,乳腺癌；新辅助化疗；病理未完全缓解；预后；复发；转移," />  ,乳腺癌；新辅助化疗；病理未完全缓解；预后；复发；转移,"/> Breast cancer,Neoadjuvant chemotherapy,Non?pCR,Prognosis,Recurrence,Metastasis,"/> 乳腺癌新辅助化疗后病理未完全缓解患者预后及复发转移的危险因素分析

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中国癌症防治杂志

中国癌症防治杂志 ›› 2023, Vol. 15 ›› Issue (6): 650-656.doi: 10.3969/j.issn.1674-5671.2023.06.09

• 临床研究 • 上一篇    下一篇

乳腺癌新辅助化疗后病理未完全缓解患者预后及复发转移的危险因素分析

  

  1. 海南医学院第一附属医院乳腺外科；广西医科大学附属肿瘤医院乳腺外科
  • 出版日期:2023-12-25 发布日期:2023-12-26
  • 通讯作者: 韦长元 E-mail：changyuanwei@gxmu.edu.cn

Analysis of risk factors of prognosis,recurrence and metastasis of breast cancer patients with  non-pathologic complete response after neoadjuvant chemotherapy

  • Online:2023-12-25 Published:2023-12-26

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摘要： 目的 探讨乳腺癌新辅助化疗后病理未完全缓解（non⁃pathologic complete response，non⁃pCR）患者的预后及复发转移的危险因素。方法 回顾性分析2016年1月至2020年12月期间在广西医科大学附属肿瘤医院乳腺外科及2020年1月至2022年12月在海南医学院第一附属医院乳腺外科诊断乳腺癌并接受新辅助化疗的500例患者的临床特征。比较病理完全缓解（pathologic complete response，pCR）及non⁃pCR患者的无病生存期（disease⁃free survival，DFS）和总生存期（overall survival，OS），通过Cox比例风险模型筛选出新辅助化疗后non⁃pCR患者复发转移的独立危险因素。结果 本研究的中位随访时间为38个月（范围：6~81个月），中位DFS及OS均未到达。新辅助化疗后的pCR率为19.4%（97/500）。pCR和non⁃pCR患者5年DFS率分别为91.9 %和81.2% （P=0.003），5年OS率分别为96.1%和81.6%（P=0.007）。新辅助化疗后共有71例患者出现复发转移，其中pCR患者复发转移4例，non⁃pCR患者复发转移67例。Cox回归分析结果显示，年龄>35岁（HR=0.393，95%CI：0.220~0.701）是non⁃pCR患者术后复发转移的保护因素，而组织学分级3级（HR=3.568，95%CI：2.050~6.210）、高Ki⁃67指数（HR=2.742，95%CI：1.528~4.921）、术后Ki⁃67指数的升高（HR=5.349，95%CI：2.470~11.586）及高pN分期（HR=6.716，95%CI：2.922~15.436）是non⁃pCR患者术后出现复发转移的独立危险因素。结论 新辅助化疗后获得pCR可改善乳腺癌患者的DFS和OS；年龄≤35岁、组织学分级3级、Ki⁃67指数>30%、术后Ki⁃67指数升高及pN高分期是non⁃pCR患者术后复发转移的独立危险因素。

关键词:  ')">"> , 乳腺癌；新辅助化疗；病理未完全缓解；预后；复发；转移

Abstract: Objective To investigate the risk factors of prognosis, recurrence and metastasis of breast cancer patients with non⁃pathologic complete response (non⁃pCR)  after neoadjuvant chemotherapy. Methods The clinical characteristics of 500 patients with breast cancer diagnosed and treated with neoadjuvant chemotherapy, in the Breast Surgery Department of Guangxi Medical University Cancer Hospital from January 2016 to December 2020 and the First Affiliated Hospital of Hainan Medical University from  January 2020 to December 2022, were retrospectively analyzed. Compare the disease⁃free survival (DFS) and overall survival (OS) of pathologic complete response (pCR) and non⁃pCR patients, respectively. Cox regression analysis was used to screen independent risk factors for recurrence and metastasis of non⁃pCR patients after neoadjuvant chemotherapy. Results The median follow⁃up time was 38 months (range: 6-81 months) in the study cohort, and the median DFS and OS were not reached. The pCR rate after neoadjuvant chemotherapy was 19.4% (97/500). The 5⁃year DFS of pCR and non⁃pCR patients were 91.9 % and 81.2%, respectively (P=0.003), and their 5⁃year OS were 96.1% and 81.6%, respectively (P=0.007). A total of 71 patients experienced recurrence and metastasis after neoadjuvant chemotherapy, including 4 patients with pCR and 67 patients with non⁃pCR. Cox regression analysis showed that age > 35 years (HR=0.393, 95%CI: 0.220-0.701) was the protective factor for recurrence and metastasis in non⁃pCR patients, while the histological grade 3 (HR=3.568, 95%CI: 2.050-6.210), high Ki⁃67 index (HR=2.742, 95%CI: 1.528-4.921), elevated postoperative Ki⁃67 index (HR=5.349, 95%CI: 2.470-11.586) and high pN stage (HR=6.716, 95%CI: 2.922-15.436) were independent risk factors for recurrence and metastasis in non⁃pCR patients. Conclusions Achieving pCR after neoadjuvant chemotherapy can improve the DFS and OS of the patients. Age≤35 years, histological grade 3, Ki⁃67>30%, elevated postoperative Ki⁃67 index and high pN stage are independent risk factors of recurrence and metastasis in non⁃pCR patients. 

Key words: Breast cancer')">Breast cancer, Neoadjuvant chemotherapy, Non?pCR, Prognosis, Recurrence, Metastasis

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  • 引用本文

    高方方, 陈彬洁, 谭启杏, 黄真, 卢伟锋, 韦长元. 乳腺癌新辅助化疗后病理未完全缓解患者预后及复发转移的危险因素分析[J]. 中国癌症防治杂志, 2023, 15(6): 650-656.

    GAO Fangfang, CHEN Binjie, TAN Qixing, HUANG Zhen, LU Weifeng, WEI Changyuan. Analysis of risk factors of prognosis,recurrence and metastasis of breast cancer patients with  non-pathologic complete response after neoadjuvant chemotherapy[J]. Chinese Journal of Oncology Prevention and Treatment, 2023, 15(6): 650-656.