三阴性乳腺癌患者的临床特征及新辅助化疗疗效与预后的相关性

 目的　探讨三阴性乳腺癌（TNBC）的临床病理特点及远期生存率。并分析其新辅助化疗的疗效与生存率的相关性。方法　研究对象为535例乳腺癌患者，其中TNBC患者75例，非TNBC患者460例，对其临床和病理资料以及 5年的无病生存（DFS）率及总生存（OS）率进行回顾性分析，并与同期的非TNBC患者进行对比。535例中88例患者接受术前新辅助化疗，TNBC患者26例，非TNBC患者62例，分析其化疗疗效与远期生存的相关性。结果　TNBC患者与非TNBC患者相比，中位年龄轻（35岁比44岁），绝经前患者居多（88.0 % 比67.2 %，P＝0.009）；浸润性导管癌多见（92. 0 % 比80.4 %，P＝0.020），组织学分级Ⅱ级者居多（56.0 %比17.2 %，P＝0.000）；淋巴结转移阳性者较少（33.3 %比53.9 %，P＝0.001）；TNBC组5年DFS（66.67 %）、OS（80.0 %）明显低于非TNBC组（74.78 %、90.0 %）。接受新辅助化疗的TNBC患者与非TNBC患者相比，化疗的总有效（OR）率（88.46 %比82.26 %）、临床完全缓解（cCR）率（65.38 %比37.10 %）、部分缓解（PR）率（23.08 %比45.16 %）差异均有统计学意义（P＜0.05）。新辅助化疗的TNBC患者与非TNBC患者相比，5年的OS率（73.08 %比80.65 %）差异具有统计学意义（P＝0.049）；5年的DFS率（65.38 %比72.58 %）差异具有统计学意义（P＝0.253）。分层分析发现：获得cCR的TNBC与非TNBC患者的5年DFS及OS差异无统计学意义（P＞0.05）。未获得cCR TNBC患者的5年DFS及OS均显著低于非TNBC患者（P＜0.05），临床OR对两组的5年DFS及OS无影响（P＞0.05）。结论　TNBC多见于年轻的绝经前妇女，主要病理类型为浸润性导管癌，核分级高，淋巴结转移少见，但相对非TNBC患者有较低的DFS率和OS率，TNBC患者对新辅助化疗更敏感，更易获得cCR，获得cCR的TNBC患者预后好，未获得cCR的TNBC患者远期生存率明显低于非TNBC患者

Relationship among clinical characteristics, response and prognosis of neoadjuvant chemotherapy in patients with triple negative breast cancer

Objective To explore the clinical and pathological characteristics of triple-negative breast cancer(TNBC) and to compare the response to neoadjuvant chemotherapy and survival in patients with TNBC and non-TNBC. Methods Five hundred and thirty-five patients were included in this retrospective study. 75 patients were TNBC and 460 were non-TNBC. The clinical and pathological characteristics, 5-year disease free survival (DFS) and overall survival (OS) were analyzed. 88 patients were treated with neoadjuvant chemotherapy in which 26 patients were TNBC, the other were non-TNBC. Their responses to neoadjuvant chemotherapy, and the relations of response and survival were analyzed. Results The patients with TNBC were younger than those with non-TNBC (35 vs 44), and most of the patients with TNBC were premenopausal at diagnosis (88.0 % vs 67.2 %, P =0.009). The frequency of invasive ductal carcinoma was higher in patients with TNBC than those with non-TNBC (92.0 % vs 80.4 %, P =0.020). Generally patients with TNBC had higher grade tumors (grade Ⅱ ) than patients with non-TNBC (56.0 % vs 17.2 %, P = 0.000). Lower rate of lymph node metastasis were observed in patients with TNBC than those with non-TNBC (33.3 % vs 53.9 %, P = 0.001). Patients with TNBC had worse 5-year DFS (66.67 %) and OS (80.0 %) than those with non-TNBC (74.78 %, 90.00 %). In this study. 88 patients were treated with neoadjuvant chemotherapy. The overall response rate(OR) of patients with TNBC was 88.46 %, including 65.38 % clinical complete response (cCR)and 23.08 % clinical partial response (cPR). It was significantly higher than patients with non-TNBC respectively (82.26 %, 37.10 %, 45.16 %) (P <0.05). Patients with TNBC had worse 5-year DFS (65.38 %)and OS (73.08 %) than those with non-TNBC (72.58 %, 80.65 %) (P <0.05). If cCR were achieved, patients with TNBC or with non-TNBC had similar 5-year DFS and 5-year OS (P>0.05). In contrast, TNBC patients with residual disease after neoadjuvant chemotherapy had worse 5-year DFS and OS compared with non-TNBC (P <0.05). Conclusion TNBC is common in young premenopausal women. Its main pathological style is nonspecial type of invasive ductal carcinoma with high grade, with low lymph node metastasis rate. Patients with TNBC are more sensitive to neoadjuvant chemotherapy than those with non-TNBC. Patients with TNBC have increased cCR rates compared with non-TNBC, and those with cCR have a good prognosis. TNBC patients in whom cCR are not achieved have significantly worse survival rates compared with that of non-TNBC patients.