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中华临床医师杂志(电子版) ›› 2024, Vol. 18 ›› Issue (07) : 641 -646. doi: 10.3877/cma.j.issn.1674-0785.2024.07.005

临床研究

老年乳腺癌新辅助治疗病理完全缓解的预测因素分析
王誉英1, 刘世伟2, 王睿3, 曾娅玲1, 涂禧慧3, 张蒲蓉2,()   
  1. 1.610041 成都,电子科技大学医学院
    2.610041 成都,四川省肿瘤临床医学研究中心 四川省肿瘤医院·研究所 四川省癌症防治中心 电子科技大学附属肿瘤医院乳腺科
    3.637000 四川南充,川北医学院临床医学院
  • 收稿日期:2024-06-24 出版日期:2024-07-15
  • 通信作者: 张蒲蓉
  • 基金资助:
    四川省科技计划重点研发项目(2023YFS0103)

Predictive factors for pathological complete response to neoadjuvant therapy for breast cancer in elderly patients

Yuying Wang1, Shiwei Liu2, Rui Wang3, Yaling Zng1, Xihui Tu3, Purong Zhang2,()   

  1. 1.School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041,China
    2.Department of Breast, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China,Chengdu 610041, China
    3.College of Clinical Medicine, North Sichuan Medical College, Nanchong 637000,China
  • Received:2024-06-24 Published:2024-07-15
  • Corresponding author: Purong Zhang
引用本文:

王誉英, 刘世伟, 王睿, 曾娅玲, 涂禧慧, 张蒲蓉. 老年乳腺癌新辅助治疗病理完全缓解的预测因素分析[J]. 中华临床医师杂志(电子版), 2024, 18(07): 641-646.

Yuying Wang, Shiwei Liu, Rui Wang, Yaling Zng, Xihui Tu, Purong Zhang. Predictive factors for pathological complete response to neoadjuvant therapy for breast cancer in elderly patients[J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(07): 641-646.

目的

研究老年乳腺癌新辅助治疗(NAT)病理完全缓解(pCR)的预测因素,进而筛选具备NAT 指征的老年患者。

方法

回顾性分析2014 年10 月至2023 年12 月四川省肿瘤医院乳腺科经治的接受NAT 的65 岁及以上老年乳腺癌,分析临床病理特征与pCR 的相关性。临床病理因素与pCR 相关性的单因素分析采用χ2 检验或Fisher 精确检验,多因素分析采用二元Logistic 回归。

结果

共132 例老年患者纳入本研究,其中22 例达到pCR,总体pCR 率为16.7%。单因素分析显示,激素受体(HR)阴性(P=0.004)、人表皮生长因子受体2(HER2)阳性(P<0.001)及Ki67高表达(P=0.013)与高pCR 率的相关性具有统计学意义。多因素分析显示,HR 阴性(OR=3.244;95%CI:1.010~10.421;P=0.048)及HER2 阳性(OR=17.907;95%CI:5.180~61.908;P<0.001)是老年乳腺癌NAT 后pCR的独立预测因素。亚组分析显示,基于HR 及HER2 状态的分子分型与pCR 率显著相关(P<0.001)。在HER2 阳性乳腺癌中,联合靶向治疗者pCR 率显著高于未联合者(60.0% vs 23.1%,P=0.031)。

结论

HR 阴性及HER2 阳性是老年乳腺癌新辅助治疗pCR 的独立预测因素。

Objective

To identify the predictive factors for pathological complete response (pCR)in elderly patients with breast cancer undergoing neoadjuvant therapy (NAT).

Methods

A retrospective analysis was conducted on elderly patients with breast cancer (≥65 years) who received NAT at the Department of Breast of Sichuan Cancer Hospital from October 2014 to December 2023. The correlation between clinicopathological characteristics and pCR was analyzed. Univariate analysis was performed using the chi-square test or Fisher’s exact test, while multivariate analysis was conducted by binary logistic regression.

Results

A total of 132 older patients were included in this study, of whom 22 achieved a pCR,with an overall pCR rate of 16.7%. Univariate analysis showed statistically significant associations of higher pCR rates with hormone receptor (HR) negativity (P=0.004), human epidermal growth factor receptor 2(HER2) positivity (P<0.001), and high Ki67 expression (P=0.013). Multivariate analysis revealed that HR negativity (odds ratio [OR]=3.244; 95% confidence interval [CI]: 1.010~10.421; P=0.048) and HER2 positivity (OR=17.907; 95%CI: 5.180~61.908; P<0.001) were independent predictive factors for pCR in elderly patients with breast cancer undergoing NAT. Subgroup analysis suggested a significant correlation of pCR rate with molecular subtypes based on HR and HER2 status (P<0.001). In HER2-positive breast cancer,the pCR rate was significantly higher in patients who received anti-HER2 therapy than in those who did not(60.0% vs 23.1%, P=0.031).

Conclusion

HR negativity and HER2 positivity are independent predictive factors for pCR in elderly patients with breast cancer receiving neoadjuvant therapy.

表1 临床病理特征与pCR 相关性的单因素分析[例(%)]
表2 临床病理特征与pCR 相关性的多因素分析
表3 分子分型与pCR 的相关性
表4 HER2 阳性乳腺癌靶向治疗与pCR 的相关性
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