=0.031) related to the efficacy.Obvious difference were found among 4 molecular subtypes in 3-years survival,Luminal A was the highest,triple-negative phenotype was the lowest(P=0.049).Cox regression showed that molecular subtype(P=0.003),age(P=0.007),T stage(P=0.013),N stage(P=0.000) were the independent prognostic factors in patients with breast cancer.Conclusion] The breast cancer molecular subtypes relate to the tumor size and lymph node metastasis,those could be used as the independent predictor for the efficacy of neoadjuvant chemotherapy.