乳腺癌患者新辅助化疗的疗效评价及影响因素的临床研究

发布时间：2018-01-05 12:33

本文关键词：乳腺癌患者新辅助化疗的疗效评价及影响因素的临床研究　出处：《山东大学》2016年硕士论文　论文类型：学位论文

【摘要】：研究目的：探讨甲状腺疾病及乳腺癌(BC)患者临床病理特征与新辅助化疗(NAC)疗效及预后的相关性。资料和方法：回顾性分析2008年5月至2015年12月间于山东大学齐鲁医院就诊的303例接受新辅助化疗的乳腺癌患者的临床病理资料及其预后信息。我们用Miller/Payne (MP)分级评价患者对NAC的疗效反应,用无病生存期(DFS)及总生存期(0s)评价患者的预后情况。通过Chi-Square检验单因素分析患者合并甲状腺疾病、初诊年龄、身体质量指数(BMI)、腋窝淋巴结转移数、乳腺癌分子分型、NAC后血小板计数、肿块最大切面缩小程度(SDMCA)、术后化疗及NAC前血小板计数与淋巴细胞计数比值(PLR)与MP分级及患者生存、局部复发或远处转移的相关性；通过Spearman相关系数检验BC患者接受NAC后彩超测残余癌最大直径与术后病理测残余癌最大直径的相关性；采用Kaplan-Meier生存曲线单因素分析合并甲状腺疾病、腋窝淋巴结转移数、NAC后血小板计数、MP分级、BMI、SDMCA及NAC前PLR与患者DFS及OS的关系；采用受试者工作特征曲线(ROC)确定SDMCA、PLR的判定界值,并采用Cox比例风险回归模型多因素分析PLR与患者DFS的关系。结果：共有303例患者纳入该研究。有预后信息者250例,中位随访时间为42.8月(1月～7.67年),至随访结束共53例患者发现局部复发或远处转移,其中25例患者死亡。98例患者可查得其甲状腺彩超及术后MP分级,其中48例患者伴发甲状腺疾病,包括甲状腺结节者44例、甲状腺功能减低者3例、甲状腺弥漫性肿大者1例,术后病理达大部缓解(MP分级为4-5级)(mPR)者11例(22.92%)；47例未伴发甲状腺疾病患者中达mPR者6例(12.77%),虽然合并甲状腺疾病者的mPR率较未合并者高(22.92%Vs 12.77%)但无统计学差异(P0.05)。NAC后肿块最大切面积较NAC前缩小3.8倍以上与mPR显著相关(18/48,37.50%VS 5/83,6.02%；P0.05)。腋窝淋巴结阳性与DSF显著相关(P0.05)。PLR的阈值为145.16,据此将患者分为PLR升高者(114例)和降低者(108例)2组,其中PLR升高者预后较差(P=0.0440.05),有统计学差异。结论：本临床研究发现：①患者合并甲状腺疾病、初诊年龄、身体体重指数、乳腺癌分子分型及新辅助化疗后血小板计数对接受新辅助化疗的乳腺癌患者术后病理达大部缓解无影响；②接受新辅助化疗的乳腺癌患者肿块最大切面缩小程度大于3.8倍者、腋窝淋巴结转移数大于3枚者、新辅助化疗前血小板计数与淋巴细胞计数比值大于145.16者术后常规病理更易获得大部缓解,其中肿块最大切面缩小程度大于3.8倍可作为预测接受新辅助化疗的乳腺癌患者对新辅助化疗反应性的指标；③患者合并甲状腺疾病、乳腺癌分子分型、肿块最大切面缩小程度及术后化疗与接受新辅助化疗的乳腺癌患者术后生存、局部复发及远处转移情况无相关性；④患者初诊年龄小于等于35岁者、身体质量指数大于25.16者、腋窝淋巴结转移数大于3枚者、新辅助化疗前血小板计数与淋巴细胞计数比值大于145.16者、新辅助化疗后血小板计数未升高者术后更易发生局部复发或远处转移或死亡；⑤腋窝淋巴结转移数大于3枚者、新辅助化疗前血小板计数与淋巴细胞计数比值大于145.16者与接受新辅助化疗的乳腺癌患者的低无病生存期及总生存期相关；⑥患者腋窝淋巴结转移数大于3枚与患者初诊年龄小于等于35岁可作为接受新辅助化疗的乳腺癌患者低无病生存期的预测指标。
[Abstract]:Objective: To investigate the thyroid diseases and breast cancer (BC) clinical and pathological features of patients with neoadjuvant chemotherapy (NAC) correlation between the curative effect and prognosis. Materials and methods: a retrospective analysis from May 2008 to December 2015 in Qilu Hospital of Shandong University from 303 patients receiving neoadjuvant chemotherapy for breast cancer patients with clinical pathological data and prognostic information. We Miller/Payne (MP) the effect of grading of NAC patients, with the disease free survival (DFS) and overall survival (0s) prognosis evaluation of patients. Through Chi-Square test, single factor analysis of patients with thyroid disease, age, body mass index (BMI), the number of axillary lymph node metastasis, molecular classification of breast cancer, platelet count after NAC, the biggest mass reduction section (SDMCA), postoperative chemotherapy and NAC before platelet count and lymphocyte count ratio (PLR) and MP classification and survival And the correlation of local recurrence or distant metastasis; by Spearman correlation test, BC patients received NAC after ultrasound measurement of residual tumor diameter and postoperative pathological test of residual tumor maximum diameter of Kaplan-Meier by single factor correlation; survival curve analysis with thyroid disease, axillary lymph node metastasis number, platelet count, NAC MP grade, BMI the relationship between SDMCA and NAC, PLR in patients with DFS and OS; the receiver operating characteristic curve (ROC) to determine SDMCA cut-off value of PLR, and multi factor regression model to analyze the relationship between PLR and DFS patients using Cox proportional hazards. Results: a total of 303 patients were included in the study. In 250 cases prognostic information, the median follow-up time was 42.8 months (January to 7.67) at the end of follow-up, a total of 53 patients were found local recurrence or distant metastasis, 25 cases of death in patients with.98 patients can check the thyroid ultrasound and postoperative MP Class, including 48 cases of patients with thyroid diseases, including 44 cases of thyroid nodules, thyroid dysfunction in 3 cases, 1 cases of diffuse thyroid enlargement, postoperative pathology of large remission (MP grade 4-5) (mPR) and 11 cases (22.92%); 6 cases of 47 cases were not associated with in patients with thyroid diseases in mPR (12.77%), although the mPR with thyroid disease rate is not high with (22.92%Vs 12.77%) but no significant difference (P0.05).NAC after the biggest mass cutting area of more than 3.8 times smaller than NAC was significantly correlated with mPR (18/48,37.50%VS 5/83,6.02%; P0.05) of axillary lymph node positive and DSF. Significant correlation (P0.05).PLR threshold is 145.16, the patients were divided into PLR increased (114 cases) and decreased (108 cases) 2 groups, which increased PLR had poor prognosis (P=0.0440.05), there was statistically significant difference. Conclusion: the clinical study found: Patients with thyroid disease, age Body, body mass index, molecular classification of breast cancer after neoadjuvant chemotherapy and platelet count on receiving neoadjuvant chemotherapy in breast cancer patients with postoperative pathology was of no relief effect; the largest section of mass in breast cancer patients receiving neoadjuvant chemotherapy to reduce the level is 3.8 times greater than that of axillary lymph node metastasis number is greater than 3 before neoadjuvant chemotherapy, platelet count and lymphocyte count ratio is greater than the 145.16 postoperative routine pathology is easier to obtain large relief, the largest tumor section reduction degree is more than 3.8 times can be used as indicators of response to neoadjuvant chemotherapy received the neoadjuvant chemotherapy of breast cancer patients; the patients with thyroid disease, breast cancer the largest tumor type, survival section reduction degree and postoperative chemotherapy and received neoadjuvant chemotherapy in patients with breast cancer after operation, there was no correlation between local recurrence and distant metastasis; 4. Patients with age less than or equal to 35 years of age, body mass index is greater than 25.16, greater than the number of axillary lymph node metastasis 3, neoadjuvant chemotherapy of platelet count and lymphocyte count ratio is greater than 145.16, after neoadjuvant chemotherapy did not increase postoperative platelet count was more prone to local recurrence or distant metastasis or death; 5. Axillary lymph node metastasis number is greater than 3, lower disease-free survival and overall survival before neoadjuvant chemotherapy platelet count and lymphocyte count ratio is greater than 145.16 and received neoadjuvant chemotherapy in patients with breast cancer; the patients with axillary lymph node metastasis and the number of more than 3 pieces of newly diagnosed patients with age less than or equal to 35 years old as a predictor of neoadjuvant chemotherapy in breast cancer patients with low disease free survival.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R737.9

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