【摘要】：目的:觀察青年乳腺癌患者的臨床病理特征并觀察青年乳腺癌患者行TAC(多西他賽+吡柔比星+環(huán)磷酰胺)方案新輔助化療后的臨床療效及毒副反應(yīng)。通過對青年乳腺癌患者中達(dá)到病理完全緩解(pCR)的單因素及多因素分析,以期找到青年乳腺癌患者一般臨床資料和免疫組化指標(biāo)中可預(yù)測病理完全緩解的因素。方法:回顧性分析2011年1月至2016年7月鄭大一附院乳腺外一科收治的年齡小于40歲的青年乳腺癌患者248名。所有患者均為于我科行乳腺腫塊微創(chuàng)旋切活檢術(shù)并于我院病理科確診為浸潤性乳腺癌的患者。248名患者均行2-4周期TAC(環(huán)磷酰胺500 mg/m2+吡柔比星50mg/m2+多西他賽75mg/m2)方案新輔助化療(藥物劑量根據(jù)身高體重計算)�；熎陂g記錄患者出現(xiàn)的不良反應(yīng)。2-4周期結(jié)束后行手術(shù)治療。術(shù)前評估臨床療效。根據(jù)術(shù)后常規(guī)病理結(jié)果統(tǒng)計pCR例數(shù)。采用卡方檢驗和logistic回歸分析對青年乳腺癌患者的一般臨床特點(BMI、BSA、臨床分期)及IHC因子(ER、PR、ki-67、HER-2、P53)進行單因素及多因素分析。所有的統(tǒng)計學(xué)分析采用SPSS 17.0軟件進行,一般臨床資料及ICH各指標(biāo)均采用卡方檢驗。經(jīng)卡方檢驗后P0.05的變量進行多因素分析,采用向后逐步釋然比檢驗方法,設(shè)置移除值為0.01。設(shè)置檢驗水準(zhǔn)均為0.05。結(jié)果:248例青年乳腺癌患者中,浸潤性導(dǎo)管癌196例(79.0%),浸潤性小葉癌9例(3.6%),其他(髓樣癌、粘液腺癌等特殊類型)浸潤性癌43例(17.4%),臨床病理分期Ⅱ期159例(64.1%),Ⅲ期89例(35.9%)。腫瘤直徑2-5cm共213例(85.9%),腫瘤直徑5cm共35例(14.1%)。腋窩淋巴結(jié)無轉(zhuǎn)移者共141例(56.9%),轉(zhuǎn)移1-3枚者62例(25.0%),3枚以上者45例(18.1%)。198例患者免疫組化結(jié)果完整,其中ER(缺失)67例(33.8%),ER(≥1%)131例(66.2%)。PR(缺失)58例(29.3%),PR(≥1%)140例(70.7%)。Her-2(-)60例(30.3%),Her-2(+)138例(69.7%)。P53陽性108例(54.5%),ki-67高表達(dá)145例(73.2%)。luminal型126例(63.6%),TNBC型54例(27.3%)。經(jīng)我院常規(guī)病理確診為浸潤性乳腺癌并完成標(biāo)準(zhǔn)2-4個周期TAC方案的青年乳腺癌患者共248人,術(shù)前采用影像學(xué)(超聲和乳腺鉬鈀)方法測量原發(fā)病灶的大小,248例患者中CR者75例(37.9%),PR 105例(53.0%),SD 15例(7.6%),PD 3例(1.5%),RR為90.9%。據(jù)術(shù)后常規(guī)病理結(jié)果示248名患者中獲得pCR患者共53人,pCR率為21.4%。血液系統(tǒng)常見不良反應(yīng)為骨髓抑制,6.9%(17/248)出現(xiàn)粒細(xì)胞減少性發(fā)熱;10.5%(26/248)患者出現(xiàn)中至重度貧血,13.8%(34/248)患者出現(xiàn)肝功能異常,消化道癥狀發(fā)生率較高,占51.3%(127/248);無化療毒副反應(yīng)致死亡病例。單因素分析中:BMI24、BSA1.7、臨床分期II期、ki-67過表達(dá)、TNBC、ER(-)與pCR具有相關(guān)性。多因素分析中:TNBC(OR=46.3,95%CI=1.046-18.474)、ki-67過表達(dá)(OR=8.201,95%CI=1.970-34.135)、臨床分期Ⅱ期(OR=5.011,95%CI=1.626-20.498)、BMI24(OR=3.179,95%CI=1.022-9.855)是pCR的獨立預(yù)測因素。結(jié)論:1、青年乳腺癌患者中以浸潤性導(dǎo)管癌多見,三陰性乳腺癌比例較高。2、應(yīng)用TAC新輔助化療后病理完全緩解率高,毒副反應(yīng)可耐受。3、青年乳腺癌患者中BMI24、臨床分期Ⅱ期、三陰性乳腺癌、ki-67高表達(dá)是新輔助化療后達(dá)到pCR的獨立預(yù)測因素。
[Abstract]:Objective: To observe the clinical and pathological features of young breast cancer patients and to observe the clinical curative effect and the side effect of the neoadjuvant chemotherapy in the patients with breast cancer. Objective To study the single factor and multi-factor analysis of the complete complete response (pCR) in the young breast cancer patients with a view to finding the factors that can be used to predict the pathological complete response in the general clinical data and the immunohistochemical index of the young breast cancer patients. Methods: A retrospective analysis of 248 young breast cancer patients with age less than 40 years of age from January 2011 to July 2016 was retrospectively analyzed. All patients were treated with minimally invasive rotary-cut biopsy of breast mass in my department and were diagnosed with invasive breast cancer in our hospital.248 patients received a new adjuvant chemotherapy of 2-4 cycles of TAC (500 mg/ m2 of cyclophosphamide and 50 mg/ m2 + docetaxel plus docetaxel 75 mg/ m2) (the dose of the drug was calculated according to the body weight). ). The adverse effects of the patient were recorded during the course of chemotherapy. The treatment was performed after the end of the 2-4 cycle. Pre-operative assessment of clinical efficacy. The number of pCR was counted according to the postoperative routine pathological results. The general clinical characteristics (BMI, BSA, clinical stage) and IHC (ER, PR, ki-67, HER-2, and P53) of young breast cancer patients were analyzed by chi-square and logistic regression. All statistical analysis was performed with SPSS 17.0 software, and the general clinical data and the ICH indexes were chi-square test. The multi-factor analysis was performed on the variable of P0.05 after the chi-square test, and the removal value was set to 0.01 using the backward step-to-step comparison test method. The test level is set to 0.05. Results: Among the 248 patients with breast cancer,196 cases (79.0%) of invasive ductal carcinoma,9 (3.6%) of infiltrative lobular carcinoma,43 (17.4%) of other infiltrative carcinomas (special type, such as myeloid and mucinous adenocarcinoma), and 159 cases (64.1%) in the stage 鈪，

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