Clinical Value of Molecular Subtypes for Breast Cancer Predicting Therapeutic Effect and Prognosis of Dose Dense Docetaxel Neoadjuvant Chemotherapy
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摘要: 目的 探讨不同乳腺癌分子亚型与多西他赛密集新辅助化疗疗效及预后的相关性。方法收集2007年3月—2009年12月可手术乳腺癌患者76例，接受四周期多西他赛密集新辅助化疗，新辅助化疗前用免疫组织化学（IHC）及荧光原位杂交(FISH)法检测肿瘤病灶中ER、PR、Her-2及Ki67的表达，根据表达水平将乳腺癌分为四个分子亚型。主要研究终点包括各亚型临床有效率(RR)、3年无病生存率（DFS）和总生存率(OS)。次要研究终点是化疗不良反应、病理完全缓解率（pCR）。结果76例患者中，最常见Ⅲ～Ⅳ度粒细胞缺乏 （28.9%）、肝功能损害（10.5%）、皮肤毒性(9.2%)以及肌肉和关节疼痛（6.6%）等化疗不良反应。pCR为5例；Luminal A亚型、Luminal B 亚型、Her-2+亚型及三阴亚型的RR分别为86.1%、82.4%、100%、100%（P= 0.256），3年DFS、OS分别为94%和97%、88%和94%、70%和70%及69%和69%。对比Luminal A亚型与Her-2+亚型、Luminal A亚型与三阴亚型的3年DFS、OS，差异均有统计学意义(P<0.05)。结论 75 mg/m2多西他赛密集新辅助化疗是安全的，Luminal A亚型比Her-2 +亚型、三阴亚型预后更好。Abstract: Objective To investigate the correlation between different molecular subtypes for breast cancer(BC) and the therapeutic effect and prognosis of dose dense docetaxel neoadjuvant chemotherapy. Methods A total of 76 patients with operable,histologically confirmed BC received 4 cycles of dose dense docetaxel neoadjuvan chemotherapy between March 2007 and December 2009.The expression of estrogen receptor (ER) progesterone receptor (PR),Her-2 and Ki67 were detected by immunohistochemical method and fluorescence in-situ hybridization before neoadjuvan chemotherapy.The patients were classified into 4 subtypes.The primary end points were clinical response rate(RR),3-year disease-free survival rates(DFS) and overall survival rate(OS) for every subtypes.Secondary end points were adverse events,pathologic complete response(pCR). Results In a total of 76 patients,the most common grade 3-4 toxicities were neutropenia (28.9%),liver function (10.5%),cutaneous (9.2%)，myalgia and arthralgia(6.6%),respectively.The pCR was 5 cases.The RR of Luminal A,Luminal B,Her-2+and triple negative were 86.1%,82.4%,100% and 100%,respectively（P=0.256）.The 3-year disease-free survival rates and overall survival rate of luminal A,luminal B,Her-2+and triple negative were 94%,97%,88%,94,70%,70%,69% and 69%,respectively.Compared with the 3-year DFS,OS of Luminal A and Her-2+,Luminal A and triple negative,there were significant difference(P<0.05). Conclusion Docetaxel 75 mg/m2 neoadjuvan chemotherapy regimen is safe.The prognosis of Luminal A is better than Her-2+ and triple negative.
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Key words:
- Breast cancer /
- Docetaxel /
- Dose dense neoadjuvant chemotherapy /
- Molecular subtype
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