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| 血小板衍生生长因子受体A表达水平与HER2+转移性乳腺癌曲妥珠单抗治疗效果的关系研究 |
| Relationship between platelet-derived growth factor receptor a expression level and the therapeutic effect of trastuzumab in her2+ metastatic breast cancer |
| 投稿时间：2025-05-20 |
| DOI：10.3969/j.issn.1000-0399.2026.05.004 |
| 中文关键词: 乳腺癌 转移 曲妥珠单抗 人类表皮生长因子受体2 血小板衍生生长因子受体A 治疗效果 预测价值 |
| 英文关键词: Breast cancer Transfer Trastuzumab Therapeutic effect Human epidermal growth factor receptor 2 Platelet-derived growth factor receptor A Predictive value |
| 基金项目:江苏省卫生健康委科研项目(编号:M2020203) |
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| 摘要点击次数: 294 |
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| 中文摘要: |
| 目的 探讨血小板衍生生长因子受体A(PDGFRA)表达水平与HER2（人类表皮生长因子受体2）阳性转移性乳腺癌曲妥珠单抗治疗效果的关系。方法 回顾性分析2021年7月至2024年8月在江苏省海安市人民医院接受曲妥珠单抗治疗的98例HER2+转移性乳腺癌患者临床资料。采用免疫组织化学法检测治疗前穿刺活检组织PDGFRA表达情况，根据曲妥珠单抗治疗效果分为有效组（n=65）、无效组（n=33）。比较两组患者的一般资料及PDGFRA表达水平，采用Spearman相关性分析PDGFRA表达水平与疗效的相关性，分析HER2+转移性乳腺癌患者PDGFRA不同表达状态下的临床病理特征，采用logistic回归分析法分析影响HER2+转移性乳腺癌曲妥珠单抗治疗无效的影响因素，并绘制受试者工作特征（ROC）曲线分析PDGFRA对HER2+转移性乳腺癌曲妥珠单抗治疗无效的预测价值。结果 98例患者中完全缓解16例、部分缓解49例，有效率为66.33%(65/98)；无效组肿瘤直径>2 cm、原发肿瘤ER阳性、PR阳性患者占比高于有效组（P<0.05），无效组PDGFRA阳性率高于有效组（P<0.05）,Spearman相关性分析结果显示，HER2+转移性乳腺癌患者PDGFRA表达情况与疗效呈显著负相关性（r=-0.514,P<0.001）。Logistic回归分析结果显示，原发肿瘤ER阳性（OR=1.547, P=0.031, 95%CI:1.039～2.302）、原发肿瘤PR阳性（OR=1.487, P=0.038, 95%CI:1.009～2.193）、PDGFRA高表达（++、+++，OR=1.523, P=0.002, 95%CI:1.135～2.044;OR=1.806, P<0.001, 95%CI:1.252～2.605）是影响HER2+转移性乳腺癌曲妥珠单抗治疗无效的危险因素（P<0.05）。ROC曲线分析结果显示，以PDGFRA++为最佳截断点预测HER2+转移性乳腺癌曲妥珠单抗治疗无效的曲线下面积与约登指数均最高，但差异无统计学意义（P>0.05）。结论 PDGFRA中等及以上强度表达可作为HER2+转移性乳腺癌患者对曲妥珠单抗治疗反应性的预测指标，且其表达强度越高与疗效呈负相关。 |
| 英文摘要: |
| Objective To explore the relationship between the expression level of platelet-derived growth factor receptor A(PDGFRA) and the therapeutic effect of trastuzumab in HER2(human epidermal growth factor receptor 2)-positive metastatic breast cancer. Methods The paraffin tissues and clinical case data of 98 patients with HER2+ metastatic breast cancer who received trastuzumab treatment in our hospital from July 2021 to August 2024 were selected for a retrospective study. The expression of PDGFRA in the puncture biopsy tissues before treatment was detected by immunohistochemistry. According to the therapeutic effect of trastuzumab, they were divided into the effective group(n=65) and the ineffective group(n=33). The general data and PDGFRA expression levels of patients in the effective group and the ineffective group were compared, and the correlation between PDGFRA expression level and therapeutic effect was analyzed by Spearman correlation analysis. The clinicopathological characteristics of PDGFRA in patients with HER2+ metastatic breast cancer under different expression states were analyzed. Logistic regression analysis was applied to analyze the related factors influencing the ineffectiveness of trastuzumab treatment for HER2+ metastatic breast cancer, and the receiver operating characteristic curve(ROC) curve was plotted to analyze the predictive value of PDGFRA for the ineffectiveness of trastuzumab treatment for HER2+ metastatic breast cancer. Results Among the 98 patients, 16 achieved complete remission and 49 achieved partial remission, with an effective rate of 66.33%(65/98). The proportion of patients with tumor diameter >2 cm, positive ER and positive PR in the primary tumor in the ineffective group was higher than that in the effective group(P<0.05), and the positive rate of PDGFRA in the ineffective group was higher than that in the effective group(P<0.05). Spearman correlation analysis showed that The expression of PDGFRA in patients with HER2+ metastatic breast cancer was significantly negatively correlated with the therapeutic effect(r=-0.514, P<0.001). The results of lgistic analysis showed that positive ER in the primary tumor(OR=1.547, P=0.031, 95%CI:1.039～2.302), positive PR in the primary tumor(OR=1.487, P=0.038, 95%CI:1.009～2.193), and high expression of PDGFRA(++, +++, OR=1.523, P=0.002, 95%CI:1.135～2.044; OR=1.806, P<0.001, 95%CI:1.252～2.605) were risk factors for the ineffectiveness of trastuzumab in HER2+ metastatic breast cancer(P<0.05). The results of ROC analysis showed that with PDGFRA++ as the optimal cut-off point, the area under the curve and Youden index for predicting the ineffectiveness of trastuzumab treatment in HER2+ metastatic breast cancer were the highest, while the difference was not statistically significant(P<0.05). Conclusion Moderate to high expression of PDGFRA can be used as a predictive indicator of trastuzumab treatment response in patients with HER2+ metastatic breast cancer, and higher expression intensity is negatively correlated with the therapeutic effect. |
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