Her-2阳性乳腺癌患者曲妥珠单抗联合新辅助化疗的效果评价及其预后影响因素分析

目的: 评价曲妥珠单抗联合新辅助化疗用于人类表皮生长因子受体2(Her-2)阳性乳腺癌患者的疗效,探讨乳腺癌患者的预后影响因素。方法: 回顾性分析112例Her-2阳性乳腺癌患者的临床资料,根据是否应用曲妥珠单抗治疗分为靶向联合化疗组和单纯化疗组。采用SPSS19.0软件对患者的临床特征进行统计分析,采用Kaplan-Meier法进行生存分析,应用Log-rank检验绘制生存曲线,采用Cox回归分析进行单因素及多因素预后分析。结果: 112例Her-2阳性乳腺癌患者中,靶向联合化疗组23例(20.54%),单纯化疗组89例(79.46%)。靶向联合化疗组患者的无病生存期(DFS)显著长于单纯化疗组(P=0.012),靶向联合化疗组患者总生存期(OS)虽然长于单纯化疗组,但组间比较差异无统计学意义(P=0.064)。激素受体(HR)阴性组Miller Payne(MP)分级为5级的患者18例(32.7%),多于HR阳性组的5例(10.9%)(P=0.009)。Cox回归单因素分析,原发肿物大小、初诊时区域淋巴结情况及术后淋巴结情况是Her-2阳性患者DFS的影响因素;原发肿物大小、初诊时区域淋巴结情况、MP分级及术后淋巴结情况是Her-2阳性乳腺癌患者OS的影响因素。多因素分析,原发肿物大小、初诊时区域淋巴结情况、是否接受放疗是Her-2阳性乳腺癌患者DFS及OS的独立影响因素。结论: HR阴性的Her-2阳性乳腺癌患者接受曲妥珠单抗联合新辅助化疗后乳房病灶可获得显著缓解。曲妥珠单抗联合新辅助化疗治疗Her-2阳性乳腺癌患者可以显著提高患者的DFS,对患者的预后具有积极的影响。

Evaluation on efficacy of trastuzumab combined with neoadj uvant chemotherapy in Her-2 positive breast cancer patients and analysis of influencing factors of prognosis

Objective:To assess the efficacy of trastuzumab combined with neoadjuvant chemotherapy in the treatment of human epidermal growth factor receptor-2 (Her-2)positive breast cancer patients,and to explore its influencing factors of prognosis of breast cancer.Methods:The clinical materials of 112 Her-2 positive breast cancer patients were collected and they were divided into combined treatment group (trastuzumab + neoadj uvant chemotherapy)and single chemotherapy group (without trastuzumab ). SPSS 1 9.0 software was employed to calculate and analyze their clinical characteristics.The survival rate and prognosis were analyzed by Kaplan-Meier method,Log-rank test, and Cox regression. Results:Among the 112 Her-2 positive breast cancer patients, 23 cases were treated with trastuzumab,89 cases were treated without trastuzumab.The disease-free survival (DFS)in combined treatment group and single chemotherapy group had significant difference (P=0.012).And there was no significant difference of overall survival (OS)between two groups (P=0.064).The HR negative group had 18 (32.7%)patients with 5-level of Miller and Payne (MP)classification which was higher than HR positive group (5/46,10.9%)(P=0.009).In univariate analysis,the tumor size,node status at diagnosis and node status after operation were the influencing factors of DFS in the Her-2 positive breast cancer patients;the tumor size,node status at diagnosis,MP classification and node status after operation were the influencing factors of OS in the Her-2 positive breast cancer patients.The result of multivariate analysis indicated that the tumor size, node status at diagnosis,and with or without radiotherapy were the independent influencing factors of DFS and OS in the Her-2 positive breast cancer patients. Conclusion:The breast lesions in the Her-2 positive breast cancer patients with negative HR are relieved after treated with trastuzumab combined with neoadjuvant chemotherapy. The combination of trastuzumab and neoadj uvant chemotherapy can significantly improve the DFS and has a positive influence in the prognosis of Her-2 positive breast cancer patients.