新辅助化疗联合双靶治疗HER-2阳性乳腺癌的有效性比较

闵婕 李心心 王欣

闵婕, 李心心, 王欣. 新辅助化疗联合双靶治疗HER-2阳性乳腺癌的有效性比较[J]. 中国肿瘤临床, 2023, 50(22): 1142-1146. doi: 10.12354/j.issn.1000-8179.2023.20231078
引用本文: 闵婕, 李心心, 王欣. 新辅助化疗联合双靶治疗HER-2阳性乳腺癌的有效性比较[J]. 中国肿瘤临床, 2023, 50(22): 1142-1146. doi: 10.12354/j.issn.1000-8179.2023.20231078
Jie Min, Xinxin Li, Xin Wang. Efficacy comparation of different neoadjuvant chemotherapies combined with trastuzumab and pertuzumab in HER-2 positive breast cancer[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2023, 50(22): 1142-1146. doi: 10.12354/j.issn.1000-8179.2023.20231078
Citation: Jie Min, Xinxin Li, Xin Wang. Efficacy comparation of different neoadjuvant chemotherapies combined with trastuzumab and pertuzumab in HER-2 positive breast cancer[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2023, 50(22): 1142-1146. doi: 10.12354/j.issn.1000-8179.2023.20231078

新辅助化疗联合双靶治疗HER-2阳性乳腺癌的有效性比较

doi: 10.12354/j.issn.1000-8179.2023.20231078
基金项目: 本文课题受天津市医学重点学科(专科)建设项目(编号:TJYXZDXK-009A)资助
详细信息
    作者简介:

    闵婕:专业方向为乳腺恶性肿瘤的临床研究

    通讯作者:

    王欣 wangxin@tjmuch.com

Efficacy comparation of different neoadjuvant chemotherapies combined with trastuzumab and pertuzumab in HER-2 positive breast cancer

Funds: This work was supported by Tianjin Key Medical Discipline (Specialty) Construction Project (No. TJYXZDXK-009A)
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  • 摘要:   目的  比较多西他赛+卡铂+曲妥珠单抗+帕妥珠单抗(TCbHP)、多西他赛+曲妥珠单抗+帕妥珠单抗(THP)与蒽环类+环磷酰胺序贯紫杉类+曲妥珠单抗+帕妥珠单抗(AC-THP)作为新辅助治疗方案对HER-2阳性激素受体(hormone receptor,HR)阳性和HER-2阳性HR阴性乳腺癌患者的有效性。  方法  回顾性分析2019年6月至2022年12月于天津医科大学肿瘤医院就诊的408例HER-2阳性且行标准新辅助治疗的乳腺癌患者的临床病理资料,根据HR状态分为HER-2阳性HR阳性组 211例、HER-2阳性HR阴性组197例。根据不同新辅助治疗方案进一步分为TCbHP、THP和AC-THP组,分别比较各组患者行各治疗方案的病理学完全缓解(pathological complete response,pCR)率 。  结果  HER-2阳性HR阳性乳腺癌患者中,TCbHP、THP和AC-THP组的pCR率分别为43.1%(69/160)、36.0%(9/25)和 38.5%(10/26),各组间比较差异无统计学意义(χ2=0.580,P=0.748);HER-2阳性HR阴性患者中,TCbHP、THP和AC-THP组的pCR率分别为85.5%(94/110)、57.3%(43/75) 和 66.7%(8/12),TCbHP组与THP组比较差异具有统计学意义(χ2=19.967,P<0.001)。  结论  TCbHP、THP和AC-THP新辅助治疗方案对HER-2阳性HR阳性乳腺癌患者的疗效相似,TCbHP作为新辅助治疗对HER-2阳性HR阴性乳腺癌疗效更优。

     

  • 表  1  211例HER-2阳性HR阳性乳腺癌患者临床病理特征

    项目 TCbHP组(n=160) THP组(n=25) AC-THP组(n=26) χ² P
    年龄(岁) 6.335 a 0.168a
     ≤35 26(16.2) 5(20.0) 2(7.6)
     36~50 75(46.9) 6(24.0) 12(46.2)
     >50 59(36.9) 14(56.0) 12(46.2)
    绝经状态 2.462 0.303
     绝经前 97(60.6) 11(44.0) 15(57.7)
     绝经后 63(39.4) 14(56.0) 11(42.3)
    临床肿瘤大小分期(期) 10.562a 0.074a
     cT1 21(13.1) 3(12.0) 1(3.8)
     cT2 102(63.8) 16(64.0) 16(61.6)
     cT3 32(20.0) 2(8.0) 8(30.8)
     cT4 5(3.1) 4(16.0) 1(3.8)
    临床淋巴结分期(期) 6.197a 0.346a
     cN0 48(30.0) 4(16.0) 5(19.2)
     cN1 90(56.2) 14(56.0) 18(69.2)
     cN2 18(11.3) 6(24.0) 3(11.6)
     cN3 4(2.5) 1(4.0) 0(0)
    TNM分期(期) 3.043a 0.495a
     Ⅰ 7(4.4) 1(4.0) 0(0)
     Ⅱ 114(71.2) 15(60.0) 17(65.4)
     Ⅲ 39(24.4) 9(36.0) 9(34.6)    
    ()内单位为%;a:采用Fisher's精确检验
    下载: 导出CSV

    表  2  197例HER-2阳性HR阴性乳腺癌患者临床病理特征

    项目 TCbHP组(n=110) THP组(n=75) AC-THP组(n=12) χ² P
    年龄(岁) 5.722a 0.196a
     ≤35 13(11.8) 3(4.0) 0(0)
     36-50 44(40.0) 32(42.7) 3(25.0)
     >50 53(48.2) 40(53.3) 9(75.0)
    绝经状态 2.714 0.268
     绝经前 55(50.0) 36(48.0) 3(25.0)
     绝经后 55(50.0) 39(52.0) 9(75.0)
    临床肿瘤大小分期(期) 8.193a 0.181a
     cT1 11(10.0) 1(1.3) 1(8.3)
     cT2 63(57.3) 50(66.7) 8(66.7)
     cT3 32(29.1) 21(28.0) 2(16.7)
     cT4 4(3.6) 3(4.0) 1(8.3)
    临床淋巴结分期(期) 9.310a 0.131a
     cN0 22(20.0) 29(38.7) 3(25.0)
     cN1 56(50.9) 27(36.0) 7(58.4)
     cN2 21(19.1) 14(18.7) 1(8.3)
     cN3 11(10.0) 5(6.6) 1(8.3)
    TNM分期(期) 13.269a 0.003a
     Ⅰ 1(0.9) 0(0) 0(0)
     Ⅱ 57(51.8) 46(61.3) 9(75.0)
     Ⅲ 52(47.3) 29(38.7) 3(25.0)    
    ()内单位为%;a:采用Fisher's精确检验
    下载: 导出CSV

    表  3  HER-2阳性HR阳性乳腺癌患者各组疗效比较

    项目 TCbHP组(n=160) THP组(n=25) AC-THP组(n=26) χ² P
    ypT0ypN0 1.730 0.421
     是 56(35.0) 7(28.0) 6(23.1)
     否 104(65.0) 18(72.0) 20(76.9)
    ypT0/isypN0 0.580 0.748
     是 69(43.1) 9(36.0) 10(38.5)
     否 91(56.9) 16(64.0) 16(61.5)    
    ()内单位为%
    下载: 导出CSV

    表  4  HER-2阳性HR阴性乳腺癌患者各组疗效比较

    项目 TCbHP组(n=110) THP组(n=75) AC-THP组(n=12) χ² P
    ypT0ypN0 11.732 0.003
    72(65.5) 32(42.7) 4(33.3)
    38(34.5) 43(57.3) 8(66.7)
    ypT0/isypN0 18.468 <0.001
    94(85.5) 43(57.3) 8(66.7)
    16(14.5) 32(42.7) 4(33.3)    
    ()内单位为%
    下载: 导出CSV

    表  5  不同HR状态乳腺癌患者行双靶新辅助治疗的疗效比较

    项目 ypT0/isypN0 未达ypT0/isypN0 χ² P
    阴性(n=197) 145(73.6) 52(26.4) 44.759 <0.001
    弱阳性(n=42) 22(52.4) 20(47.6)
    强阳性(n=169) 66(39.1) 103(60.9)    
    ()内单位为%
    下载: 导出CSV
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  • 收稿日期:  2023-10-15
  • 录用日期:  2023-12-11
  • 修回日期:  2023-12-02

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