摘要
目的:探究乳腺癌HER-2蛋白低表达新辅助化疗的疗效,进一步探索影响疗效及预后的因素。方法:收集并分析2016年1月至2022年12月期间213例就诊于我院乳腺外科初始行新辅助化疗的HER-2阴性乳腺癌患者相关临床资料。采用检验和方差分析探究不同HER-2蛋白表达与新辅助化疗疗效及相病理特征关性。运用非条件logistic回归模型探索影响新辅助化疗后HER-2低表达乳腺癌病理完全缓解(pathologic complete response,pCR)率的因素。新辅助化疗前后HER-2状态的一致性检验采用Cohen's kappa系数(κ)。使用Kaplan-Meier法绘制生存曲线,运用非条件logistic回归模型探索影响HER-2低表达乳腺癌总生存(overall survival,OS)的因素。结果:HER-2低表达组170例,HER-20表达组43例,HER-2低表达乳腺癌有更高的腋窝、锁骨上、锁骨下淋巴结转移率(P=0.002)、组织学分级低(P=0.045)、脉管侵犯低(P=0.015)、ER/PR/HR阳性者占比更高(P<0.001)。在年龄、BMI值、月经状态、病理类型、T分期和TNM分期、Ki-67差异无统计学意义(P>0.05)。接受新辅助化疗后,HER-2蛋白表达IHC 0、IHC 1+和IHC 2+/ISH-三者的pCR率依次降低,分别为48.8%、40.7%和23.8%,三者间的差异有统计学意义(P=0.009),总人群HER-2低表达组pCR率低于零表达组,但两者差异无统计学意义(P=0.082)。NAC前后肿瘤HER-2状态一致性为中等(κ=0.494)。logistic回归分析锁骨上下淋巴结状态是HER-2低表达乳腺癌新辅助化疗后pCR率的独立影响因素(P<0.05)。HER-2低表达总生存分析结果发现,肿瘤大小、病理分期及pCR均是影响乳腺癌患者预后的因素(P<0.05)。结论:HER-2低表达乳腺癌有独特的临床病理学特征,锁骨上下淋巴结状态是HER-2低表达乳腺癌新辅助化疗后pCR率的独立影响因素(P<0.05),淋巴结转移、肿瘤大小、病理分期及pCR是影响乳腺癌患者生存的因素。
Objective:To study the effect of low HER-2 protein expression on neoadjuvant chemotherapy in breast cancer.Additionally,the factors associated with treatment efficacy and prognosis were examined in greater detail.Method:Data from 213 patients with HER-2 negative breast cancer who underwent neoadjuvant chemotherapy in our hospital between January 2016 and December 2022 were gathered for this study.The relationship between different levels of HER-2 protein expression and the efficacy and pathological characteristics of neoadjuvant chemotherapy was investigated by test and variance analyses.A non-conditional logistic regression model was used to examine factors impacting the pathologic complete response(pCR)with low HER-2 expression.The consistency of HER-2 status before and after neoadjuvant chemotherapy was assessed by Cohen's kappa coefficient(κ).The Kaplan-Meier method was used to generate the survival curve,and an unconditional logistic regression model was used to analyze factors affecting the overall survival(OS)with low HER-2 expression.Results:The study involved 213 patients,with 170 in the low HER-2 expression group and 43 in the HER-20 expression group.The results showed that HER-2-low-positive breast cancer had a higher incidence axillary of supraclavicular and infraclavicular lymph node metastasis(P=0.002),low histological grade(P=0.045),low vascular invasion(P=0.015),and a higher proportion of ER/PR/HR(P<0.001),but no significant differences in age,BMI,menstrual status,pathological type,T stage,TNM stage and Ki-67 were observed(P>0.05).After neoadjuvant chemotherapy,the pCR rates of HER-2 protein expression IHC 0,IHC 1+and IHC 2+/ISH-decreased sequentially,with 48.8%,40.7%and 23.8%,the difference among the three was statistical significance(P=0.009).In the total population,the pCR rate of HER-2 low expression group was lower than that of 0 expression group,with no significant difference(P=0.082).The consistency of tumor HER-2 status before and after neoadjuvant chemotherapy was moderate(κ=0.494).Logi
作者
郑璐
汤铜
王芝涛
王本忠
ZHENG Lu;TANG Tong;WANG Zhitao;WANG Benzhong(Department of Breast Surgery,the First Affiliated Hospital of Anhui Medical University,Anhui Hefei 230022,China;Department of General Surgery;Department of Hematology,the Second Affiliated Hospital of Anhui Medical University,Anhui Hefei 230601,China)
出处
《现代肿瘤医学》
CAS
北大核心
2023年第20期3784-3790,共7页
Journal of Modern Oncology
基金
国家自然科学基金青年项目(编号:82200225)
吴阶平医学基金会临床科研专项资助基金(编号:320.6750.2021-10-25)
安徽省高等教育人文社会科学重点项目(编号:SK2021A0167)
安徽医科大学校科研基金资助项目(编号:2018xkj038)。
关键词
乳腺癌
人表皮生长因子受体2低表达
新辅助化疗
预后因素
breast cancer
low expression of human epidermal growth factor receptor 2
neoadjuvant chemotherapy
prognostic factors
