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浙江大学学报（医学版）
浙江大学学报（医学版）  2016, Vol. 45 Issue (6): 614-619    DOI: 10.3785/j.issn.1008-9292.2016.11.09
原著     
新辅助化疗前后激素受体变化的乳腺癌患者辅助内分泌治疗的疗效
夏光发1,2, 朱娟英2, 袁军2, 曹博2, 唐婕2, 陈益定1
1. 浙江大学医学院附属第二医院肿瘤外科, 浙江 杭州 310006;
2. 嘉兴市妇幼保健院乳腺科, 浙江 嘉兴 314000
Efficacy of adjuvant endocrine therapy in breast cancer patients with a positive-to-negative switch of hormone receptor status after neoadjuvant chemotherapy
XIA Guangfa1,2, ZHU Juanying2, YUAN Jun2, CAO Bo2, TANG Jie2, CHEN Yiding1
1. Department of Surgical Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China;
2. Department of Breast Surgery, Jiaxing Maternity and Child Health Care Hospital, Jiaxing 314000, China
 全文: PDF(1107 KB)  
摘要：

目的：探讨接受新辅助化疗后激素受体由阳性转变为阴性的乳腺癌患者接受辅助内分泌治疗的疗效。方法：回顾性分析2000年12月至2013年12月在嘉兴市妇幼保健院接受新辅助化疗后激素受体由阳性转为阴性的乳腺癌患者106例，按照是否接受辅助内分泌治疗分为观察组和对照组，分析辅助内分泌治疗对其预后的影响，采用Kaplan-Meier法进行生存分析，并通过log-rank法比较不同患者的生存差异，使用Cox模型对患者无病存活率、总存活率的影响因素进行多因素回归分析。结果：106例患者中61例（57.5%）使用了辅助内分泌治疗，中位随访时间为68（14～103）个月。人表皮生长因子受体2（HER-2）状态、临床分期、术后腋窝淋巴结状态以及是否接受辅助内分泌治疗与患者5年无病存活率和总存活率显著相关（均P<0.05），观察组患者5年无病存活率和总存活率均高于对照组患者（77.1%与53.5%，80.9%与71.0%，均P<0.05）。Cox多因素回归分析结果显示，是否接受辅助内分泌治疗是患者5年无病存活率的独立预测指标（HR=2.096，95%CI：1.081~4.065，P<0.05）。结论：激素受体在新辅助化疗后由阳性转为阴性的乳腺癌患者仍可从辅助内分泌治疗中获益。
关键词： 乳腺肿瘤/治疗;  乳腺肿瘤/病理学;  受体;  雌激素;  受体;  孕酮;  辅助化疗/方法;  治疗结果;  存活率;  回顾性研究    
Abstract:

Objective: To evaluate the efficacy of adjuvant endocrine therapy (AET) in breast cancer patients with a positive-to-negative switch of hormone receptor status after neoadjuvant chemotherapy (NAC). Methods: One hundred and six patients who presented with hormone receptor (HR)-positive breast cancer at diagnosis and turned to HR-negative after NAC during December 2000 and December 2013 in Jiaxing Maternity and Child Health Care Hospital were retrospectively identified. Kaplan-Meier analysis and log-rank test were used for univariate analyses of factors related to disease free survival (DFS) and overall survival (OS). Multivariate analysis was carried out using the Cox proportional hazards model in patients with DFS and OS. Results: All the patients were categorized into two groups on the basis of the administration of AET:61 AET-administered patients (57.5%) and 45 AET-naïve patients (42.5%). After a median follow-up of 68 months (range 14-103 months), human epidermal growth factor receptor 2 (HER-2) status, initial clinical stage, pathological axillary lymph node status and the use of AET were identified as the variables affecting DFS and OS (all P<0.05). Patients treated with AET had a significantly improved 5-year DFS rate when compared with that without AET (77.1% vs 53.5%,P<0.05). The 5-year OS of AET-administered patients was also better than that of AET-naïve patients (80.9% vs 71.0%,P<0.05). Cox regression analysis showed that AET-administered or not was the independent predictor for 5-year DFS (HR=2.096, 95% CI:1.081-4.065, P<0.05). Conclusion: Patients with HR altered from positive to negative after NAC may still gain benefit from AET.
Key words: Breast neoplasms/therapy    Breast neoplasms/pathology    Receptors, estrogen    Receptors, progesterone    Chemotherapy, adjuvant/methods    Treatment outcome    Survival rate    Retrospective studies
收稿日期: 2016-02-12
CLC:  R737.9  
基金资助:

浙江省卫生高层次创新人才培养工程；浙江省自然科学基金（LZ16H160002）
通讯作者: 陈益定(1971-),男,博士,主任医师,博士生导师,主要从事恶性肿瘤早期诊治研究;E-mail:ydchen@zju.edu.cn;http://orcid.org/0000-0002-2263-6275     E-mail: ydchen@zju.edu.cn
作者简介: 夏光发(1982-),女,硕士研究生,主治医师,主要从事乳腺癌的临床研究;E-mail:375928585@qq.com;http://orcid.org/0000-0001-6953-8958
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引用本文:

夏光发 等. 新辅助化疗前后激素受体变化的乳腺癌患者辅助内分泌治疗的疗效[J]. 浙江大学学报（医学版）, 2016, 45(6): 614-619.

XIA Guangfa, ZHU Juanying, YUAN Jun, CAO Bo, TANG Jie, CHEN Yiding. Efficacy of adjuvant endocrine therapy in breast cancer patients with a positive-to-negative switch of hormone receptor status after neoadjuvant chemotherapy. Journal of ZheJiang University(Medical Science), 2016, 45(6): 614-619.

链接本文:

http://www.zjujournals.com/xueshu/med/CN/10.3785/j.issn.1008-9292.2016.11.09    或    http://www.zjujournals.com/xueshu/med/CN/Y2016/V45/I6/614

[1] BURCOMBE RJ, MAKRIS A, RICHMAN PI, et al. Evaluation of ER, PgR, HER-2 and Ki-67 as predictors of response to neoadjuvant anthracycline chemotherapy for operable breast cancer[J]. Br J Cancer, 2005, 92(1):147-155.
[2] HIRATA T, SHIMIZU C, YONEMORI K, et al. Change in the hormone receptor status following administration of neoadjuvant chemotherapy and its impact on the long-term outcome in patients with primary breast cancer[J]. Br J Cancer, 2009, 101(9):1529-1536.
[3] JAIN V, LANDRY M, LEVINE EA. The stability of estrogen and progesterone receptors in patients receiving preoperative chemotherapy for locally advanced breast carcinoma[J]. Am Surg, 1996, 62(2):162-165.
[4] TACCA O, PENAULT-LLORCA F, ABRIAL C, et al. Changes in and prognostic value of hormone receptor status in a series of operable breast cancer patients treated with neoadjuvant chemotherapy[J]. Oncologist, 2007, 12(6):636-643.
[5] EISENHAUER E A, THERASSE P, BOGAERTS J, et al. New response evaluation criteria in solid tumours:revised RECIST guideline (version 1.1)[J]. Eur J Cancer, 2009, 45(2):228-247.
[6] CONNOR CS, TAWFIK OW, JOYCE AJ, et al. A comparison of prognostic tumor markers obtained on image-guided breast biopsies and final surgical specimens[J]. Am J Surg, 2002, 184(4):322-324.
[7] TAUCHER S, RUDAS M, MADER RM, et al. Prognostic markers in breast cancer:the reliability of HER2/neu status in core needle biopsy of 325 patients with primary breast cancer[J]. Wien Klin Wochenschr, 2004, 116(1-2):26-31.
[8] MUELLER-HOLZNER E, FINK V, FREDE T, et al. Immunohistochemical determination of HER2 expression in breast cancer from core biopsy specimens:a reliable predictor of HER2 status of the whole tumor[J]. Breast Cancer Res Treat, 2001, 69(1):13-19.
[9] CHEN X, YUAN Y, GU Z, et al. Accuracy of estrogen receptor, progesterone receptor, and HER2 status between core needle and open excision biopsy in breast cancer:a meta-analysis[J]. Breast Cancer Res Treat, 2012, 134(3):957-967.
[10] ZHANG N, MORAN MS, HUO Q, et al. The hormonal receptor status in breast cancer can be altered by neoadjuvant chemotherapy:a meta-analysis[J]. Cancer Invest, 2011, 29(9):594-598.
[11] GOLDHIRSCH A, WOOD WC, COATES AS, et al. Strategies for subtypes-dealing with the diversity of breast cancer:highlights of the St. gallen international expert consensus on the primary therapy of early breast cancer 2011[J]. Ann Oncol, 2011, 22(8):1736-1747.
[12] PEROU C M, SØRLIE T, EISEN M B, et al. Molecular portraits of human breast tumours[J]. Nature, 2000, 406(6797):747-752.
[13] SØRLIE T, PEROU C M, TIBSHIRANI R, et al. Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications[J]. Proc Natl Acad Sci U S A, 2001, 98(19):10869-10874.
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