新辅助化疗后乳腺病理完全缓解与腋窝病理完全缓解的关联性

doi:10.6040/j.issn.1671-7554.0.2017.1094

摘要/Abstract

摘要： 目的探讨新辅助化疗(NAC)后乳腺病理完全缓解(pCR)患者腋窝转移的风险及意义。方法回顾性连续收集2014年3月5日至2017年7月21日在河南省肿瘤医院乳腺科接受NAC的原发乳腺癌病例资料701例。采用χ2检验比较腋窝pCR(apCR)与临床病理特征及乳腺pCR(bpCR)的关系,应用Logistic回归分析各个变量与apCR的关联性。结果淋巴结分期、雌激素受体(ER)、人类表皮生长因子受体2(HER2)是apCR的独立预测因素。bpCR组中HER2阳性、cN0患者93%腋窝没有转移,基底样型(BL)、cN0组7例中的6例腋窝达到pCR,cN1组apCR率达67%;而在Luminal A&B型组患者中,cN0组apCR分别有3、17例(60%、40%),cN1组分别有8、20例(47%、27%)。未bpCR组NAC后腋窝转移风险比bpCR组高4.53倍。结论 NAC后bpCR与腋窝转移有高度关联性,HER2阳性的cN0/1患者和BL型cN0患者,NAC后如达到bpCR,其腋窝转移风险较低。

关键词: 乳腺癌, 新辅助化疗, 腋窝淋巴结, 病理完全缓解

Abstract: Objective To investigate the risk and significance of axillary metastasis in patients who achieved breast pathologic complete response(pCR)after neoadjuvant chemotherapy(NAC). Methods The clinical data of 701 breast cancer cases treated with NAC during 5th March 2014 and 21st July 2017 were retrospectively analyzed. The relationship of axillary pCR(apCR)with clinicopathological characteristics and breast pCR(bpCR)was calculated using χ2 test. The correlation between the variables and apCR was analyzed with multivariate binary logistic regression. Results Lymph node staging, estrogen receptor(ER)and HER2 were independent predictors for apCR. Among bpCR patients who were HER2 positive and cN0, 93% had no nodal metastasis(14/15), and 6 of 7 cases had an apCR in basal-like, cN0 group. The aPCR rate in the cN1 group were 67%. Among Luminal A&B groups, 3 and 17(60%, 40%)patients with cN0 disease, while 8 and 20(47%, 27%)patients with cN1 disease had an apCR. Compared with patients with bpCR, those without bpCR had 4.53 times higher risk of positive nodal metastases. Conclusion The nodal status is highly correlated with bpCR after neoadjuvant chemotherapy. Patients with cN0/1 who are HER2 positive and BL subtype patients with cN0 have low risk of nodal metastases if they achieve bpCR after neoadjuvant chemotherapy.

Key words: Breast cancer, Neoadjuvant chemotherapy, Axillary lymph node, Pathologic complete response

中图分类号:

R737.9

朱久俊,焦得闯,乔江华,王丽娜,马有钊,阳跃,卢振铎,刘真真. 新辅助化疗后乳腺病理完全缓解与腋窝病理完全缓解的关联性[J]. 山东大学学报 (医学版), 2018, 56(1): 32-37.

ZHU Jiujun, JIAO Dechuang, QIAO Jianghua, WANG Lina, MA Youzhao, YANG Yue, LU Zhenduo, LIU Zhenzhen. Correlation between breast and axillary pathologic complete response after neoadjuvant chemotherapy[J]. Journal of Shandong University (Health Sciences), 2018, 56(1): 32-37.

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