刘英,黄建军
LIU Ying,HUANG Jianjun

• 1:达州市第二人民医院普外科
• 2:贵阳医学院附院乳腺外科

摘要(Abstract)：

目的:观察表柔比星联合环磷酰胺的新辅助化疗方案(EC方案)对不同分子亚型乳腺癌的疗效。方法:对接受EC化疗方案的89例乳腺癌病人应用免疫组织化学方法检测雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(HER-2)、表皮生长因子受体(EGFR)以及细胞角蛋白5/6(CK5/6)表达,依据5个因子的表达水平将患者分为Luminal A型、Luminal B型、HER-2(+)型、基底细胞(basal-like)型及正常乳腺样(normal breast-like)型5个分子亚型,分析不同分子亚型新辅助化疗疗效。结果:89例患者Luminal A型者占42.7%(38/89)、Luminal B型占28.1%(25/89)、HER-2(+)型占14.6%(13/89)、basal-like型占4.5%(4/89)及normal breast-like型占10.1%(9/89);89例乳腺癌患者经4个周期EC方案新辅助化疗后,7.9%(7/89)达病理完全缓解(p CR),9%(8/89)达完全缓解(CR),75.3%(67/89)达部分缓解(PR),客观有效(CR+PR)率84.3%,7.9%(7/89)的病人病情稳定(SD),无疾病进展(PD)病例;basal-like型乳腺癌p CR率高,为75%(3/4),占总的病理完全缓解人数的42.9%(3/7),各亚组间发病年龄、AJCC分期、肿瘤大小、淋巴结状态、临床有效差异无统计学意义,是否p CR各亚组间差异有统计学意义(P<0.05)。结论:乳腺癌分子分型可作为乳腺癌p CR的预测因子,相比之下,basal-like亚型乳腺癌可能具有更高的p CR。
Objective: To investigate the curative effect of neoadjuvant chemotherapy under the scheme of epirubicin combined cyclophosphamide( EC) on different molecular subtypes of breast cancer. Methods: Analyzing 89 patients who accepted preoperative chemotherapy under the scheme of EC,testing the immunohistochemical expression levels of ER,PR,HER-2,EGFR and CK5 /6,then,the patients were divided into the type of Luminal A,the type of Luminal B,the type of HER-2( +),the type of basal-like and the type of normal breast-like,the curative effect of neoadjuvant chemotherapy in different molecular subtypes was analyzed. Results: The type of Luminal A,the type of Luminal B,the type of HER-2( +),the type of basal-like and the type of normal breast-like was respectively accounted for proportion of 42. 7%( 38 /89),28. 1%( 25 /89),14. 6%( 13 /89),4. 5%( 4 /89),10. 1%( 9 /89) in 89 cases. These patients accepted four cycles of EC plan chemotherapy,7. 9%( 7 /89) reached pathologic complete remission( p CR),9%( 8 /89) attained complete response( CR),75. 3%( 67 /89) had partial remission( PR),84. 3% had the objective effective rate( CR + PR),7. 9%( 7 /89) had stable disease condition( SD),none had progression of disease( PD). The type of basal-like had a high rate of p CR,75%( 3 /4),accounted for 42. 9%( 3 /7) in all p CR. There were no statistical differences in onset age,AJCC stage,tumor size,lymph node status,clinical effective,while there was statistical significance in whether the pathological complete response among different subgroups. Conclusions: Breast cancer molecular classification can serve as a predictor of breast cancer,by contrast,the type of basal-like breast cancer has a higher rate of p CR.

关键词(KeyWords)： 乳腺肿瘤;癌;分型;新辅助化疗;疗效
breast neoplasms;carcinoma;type;neoadjuvant chemotherapy;curative effects

Abstract:

Keywords:

基金项目(Foundation): 贵州省科技厅基金[黔科合LG字(2011)041号]

作者(Author): 刘英,黄建军
LIU Ying,HUANG Jianjun

DOI: 10.19367/j.cnki.1000-2707.2015.02.017

参考文献(References)：

• [1]Piccart MJ,Kerger J,Tomiak E,et al.Systemic treatment for locally advanced breast cancer:what we still need to learn after a decade of multimodality clinical trials[J].Eur J Cancer,2009(2-3):667-672.
• [2]Ellis P,Smith I,Ashley S,et al.Clinical prognostic and predictive factors for primary chemotherapy in operable breast cancer[J].Clin Onco1,2008(15):107-114.
• [3]Bonadonna G,Valagussa P,Brambilla C,et al.Preoperative chemotherapy in operable breast cancer[J].cancer,2011(341):1185.
• [4]Fisher B,Bryant J,Wolmark N,et al.Effect of preoperative chemotherapy on the outcome of women with operable breast cancer[J].Clin Oncol,2008(14):2672-2685.
• [5]Romond E,Perez EA,Bryant J.Trastuzumab plus adjuvant chemotherapy for operable HER-2-positive breast cancer[J],2005(16).
• [6]Liu H,Fan Q,Zhang Z,et al.Basal-HER-2 phenotype shows poorer survival than basal-like phenotype in hormone receptor-negative invasive breast cancers[J].Hum Pathol,2008(39):167-174.
• [7]Sorlie T,Tibshirani R,Parker J,et al.Repeated observation of breast tumor subtypes in independent gene expression data sets[J].Proc Natl Acad Sci USA,2009(14):8418.
• [8]Nielsen TD,Hsu FD,Torrice C,et al.The basel-like subtype of invasive breast carcinoma[J].Clin Cancer Res,2007(16):5367-5374.
• [9]Carey LA,Perou CM,Livasy CA,et al.Race,breast cancer subtypes,and survival in the Carolina Breast Cancer Study[J].JAMA,2007(295):2492.
• [10]Rakha EA,E1-Sayed ME,Green AR,et al.Breast carcinoma with basal differentiation:a proposal for pathology definition[J].Histopathology,2007(4):434-438.
• [11]Kim MJ,Ro JY,Ahn SH,et al.Clinicopathologic significance of the basal-like subtype of breast cancer:A comparison with hormone receptor and HER-2/neu-overexpression phenotype[J].Hum Pathol,2008(37):1217.
• [12]连臻强,何洁华,王曦,等.乳腺癌不同分子亚型的临床特点和生存分析[J].中华乳腺病杂志,2009(2):139-146.
• [13]耿其荣,刘冬耕,史艳侠,等.浸润性乳腺癌近似分子亚型的临床意义[D].中山大学学报,2009(4):458-462.
• [14]沈镇宙,邵志敏.乳腺肿瘤学[M].上海:上海科学技术出版社,2009:275-276.
• [15]Belembaogo E,Reillet V,Chollet P,et al.Neoadjuvant chemotherapy in 126 operable breast cancers[J].Eur J Cancer,2009(27A):896-900
• [16]张慧明,张保宁,宣立学,等.可手术的不同分子亚型乳腺癌的临床特征和生存分析[J].中华肿瘤杂志,2009(6):447-451.
• [17]Carey LA,Dees EC,Sawyer L,et al.The triple nagetive paradox:primary tumor chemosensitivity of breast cancer subtypes[J].Clin Cancer Res,2011(13):2329-2334.
• [18]Bauer KR,Brown M,Cress RD,et al.Descriptive analysis of estrogen receptor(ER)-negative,progesterone receptor(PR)-negative,and HER-2-negative invasive breast cancer,the so-called triple-negative breast phenotype:a population—based study from the Califomia Cancer Registry[J].Cancer,2009(9):1721-1728.

文章评论(Comment)：