乳腺癌新辅助化疗后同侧内乳区淋巴结病理完全缓解的预测因素及预后价值

张玮芳; 刘金钊; 张香梅; 张硕; 马祥敏; 刘运江

doi:10.3971/j.issn.1000-8578.2022.22.0285

乳腺癌新辅助化疗后同侧内乳区淋巴结病理完全缓解的预测因素及预后价值

Predictive Factors and Prognostic Value of Pathologic Complete Response of Internal Mammary Lymph Nodes in Breast Cancer After Neoadjuvant Chemotherapy

摘要

摘要:
目的探讨乳腺癌新辅助化疗后内乳区淋巴结病理完全缓解（ipCR）的预测因素及其对预后的影响。
方法对70例伴内乳区淋巴结转移的原发乳腺癌并接受新辅助化疗患者病例资料进行回顾性分析，根据术后病理分为ipCR组和non-ipCR组。对乳腺癌新辅助化疗后同侧ipCR的预测因素，χ²检验、Fisher及Logistic回归分别进行单因素和多因素分析，Kaplan-Meier曲线和Cox回归进行预后分析。
结果 70例患者中31例获得ipCR（44.3%）。单因素分析显示，腋窝pCR、激素受体表达水平、HER2状态与ipCR有关（P < 0.05）。多因素分析显示，年龄、腋窝pCR、HER2状态是ipCR的独立预测因子。ipCR组平均DFS达96.0个月（95%CI: 49.5~84.7），明显优于non-ipCR组为67.1个月（95%CI: 81.7~110.3, P < 0.05）。ipCR组复发转移风险较non-ipCR组降低87%（HR=0.13, 95%CI: 0.04~0.44, P < 0.01）。ipCR、Ki67表达水平、乳房pCR是影响患者预后的独立因素。
结论新辅助化疗后是否获得ipCR与临床病理因素存在相关性。ipCR可用于预测内乳区淋巴结转移患者的预后。

Abstract:
Objective To explore the prognostic factors of the pathological complete response of internal mammary lymph node (ipCR) after neoadjuvant chemotherapy and its effect on breast cancer prognosis.
Methods We retrospectively analyzed the clinical data of 70 patients with primary breast cancer with internal mammary lymph node metastasis who received neoadjuvant chemotherapy. Patients were divided into the ipCR group and non-ipCR group based on their postoperative pathology. χ² test, Fisher, and Logistic regression were used for univariate and multivariate analysis. Meanwhile, the Kaplan-Meier curve and Cox regression were used for prognostic analysis.
Results Of 70 patients, 31 obtained ipCR (44.3%). Univariate analysis showed that the expression levels of apCR, HR, and HER2 status were related to ipCR (P < 0.05). Multivariate analysis showed that age, apCR, and HER2 status were independent predictors of ipCR (P < 0.05). The average DFS of ipCR group was better than non-ipCR group (96.0 vs. 67.1 months, P < 0.05). The risk of recurrence and metastasis was 87% lower in the ipCR group than in the non-ipCR group (HR=0.13, 95%CI: 0.04-0.44, P < 0.01). ipCR, Ki67 expression level, and breast pCR (bpCR) were independent factors affecting patients' prognosis.
Conclusion There is a correlation between clinico pathological factors and ipCR after neoadjuvant chemotherapy. ipCR can be used to predict the prognosis of patients with internal mammary lymph node metastasis.

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