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

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。%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-na?ve 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-na?ve 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.