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目的:探讨HER-2表达与乳腺癌不同方案辅助化疗疗效的关系,为患者筛选有效的化疗方案。方法:应用蒽环类和(或)紫杉类三种化疗方案对308例Ⅰ-Ⅲ期乳腺癌患者进行辅助化疗,免疫组织化学SP法检测标本中HER-2的表达,中位随访45.00(13.2～94.1)个月,分析化疗方案及病理学特征(HER-2状态,激素受体状态,病理分期)与生存率的关系。结果:总复发转移率22.07%(68/308),平均疾病进展时间27.58个月。HER-2阳性患者中,蒽环类化疗组无病生存率(DFS)135/191,紫杉类化疗组DFS15/16(x2=3.938,P<0.05)差异有显著性;蒽环紫杉类联合组DFS35/39与蒽环类组相比(x2=6.104,P<0.05)差异有显著性。对激素受体阳性的患者,用蒽环类化疗组DFS(116/165),与紫杉醇类化疗DFS(19/20)(x2=5.517,P<0.05)差异有显著性。在腋窝淋巴结阳性的的患者中,蒽环类化疗组无病生存率(DFS)73/113,紫杉类化疗组DFS17/19(x2=4.638,P<0.05)差异有显著性;蒽环紫杉类联合组DFS36/41与蒽环类组相比(x2=7.831,P<0.01)差异有显著性。结论:HER-2阳性乳腺癌患者对紫杉类化疗药物更敏感;紫杉类比蒽环类药物对激素受体阳性的患者疗效更好而对激素受体阴性的患者无明显区别;蒽环紫杉联合类和紫杉类药物对淋巴结阳性者疗效比蒽环类好,蒽环类和紫杉类及联合类药物对淋巴结阴性者疗效相当。
Objective: To investigate the relationship between the expression of HER-2 and the efficacy of adjuvant chemotherapy in different regimens of breast cancer and screen the effective chemotherapy regimen for patients. Methods: 308 patients with stage Ⅰ-Ⅲ breast cancer were treated with anthracycline and (or) taxane chemotherapy. HER-2 expression was detected by immunohistochemical SP method. The median follow-up was 45.00 ( 13.2 ~ 94.1) months, the relationship between chemotherapy regimen and pathological features (HER-2 status, hormone receptor status, pathological staging) and survival rate was analyzed. Results: The total recurrence and metastasis rate was 22.07% (68/308) and the mean disease progression time was 27.58 months. Among the HER-2-positive patients, anthracycline-treated patients had a disease-free survival rate (DFS) of 135/191 and a taxane chemotherapy group of DFS of 15/16 (x2 = 3.938, The difference between the combination group DFS35 / 39 and the anthracycline group (x2 = 6.104, P <0.05) was significant. For hormone receptor-positive patients, there was a significant difference between the DFS (116/165) anthracycline group and the DFS (19/20) (x2 = 5.517, P <0.05) for paclitaxel-based chemotherapy. In axillary lymph node-positive patients, anthracycline chemotherapy-free survival (DFS) 73/113, and taxane chemotherapy DFS17 / 19 (x2 = 4.638, P <0.05) were significantly different; Anthracycline Violet There was significant difference between DFS36 / 41 and anthracycline group (x2 = 7.831, P <0.01) in cedar combined group. CONCLUSIONS: HER-2-positive breast cancer patients are more sensitive to taxanes chemotherapeutics; taxanes are more effective than anthracyclines in hormone receptor-positive patients and have no significant difference in hormone receptor-negative patients; Anthracyclines Violet Cunninghamia and taxanes are more effective than anthracyclines in lymph node positive patients, anthracycline and taxane and combined drugs are effective in patients with lymph node negative.