青年乳腺癌新辅助化疗疗效观察及病理完全缓解的预测因素分析
发布时间：2019-05-17 15:43
【摘要】：目的:观察青年乳腺癌患者的临床病理特征并观察青年乳腺癌患者行TAC(多西他赛+吡柔比星+环磷酰胺)方案新辅助化疗后的临床疗效及毒副反应。通过对青年乳腺癌患者中达到病理完全缓解(pCR)的单因素及多因素分析,以期找到青年乳腺癌患者一般临床资料和免疫组化指标中可预测病理完全缓解的因素。方法:回顾性分析2011年1月至2016年7月郑大一附院乳腺外一科收治的年龄小于40岁的青年乳腺癌患者248名。所有患者均为于我科行乳腺肿块微创旋切活检术并于我院病理科确诊为浸润性乳腺癌的患者。248名患者均行2-4周期TAC(环磷酰胺500 mg/m2+吡柔比星50mg/m2+多西他赛75mg/m2)方案新辅助化疗(药物剂量根据身高体重计算)。化疗期间记录患者出现的不良反应。2-4周期结束后行手术治疗。术前评估临床疗效。根据术后常规病理结果统计pCR例数。采用卡方检验和logistic回归分析对青年乳腺癌患者的一般临床特点(BMI、BSA、临床分期)及IHC因子(ER、PR、ki-67、HER-2、P53)进行单因素及多因素分析。所有的统计学分析采用SPSS 17.0软件进行,一般临床资料及ICH各指标均采用卡方检验。经卡方检验后P0.05的变量进行多因素分析,采用向后逐步释然比检验方法,设置移除值为0.01。设置检验水准均为0.05。结果:248例青年乳腺癌患者中,浸润性导管癌196例(79.0%),浸润性小叶癌9例(3.6%),其他(髓样癌、粘液腺癌等特殊类型)浸润性癌43例(17.4%),临床病理分期Ⅱ期159例(64.1%),Ⅲ期89例(35.9%)。肿瘤直径2-5cm共213例(85.9%),肿瘤直径5cm共35例(14.1%)。腋窝淋巴结无转移者共141例(56.9%),转移1-3枚者62例(25.0%),3枚以上者45例(18.1%)。198例患者免疫组化结果完整,其中ER(缺失)67例(33.8%),ER(≥1%)131例(66.2%)。PR(缺失)58例(29.3%),PR(≥1%)140例(70.7%)。Her-2(-)60例(30.3%),Her-2(+)138例(69.7%)。P53阳性108例(54.5%),ki-67高表达145例(73.2%)。luminal型126例(63.6%),TNBC型54例(27.3%)。经我院常规病理确诊为浸润性乳腺癌并完成标准2-4个周期TAC方案的青年乳腺癌患者共248人,术前采用影像学(超声和乳腺钼钯)方法测量原发病灶的大小,248例患者中CR者75例(37.9%),PR 105例(53.0%),SD 15例(7.6%),PD 3例(1.5%),RR为90.9%。据术后常规病理结果示248名患者中获得pCR患者共53人,pCR率为21.4%。血液系统常见不良反应为骨髓抑制,6.9%(17/248)出现粒细胞减少性发热;10.5%(26/248)患者出现中至重度贫血,13.8%(34/248)患者出现肝功能异常,消化道症状发生率较高,占51.3%(127/248);无化疗毒副反应致死亡病例。单因素分析中:BMI24、BSA1.7、临床分期II期、ki-67过表达、TNBC、ER(-)与pCR具有相关性。多因素分析中:TNBC(OR=46.3,95%CI=1.046-18.474)、ki-67过表达(OR=8.201,95%CI=1.970-34.135)、临床分期Ⅱ期(OR=5.011,95%CI=1.626-20.498)、BMI24(OR=3.179,95%CI=1.022-9.855)是pCR的独立预测因素。结论:1、青年乳腺癌患者中以浸润性导管癌多见,三阴性乳腺癌比例较高。2、应用TAC新辅助化疗后病理完全缓解率高,毒副反应可耐受。3、青年乳腺癌患者中BMI24、临床分期Ⅱ期、三阴性乳腺癌、ki-67高表达是新辅助化疗后达到pCR的独立预测因素。
[Abstract]:Objective: To observe the clinical and pathological features of young breast cancer patients and to observe the clinical curative effect and the side effect of the neoadjuvant chemotherapy in the patients with breast cancer. Objective To study the single factor and multi-factor analysis of the complete complete response (pCR) in the young breast cancer patients with a view to finding the factors that can be used to predict the pathological complete response in the general clinical data and the immunohistochemical index of the young breast cancer patients. Methods: A retrospective analysis of 248 young breast cancer patients with age less than 40 years of age from January 2011 to July 2016 was retrospectively analyzed. All patients were treated with minimally invasive rotary-cut biopsy of breast mass in my department and were diagnosed with invasive breast cancer in our hospital.248 patients received a new adjuvant chemotherapy of 2-4 cycles of TAC (500 mg/ m2 of cyclophosphamide and 50 mg/ m2 + docetaxel plus docetaxel 75 mg/ m2) (the dose of the drug was calculated according to the body weight). ). The adverse effects of the patient were recorded during the course of chemotherapy. The treatment was performed after the end of the 2-4 cycle. Pre-operative assessment of clinical efficacy. The number of pCR was counted according to the postoperative routine pathological results. The general clinical characteristics (BMI, BSA, clinical stage) and IHC (ER, PR, ki-67, HER-2, and P53) of young breast cancer patients were analyzed by chi-square and logistic regression. All statistical analysis was performed with SPSS 17.0 software, and the general clinical data and the ICH indexes were chi-square test. The multi-factor analysis was performed on the variable of P0.05 after the chi-square test, and the removal value was set to 0.01 using the backward step-to-step comparison test method. The test level is set to 0.05. Results: Among the 248 patients with breast cancer,196 cases (79.0%) of invasive ductal carcinoma,9 (3.6%) of infiltrative lobular carcinoma,43 (17.4%) of other infiltrative carcinomas (special type, such as myeloid and mucinous adenocarcinoma), and 159 cases (64.1%) in the stage 鈪，
本文编号：2479210
[Abstract]:Objective: To observe the clinical and pathological features of young breast cancer patients and to observe the clinical curative effect and the side effect of the neoadjuvant chemotherapy in the patients with breast cancer. Objective To study the single factor and multi-factor analysis of the complete complete response (pCR) in the young breast cancer patients with a view to finding the factors that can be used to predict the pathological complete response in the general clinical data and the immunohistochemical index of the young breast cancer patients. Methods: A retrospective analysis of 248 young breast cancer patients with age less than 40 years of age from January 2011 to July 2016 was retrospectively analyzed. All patients were treated with minimally invasive rotary-cut biopsy of breast mass in my department and were diagnosed with invasive breast cancer in our hospital.248 patients received a new adjuvant chemotherapy of 2-4 cycles of TAC (500 mg/ m2 of cyclophosphamide and 50 mg/ m2 + docetaxel plus docetaxel 75 mg/ m2) (the dose of the drug was calculated according to the body weight). ). The adverse effects of the patient were recorded during the course of chemotherapy. The treatment was performed after the end of the 2-4 cycle. Pre-operative assessment of clinical efficacy. The number of pCR was counted according to the postoperative routine pathological results. The general clinical characteristics (BMI, BSA, clinical stage) and IHC (ER, PR, ki-67, HER-2, and P53) of young breast cancer patients were analyzed by chi-square and logistic regression. All statistical analysis was performed with SPSS 17.0 software, and the general clinical data and the ICH indexes were chi-square test. The multi-factor analysis was performed on the variable of P0.05 after the chi-square test, and the removal value was set to 0.01 using the backward step-to-step comparison test method. The test level is set to 0.05. Results: Among the 248 patients with breast cancer,196 cases (79.0%) of invasive ductal carcinoma,9 (3.6%) of infiltrative lobular carcinoma,43 (17.4%) of other infiltrative carcinomas (special type, such as myeloid and mucinous adenocarcinoma), and 159 cases (64.1%) in the stage 鈪，
本文编号：2479210
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