【摘要】：目的： 乳腺癌是女性最常見的惡性腫瘤之一,嚴重威脅人類健康。研究表明MicroRNA-21(miRNA-21or miR-21)對乳腺癌預后有一定的預測價值,但目前的結論存在爭議。本研究通過meta分析系統(tǒng)評估m(xù)iR-21異常表達與乳腺癌患者預后的關系。 方法： 檢索PubMed、EMBASE、Web of Science和中國知網(CNKI)數(shù)據庫,根據納入和排除標準,有關miR-21表達水平與乳腺癌預后關系的文獻入選本研究。通過計算合并風險比(hazard ratios, HRs)及相應的95%置信區(qū)間(confidence interval, CI)以及評價研究間異質性等進行數(shù)據分析。所有統(tǒng)計分析在STATA12.0軟件中完成。 結果： 來自10個研究的1,439例乳腺癌病例入選本meta分析。MiR-21表達水平升高,乳腺癌患者總生存期(HR=2.57,95%CI:1.37-4.81,P=0.003)及無病生存期/無復發(fā)生存期(HR=1.45,95%CI:1.16-1.82,P=0.001)均縮短,二者均具有統(tǒng)計學差異。而且,miR-21在亞洲人群中預后價值更明顯(HR:5.07,95%CI:2.89--8.92,P0.001),在高加索人群中的預后作用未達到顯著性差異(HR=1.44,95%CI:0.99_2.10,P=0.058).通過分析比值比,miR-21與腫瘤分期、組織學分級、激素受體狀態(tài)等一系列臨床病理特征關系密切。 結論： 本研究顯示miR-21表達水平升高,乳腺癌患者預后不佳,尤其是亞洲人群。 目的： 探討分子生物學標志物及乳腺癌分子分型等臨床病理特征與乳腺癌新輔助化療療效的關系。 方法： 對86例在浙江大學醫(yī)學院附屬第二醫(yī)院腫瘤外科就診的乳腺癌新輔助化療患者的臨床病理資料進行回顧性分析。患者經B超引導下乳腺腫塊穿刺病理確診乳腺癌,免疫組織化學法明確穿刺標本中雌激素受體(estrogen receptor, ER)、孕激素受體(progesterone receptor,PR)、人類表皮生長因子受體2(human epidermal growth factor receptor-2, Her-2)和Ki-67的表達,并以此將患者分成Luminal A、 Luminal B、Her2過表達和三陰型。根據RECIST實體瘤療效評價標準進行療效評價,分析臨床病理特征與新輔助化療臨床療效及病理改變的關系。結果： 86例接受新輔助化療乳腺癌患者的病理完全緩解率為24.42%,總反應率為69.77%。ER陰性患者的病理完全緩解率為48.3%，PR陰性為40%,與相應的陽性患者(ER陽性12.3%、PR陽性11.9%)相比,激素受體陰性患者病理完全緩解率高,二者均具有統(tǒng)計學差異(P值分別為0.001和0.002)。在新輔助化療中使用曲妥珠單抗的Her2過表達型乳腺癌患者的臨床總反應率為94.4%,未使用者為64.3%,二者臨床療效有統(tǒng)計學差異(P=0.021)。三陰型乳腺癌病理完全緩解率為46.2%,明顯高于其他類型乳腺癌(P=0.046)。 結論： ER陰性、PR陰性乳腺癌對新輔助化療更敏感。對于Her2過表達的乳腺癌在新輔助化療中聯(lián)用曲妥珠單抗獲益更多。相較于其他類型乳腺癌,三陰型乳腺癌的新輔助化療療效更佳。
[Abstract]:Objective: breast cancer is one of the most common malignant tumors in women, which is a serious threat to human health. Studies have shown that MicroRNA-21 (miRNA-21or miR-21) can predict the prognosis of breast cancer, but the current conclusions are controversial. This study evaluated the relationship between abnormal expression of miR-21 and prognosis of breast cancer patients by meta analysis system. Methods: PubMed,EMBASE,Web of Science and (CNKI) databases were searched. According to the inclusion and exclusion criteria, the literature on the relationship between the expression of miR-21 and the prognosis of breast cancer was included in this study. The combined risk ratio (hazard ratios, HRs) and the 95% confidence interval (confidence interval, CI) were calculated and the heterogeneity was evaluated. All statistical analysis is done in STATA12.0 software. Results: 1439 cases of breast cancer from 10 studies were included in this meta analysis. The expression of MiR-21 increased and the total survival time (HR=2.57,95%CI:1.37-4.81,) of breast cancer patients increased. P0. 003) and disease-free survival / relapse-free survival (HR=1.45,95%CI:1.16-1.82,P=0.001) were shortened, and there was statistical difference between them. Moreover, miR-21 had more significant prognostic value (HR:5.07,95%CI:2.89--8.92,P0.001) in Asian population than in Caucasian population (HR=1.44,95%CI:0.99_2.10,). P0. 058) By analyzing the ratio, miR-21 is closely related to a series of clinicopathological features such as tumor stage, histological grade, hormone receptor status, etc. Conclusion: this study showed that the expression of miR-21 increased and the prognosis of breast cancer patients was poor, especially in Asian population. Objective: to investigate the relationship between molecular biomarkers, molecular classification and neoadjuvant chemotherapy in breast cancer. Methods: the clinicopathological data of 86 patients with neoadjuvant chemotherapy of breast cancer in the second affiliated Hospital of Zhejiang University Medical College were retrospectively analyzed. Breast cancer was diagnosed by puncture and pathology under the guidance of B-ultrasound. The estrogen receptor (estrogen receptor, ER), progesterone receptor (progesterone receptor,PR) was determined by immunohistochemical method. The expression of human epidermal growth factor receptor 2 (human epidermal growth factor receptor-2, Her-2) and Ki-67 were divided into Luminal A, Luminal Bu Her2 overexpression and triple negative type. The clinical and pathological characteristics of neoadjuvant chemotherapy were analyzed according to the evaluation criteria of RECIST solid tumor. Results: the pathological complete remission rate of 86 breast cancer patients receiving neoadjuvant chemotherapy was 24.42 and the total response rate was 48.3 PR negative in 69.77%.ER negative patients. Compared with the corresponding positive patients (ER positive 12.3% and PR positive 11.9%), the complete remission rate of steroid receptor negative patients was higher than that of the corresponding positive patients (P = 0.001 and 0.002, respectively). In neoadjuvant chemotherapy, the total clinical response rate of Her2 overexpression breast cancer patients treated with tritozumab was 94. 4% and 64.3% respectively. There was statistical difference between the two groups (P0. 021). The pathological complete remission rate of triple negative breast cancer was 46.2, which was significantly higher than that of other types of breast cancer (P0. 046). Conclusion: ER negative and PR negative breast cancer are more sensitive to neoadjuvant chemotherapy. For breast cancer with Her2 overexpression, combined use of trotozumab was more beneficial in neoadjuvant chemotherapy. Neoadjuvant chemotherapy is better for triple negative breast cancer than for other types of breast cancer.
【學位授予單位】：浙江大學
【學位級別】：博士
【學位授予年份】：2015
【分類號】：R737.9

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1 顏黎栩;黃馬燕;吳秋良;邵建永;;miR-21表達異常與乳腺癌臨床病理特征及預后的關系[J];中國病理生理雜志;2009年04期

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