分子分型在乳腺癌辅助治疗选择中的临床研究

目的:探讨分子分型与乳腺癌患者临床特征的关系，分析分子分型在乳腺癌辅助治疗中的临床疗效以及安全性。方法:选择2011年4月至2014年5月来我院诊治的109例乳腺癌患者，回顾性分析临床资料，按照ER、PR和HER2的表达情况分成4种分子亚型，探讨分子分型与乳腺癌患者临床特征的关系，不同分子分型乳腺癌患者采取不同的治疗方案。同期选择20例乳腺癌组成对照组患者，采取常规化疗方案治疗，分析各组治疗的临床疗效以及安全性。结果:在109例乳腺癌患者中，分子分型各型所占例数分别为:Luminal A型50例（45.87%）、Luminal B型20例（18.35%）、HER2阳性型22例（20.18%）、三阴型17例（15.60%）。四种分子亚型在绝经前后占据的患者例数、原发肿瘤各期所占例数以及除II期以外的临床分期所占例数均存在明显差异性，具有统计学意义（P<0.05）。在年龄、组织学类型、临床分期方面四种分子亚型所占的例数无明显差异性（P>0.05）。不同治疗方案下，Luminal A型、Luminal B型、HER2阳性型以及三阴型乳腺癌患者的总缓解率分别为86.0%、80.0%、81.8%和70.6%，均显著高于对照组患者30.0%的总缓解率，具有明显差异性（P<0.05%）。109例乳腺癌患者的完全缓解率为80.7%，16例SD患者中，6例为Luminal A型患者，3例为Luminal B型患者，3例为HER2阳性型患者，4例为三阴型患者。经过检测，三种治疗方案均发生粒细胞减少、肝脏毒性、消化道毒性、外周神经毒性、脱发以及其他并发症。其中三种治疗方案发生粒细胞减少、消化道毒性与外周神经毒性等并发症的例数存在差异性（P<0.05）。所有患者只需减少药量，不良反应均可减轻甚至消除。结论:乳腺癌患者分为Luminal A型、Luminal B型、HER2阳性型以及三阴型四种分子亚型，比例最高的是Luminal A型。不同的分子亚型采取不同的治疗方案，能够获得令人满意的治疗效果，但会发生一些较轻的不良反应。分子分型对乳腺癌患者的治疗具有重要的指导作用，值得在临床上推广。

Molecular typing in breast cancer adjuvant therapy selection

Objective:To investigate the relationship of clinical features and molecular typing of breast cancer.Methods:All 109 breast cancer patients were retrospectively analyzed，and with the ER，PR and HER2 expression were divided into four molecular subtypes.Results:In 109 breast cancer patients.Luminal A type 50 cases (45.87%)，Luminal B type 20 cases (18.35%) HER2-positive type 22 cases (20.18%) SP6 17 cases (15.60%).Number of patients before and after menopause four molecular subtypes occupied by the primary tumor as well as the number of cases for each of the accounts，except phase II clinical staging share a few examples (P<0.05).Age，histological type，clinical staging of the four molecular subtypes had no significant difference (P>0.05).In the different treatment options，Luminal A type，Luminal B type，HER2-positive type overall response rate was 86.0%，overall response rate was significantly higher than 30.0% of the controls (P<0.05).In 109 breast cancer patients complete remission rate was 80.7%，16 SD,six patients with Luminal A，Luminal B type 3 cases，three patients with HER2-positive，four cases with triple-negative.In three treatment regimens neutropenia，hepatotoxicity，gastrointestinal toxicity，peripheral neuropathy，hair loss and other complications occurred.To reduce the dosage，adverse reactions may be reduced or even eliminated.Conclusion:Breast cancer patients were divided into Luminal A type，Luminal B type，HER2-positive and triple-negative type four kinds of molecular subtypes，the highest proportion of Luminal A type.Different molecular subtypes take different treatment options，can obtain satisfactory therapeutic effect，but it will be some minor adverse reactions.The molecular typing of breast cancer treatment has an important role in clinical practice.