CAJ | 학술논문

目的对乳腺癌新辅助治疗后病理完全缓解(pCR)的预测因素进行分析.方法选择2009年1月至2011年12月确诊为原发性乳腺癌并接受新辅助治疗的159例患者为研究对象进行前瞻性分析,年龄28 ～ 70岁,中位年龄50岁.以紫杉类及蒽环类药物为基础方案,同时对人类表皮生长因子受体2阳性患者联合应用曲妥珠单抗.分析组织病理免疫组化结果及分子分型对pCR的预测价值.影像学疗效评价采用RECIST 1.1标准,组织学评估采用Miller-Payne标准.结果新辅助治疗影像学评价原发病灶临床总体缓解率75.5％ (120/159),其中临床完全缓解10.1％(16/159),部分缓解65.4％ (104/159),疾病稳定24.5％ (39/159),无疾病进展病例.病理组织学评价G5(pCR) 27.7％ (44/159),G4 28.3％ (45/159),G3 18.9％ (30/159),G2 12.6％ (20/159),G112.6％ (20/159).组织病理检查免疫组化高组织学分级(Z=-2.820,P=0.005)、Ki67高表达(Z=-1.989,P=0.047)、p53高表达(Z=-2.457,P =0.014)的肿瘤pCR率更高；在分子分型中三阴型乳腺癌pCR率高于非三阴型乳腺癌(P=0.000).结论组织学分级、Ki67、p53与pCR密切相关,三阴型乳腺癌pCR率更高.
목적 대유선암신보조치료후병리완전완해(pCR)적예측인소진행분석.방법 선택2009년1월지2011년12월학진위원발성유선암병접수신보조치료적159례환자위연구대상진행전첨성분석,년령28 ～ 70세,중위년령50세.이자삼류급은배류약물위기출방안,동시대인류표피생장인자수체2양성환자연합응용곡타주단항.분석조직병리면역조화결과급분자분형대pCR적예측개치.영상학료효평개채용RECIST 1.1표준,조직학평고채용Miller-Payne표준.결과 신보조치료영상학평개원발병조림상총체완해솔75.5％ (120/159),기중림상완전완해10.1％(16/159),부분완해65.4％ (104/159),질병은정24.5％ (39/159),무질병진전병례.병리조직학평개G5(pCR) 27.7％ (44/159),G4 28.3％ (45/159),G3 18.9％ (30/159),G2 12.6％ (20/159),G112.6％ (20/159).조직병리검사면역조화고조직학분급(Z=-2.820,P=0.005)、Ki67고표체(Z=-1.989,P=0.047)、p53고표체(Z=-2.457,P =0.014)적종류pCR솔경고；재분자분형중삼음형유선암pCR솔고우비삼음형유선암(P=0.000).결론 조직학분급、Ki67、p53여pCR밀절상관,삼음형유선암pCR솔경고.
Objective To assess the effect of neoadjuvant chemotherapy and the factors related with pathological complete response (pCR) of neoadjuvant chemotherapy in breast cancer.Methods The data of 159 primary breast cancer patients who had received neoadjuvant chemotherapy and operation with complete MRI data and histopathology evaluation in this center from January 2009 to December 2011 was analyzed.All the patients were female,aging from 28 to 70 years with a median of 50 years.The neoadjuvant chemotherapy regimens were based on anthracyclines or taxanes,and trastuzumab was used in almost half of the human epidermalgrowth factor receptor 2 positive patients.The response of neoadjuvant chemotherapy was comprehensively evaluated based on RECIST 1.1 and Miller-Payne grading system.SPSS 18.0 was used for statistical analysis.Results Among the 159 patients,10.1％ patients had achieved complete response according to the MRI evaluation,and the rate of partial response,stable disease,and progressive disease was 65.4％,24.5％,and 0 respectively.According to the Miller-Payne grading system,27.7％ patients had pathological response evaluated as G5 (pCR),and the response evaluated as G4,G3,G2,and G1 were 28.3％,18.9％,12.6％,and 12.6％ respectively.The higher histological grade were correlated with pCR statistically (Z =-2.820,P =0.005).Meanwhile strong expression of Ki67 (Z =-1.989,P =0.047) and p53 (Z =-2.457,P =0.014) were related to pCR in a significant statistically way.Conclusions The response of neoadjuvant chemotherapy can be predicted.The histological grade and the immunohistochemistry results of Ki67 and p53 are related to pCR of neoadjuvant chemotherapy for primary breast cancer.Basal-like breast cancer had a higher pCR statistically.