乳腺癌分子分型与新辅助化疗效果及预后的关系

发布时间：2018-04-17 05:00

本文选题：乳腺癌 + 分子分型　；参考：《青岛大学》2017年硕士论文

【摘要】：目的探讨基于免疫组化的乳腺癌分子分型与新辅助化疗效果及预后的关系,为乳腺癌的新辅助治疗提供参考。方法收集2014年1月至2015年12月青岛大学附属医院乳腺中心确诊为乳腺癌并接受新辅助化疗的121名患者病历资料,通过免疫组织化学方法检测的人表皮生长因子受体2(HER-2)、孕激素受体(PR)及雌激素受体(ER)表达水平,将乳腺癌分为管腔型(Luminal型)、HER-2过表达和三阴型3个分子亚型,探讨分子分型与新辅助化疗效果及预后的关系。结果本研究共入组乳腺癌患者121例,其中Luminal型占57.0%(69/121),三阴型19.8%(24/121),HER-2过表达型23.1%(28/121)。患者的一般情况如年龄、家族史、月经状态、手术方式、肿瘤分期、肿瘤大小、及颈部淋巴结超声是否发现转移淋巴结在三种分子分型中无显著差异(P均0.05)。乳腺癌分子分型与影像学疗效评价及化疗反应度的差异均无统计学意义(P均0.05),但在病理完全缓解方面存在显著差异(P0.05)。中位随访20个月后,23例患者出现复发或转移,15例患者死亡。2年总体DFS为81.6%,Luminal型2年DFS为87.9%,三阴型2年DFS为71.4%,HER-2过表达型2年DFS为74.1%,Kaplan-Meier法计算乳腺癌分子亚型的无病生存,差异具有统计学意义(Log rankp=0.042)。2年总体的OS为88.5%,Luminal型2年OS为93.8%,三阴型2年OS为81.0%,HER-2过表达型2年OS为81.5%,Kaplan-Meier法显示Luminal型的乳腺癌总生存要优于三阴型和HER-2过表达型,但未达到有统计学意义(P=0.051)。结论乳腺癌分子分型可以预测乳腺癌新辅助化疗后的病理完全缓解,与乳腺癌新辅助化疗的影像学评价及术后化疗反应度无关。分子分型能够作为新辅助化疗患者复发转移的预测指标。
[Abstract]:Objective to investigate the relationship between molecular classification of breast cancer based on immunohistochemistry and the effect and prognosis of neoadjuvant chemotherapy in order to provide reference for neoadjuvant therapy of breast cancer.Methods from January 2014 to December 2015, 121 patients with breast cancer diagnosed as breast cancer and received neoadjuvant chemotherapy in the breast center of the affiliated Hospital of Qingdao University were collected.The expression of human epidermal growth factor receptor 2hER-2, progesterone receptor (PRP) and estrogen receptor (ER) were detected by immunohistochemical method. The breast cancer was divided into three molecular subtypes: luminal type HER-2 overexpression and tri-negative type.To explore the relationship between molecular typing and neoadjuvant chemotherapy effect and prognosis.Results there were 121 patients with breast cancer in this study. The Luminal type accounted for 57.0% of 69 / 121, and the third negative type 19.8% 24 / 121% HER-2 over-expressed 23.1R / 121D.There were no significant differences in age, family history, menstrual status, operation mode, tumor stage, tumor size, and cervical lymph node metastasis among the three molecular types (P < 0.05).There was no significant difference in molecular classification, imaging efficacy evaluation and chemotherapeutic response of breast cancer (P 0.05), but there was a significant difference in complete pathological response (P 0.05).After a median follow-up of 20 months, 15 patients died of recurrence or metastasis, the total DFS of 2 years was 81.6 luminal type DFS was 87.9, and the DFS of three negative type 2 years DFS was 71.4 HER-2 overexpression 2 years DFS was 74.1%. The disease-free survival of breast cancer molecular subtype was calculated by Kaplan-Meier method.The difference was statistically significant (P < 0.01). The overall OS of two years was 88.5 and that of Luminal type was 93.8, and that of 3-negative type was 81.0 HER-2. The total survival of Luminal type was better than that of triple negative type and HER-2 overexpression type, but there was no significant difference between them.Conclusion Molecular classification of breast cancer can predict the complete remission of breast cancer after neoadjuvant chemotherapy, but it is not related to the imaging evaluation of neoadjuvant chemotherapy and the degree of postoperative chemotherapeutic response.Molecular typing can be used as a predictor of recurrence and metastasis in neoadjuvant chemotherapy patients.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

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