本文選題：乳腺癌 + 分子分型　； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的探討基于免疫組化的乳腺癌分子分型與新輔助化療效果及預(yù)后的關(guān)系,為乳腺癌的新輔助治療提供參考。方法收集2014年1月至2015年12月青島大學(xué)附屬醫(yī)院乳腺中心確診為乳腺癌并接受新輔助化療的121名患者病歷資料,通過免疫組織化學(xué)方法檢測的人表皮生長因子受體2(HER-2)、孕激素受體(PR)及雌激素受體(ER)表達水平,將乳腺癌分為管腔型(Luminal型)、HER-2過表達和三陰型3個分子亞型,探討分子分型與新輔助化療效果及預(yù)后的關(guān)系。結(jié)果本研究共入組乳腺癌患者121例,其中Luminal型占57.0%(69/121),三陰型19.8%(24/121),HER-2過表達型23.1%(28/121)。患者的一般情況如年齡、家族史、月經(jīng)狀態(tài)、手術(shù)方式、腫瘤分期、腫瘤大小、及頸部淋巴結(jié)超聲是否發(fā)現(xiàn)轉(zhuǎn)移淋巴結(jié)在三種分子分型中無顯著差異(P均0.05)。乳腺癌分子分型與影像學(xué)療效評價及化療反應(yīng)度的差異均無統(tǒng)計學(xué)意義(P均0.05),但在病理完全緩解方面存在顯著差異(P0.05)。中位隨訪20個月后,23例患者出現(xiàn)復(fù)發(fā)或轉(zhuǎn)移,15例患者死亡。2年總體DFS為81.6%,Luminal型2年DFS為87.9%,三陰型2年DFS為71.4%,HER-2過表達型2年DFS為74.1%,Kaplan-Meier法計算乳腺癌分子亞型的無病生存,差異具有統(tǒng)計學(xué)意義(Log rankp=0.042)。2年總體的OS為88.5%,Luminal型2年OS為93.8%,三陰型2年OS為81.0%,HER-2過表達型2年OS為81.5%,Kaplan-Meier法顯示Luminal型的乳腺癌總生存要優(yōu)于三陰型和HER-2過表達型,但未達到有統(tǒng)計學(xué)意義(P=0.051)。結(jié)論乳腺癌分子分型可以預(yù)測乳腺癌新輔助化療后的病理完全緩解,與乳腺癌新輔助化療的影像學(xué)評價及術(shù)后化療反應(yīng)度無關(guān)。分子分型能夠作為新輔助化療患者復(fù)發(fā)轉(zhuǎn)移的預(yù)測指標(biāo)。
[Abstract]:Objective to investigate the relationship between molecular classification of breast cancer based on immunohistochemistry and the effect and prognosis of neoadjuvant chemotherapy in order to provide reference for neoadjuvant therapy of breast cancer.Methods from January 2014 to December 2015, 121 patients with breast cancer diagnosed as breast cancer and received neoadjuvant chemotherapy in the breast center of the affiliated Hospital of Qingdao University were collected.The expression of human epidermal growth factor receptor 2hER-2, progesterone receptor (PRP) and estrogen receptor (ER) were detected by immunohistochemical method. The breast cancer was divided into three molecular subtypes: luminal type HER-2 overexpression and tri-negative type.To explore the relationship between molecular typing and neoadjuvant chemotherapy effect and prognosis.Results there were 121 patients with breast cancer in this study. The Luminal type accounted for 57.0% of 69 / 121, and the third negative type 19.8% 24 / 121% HER-2 over-expressed 23.1R / 121D.There were no significant differences in age, family history, menstrual status, operation mode, tumor stage, tumor size, and cervical lymph node metastasis among the three molecular types (P < 0.05).There was no significant difference in molecular classification, imaging efficacy evaluation and chemotherapeutic response of breast cancer (P 0.05), but there was a significant difference in complete pathological response (P 0.05).After a median follow-up of 20 months, 15 patients died of recurrence or metastasis, the total DFS of 2 years was 81.6 luminal type DFS was 87.9, and the DFS of three negative type 2 years DFS was 71.4 HER-2 overexpression 2 years DFS was 74.1%. The disease-free survival of breast cancer molecular subtype was calculated by Kaplan-Meier method.The difference was statistically significant (P < 0.01). The overall OS of two years was 88.5 and that of Luminal type was 93.8, and that of 3-negative type was 81.0 HER-2. The total survival of Luminal type was better than that of triple negative type and HER-2 overexpression type, but there was no significant difference between them.Conclusion Molecular classification of breast cancer can predict the complete remission of breast cancer after neoadjuvant chemotherapy, but it is not related to the imaging evaluation of neoadjuvant chemotherapy and the degree of postoperative chemotherapeutic response.Molecular typing can be used as a predictor of recurrence and metastasis in neoadjuvant chemotherapy patients.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.9

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