目的 探讨乳腺癌新辅助化疗十年疗效及影响患者预后的因素。方法 回顾性收集190例接受新辅助化疗的局部晚期乳腺癌患者的临床病理资料,检测新辅助化疗后病理完全缓解率(pCR),完成十年随访,分析影响患者长期预后的因素。结果 190例中,新辅助化疗后达病理完全缓解者共22例(11.58%)。单因素分析显示Ki-67表达水平、化疗方案和Luminal分型与pCR相关(P均<0.05),多因素分析显示Ki-67的表达水平是影响新辅助化疗后病理完全缓解的独立因素(P<0.05)。该组患者10年总生存率为56.3%,pCR是新辅助化疗乳腺癌患者预后的独立影响因素(P<0.05)。结论 Ki-67是影响乳腺癌新辅助化疗后病理完全缓解的独立因素;pCR是新辅助化疗乳腺癌患者预后的独立影响因素。
Abstract
Objective To explore the influencing factors of the curative effect and prognosis of patients with breast cancer who have undergone neoadjuvant chemotherapy.Methods The clinicopathologic data on 190 locally advanced breast cancer patients receiving neoadjuvant chemotherapy was retrospectively collected and the factors that influenced pathologic complete response and prognosis of patients after neoadjuvant chemotherapy were analyzed.Results Among the 190 patients, 22 cases (11.58%) had pathological complete response after neoadjuvant chemotherapy. Univariate analysis showed that the expression level of ki-67, chemotherapy regimen and Luminal typing were correlated with PCR (P<0.05). Multivariate analysis showed that the expression level of ki-67 was an independent factor influencing the pathological complete response after neoadjuvant chemotherapy (P<0.05). The overall 10-year survival rate was 56.3%. Multivariate analysis showed that PCR was an independent factor affecting the survival rate of breast cancer patients after neoadjuvant chemotherapy (P<0.05).Conclusions Ki-67 is an independent factor that affects pathological complete response after neoadjuvant chemotherapy for breast cancer while PCR is an independent factor influencing the prognosis of breast cancer patients after neoadjuvant chemotherapy.
关键词
乳腺癌 /
新辅助化疗 /
预后 /
Ki-67 /
pCR
Key words
breast cancer /
neoadjuvant chemotherapy /
prognosis /
Ki-67 /
pCR
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Mcshane L M, Altman D G, Sauerbrei W, et al. Reporting Recommendations for Tumor Marker Prognostic Studies (REMARK)[J]. J Natl Cancer Inst,2005,97(16):1180-1184.
[2] 沈镇宙,邵志敏. 乳腺肿瘤学[M].上海:上海科学技术出版社,2005.4:271.
[3] Rabanal C, Ruiz R, Neciosup S, et al. Metronomic chemotherapy for non-metastatic triple negative breast cancer: selection is the key[J]. World J Clin Oncol,2017,8(6):437-446.
[4] Elies A, Riviere S, Pouget N, et al. The role of neoadjuvant chemotherapy in ovarian cancer[J]. Expert Rev Anticancer Ther,2018,18(6):555-566.
[5] Yalcin B. Overview on locally advanced breast cancer: defining, epidemiology, and overview on neoadjuvant therapy[J]. Exp Oncol,2013,35(4):250-252.
[6] Chen X S, Wu J Y, Huang O, et al. Molecular subtype can predict the response and outcome of Chinese locally advanced breast cancer patients treated with preoperative therapy[J]. Oncol Rep,2010,23(5):1213-1220.
[7] Bernard A, William B,John B,et al.Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials[J]. Lancet Oncol,2018,19(1):27-39.
[8] Abubakar M, Orr N, Daley F, et al. Prognostic value of automated KI67 scoring in breast cancer: a centralised evaluation of 8088 patients from 10 study groups[J]. Breast Cancer Res,2016,18(1):104.
[9] Ellis M J, Suman V J, Hoog J, et al. Ki67 proliferation index as a tool for chemotherapy decisions during and after neoadjuvant aromatase inhibitor treatment of breast cancer: results from the American College of Surgeons Oncology Group Z1031 Trial (Alliance)[J]. J Clin Oncol,2017,35(10):1061-1069.
[10] Ei B H, Zribi A, Laabidi S, et al. Ki-67: role in diagnosis, prognosis and follow-up after treatment of breast cancers[J]. Tunis Med,2015,93(12):737-741.
[11] Luporsi E, Andre F, Spyratos F, et al. Ki-67: level of evidence and methodological considerations for its role in the clinical management of breast cancer: analytical and critical review[J]. Breast Cancer Res Treat,2012,132(3):895-915.
[12] Darwito D, Dharmana E, Riwanto I, et al. Effects of omega-3 supplementation on Ki-67 and VEGF expression levels and clinical outcomes of locally advanced breast cancer patients treated with neoadjuvant CAF chemotherapy: a randomized controlled trial report[J]. Asian Pac J Cancer Prev,2019,20(3):911-916.
[13] Tokuda E, Horimoto Y, Arakawa A, et al. Differences in Ki67 expressions between pre- and post-neoadjuvant chemotherapy specimens might predict early recurrence of breast cancer[J]. Hum Pathol,2017,63:40-45.
[14] 蒋 奕,叶新青,黄俊淇,等. 乳腺癌新辅助化疗前后分子标记物变化及其与疗效的关系[J]. 广西医科大学学报,2015,32(2):211-215.
[15] 刘 伟,李健斌,王 涛,等. 蒽环类联合紫杉类方案在乳腺癌新辅助化疗中的有效性及安全性评价[J]. 临床肿瘤学杂志,2016,21(3):228-232.
[16] Luangdilok S, Samarnthai N, Korphaisarn K. Association between pathological complete response and outcome following neoadjuvant chemotherapy in locally advanced breast cancer patients[J]. J Breast Cancer,2014,17(4):376-385.
[17] Wu K, Yang Q, Liu Y, et al. Meta-analysis on the association between pathologic complete response and triple-negative breast cancer after neoadjuvant chemotherapy[J]. World J Surg Oncol,2014,12:95.
[18] Chaudhary L N, Wilkinson K H, Kong A. Triple-negative breast cancer: who should receive neoadjuvant chemotherapy?[J]. Surg Oncol Clin N Am,2018,27(1):141-153.
[19] Perou C M, Sorlie T, Eisen M B, et al. Molecular portraits of human breast tumours[J]. Nature,2000,406(6797):747-752.
[20] Cazzaniga M E, Pinotti G, Montagna E, et al. Metronomic chemotherapy for advanced breast cancer patients in the real world practice: final results of the VICTOR-6 study[J]. Breast,2019,48:7-16.