分子分型对新辅助化疗后肿瘤退缩模式的影响

分子分型对新辅助化疗后肿瘤退缩模式的影响(论文18000字)
摘要
目的
探索新辅助化疗后不同分子分型乳腺癌乳腺原发肿瘤的退缩模式。
方法
将102例 期乳腺浸润性导管癌患者行新辅助化疗，新辅助化疗后手术标本制作次连续病理大切片，显微镜下勾画残余肿瘤范围， 软件配准， 软件三维重建残余肿瘤，评价新辅助化疗后原发肿瘤病理退缩模式。
结果
19例Luminal A型患者新辅助化疗后，向心性退缩( ， )9例(47.4％)，非向心性退缩( ， )10例(52.6％)。28例 阴性)型患者新辅助化疗后，向心性退缩15例(53.6％)，非向心性退缩13例(46.4％)。19例Luminal B(HER2阳性)型患者新辅助化疗后，向心性退缩15例(78.9％)，非向心性退缩4例(21.1％)。10例HER2阳性型患者新辅助化疗后，向心性退缩8例(80％)，非向心性退缩2例(20％)。26例三阴性型患者新辅助化疗后，向心性退缩21例(80.8％)，非向心性退缩5例(19.2％)。差异有统计学意义，P＜0.05。
结论
Luminal B(HER2阳性)型、HER2阳性型及三阴性型的原发肿瘤更容易出现向心性退缩(分别为78.9％、80%、80.8%)，Luminal A型、Luminal B(HER2阴性)型的原发肿瘤退缩模式偏向不明显(向心性退缩 47.4%、53.6%)。分子分型有助于预测乳腺癌新辅助化疗后原发肿瘤的退缩模式，有助于进一步选择新辅助化疗后合适的保乳治疗的患者、降低局部复发率。
关键词
乳腺肿瘤；新辅助化疗；分子分型；退缩模式
 
Abstract
Objective 
The objective of this study was to investigate the differences of shrinkage mode of the primary tumor in different molecular subtypes of breast cancer after neoadjuvant chemotherapy(NAC).
Methods 
102 women with pathologically proven solitary invasive ductal carcinoma (IIA-IIIC) were recruited.All patients received whole cycles of NAC.Breast specimen was prepared with PMSS,and residual tumors were microscopically outline,scanned and registered by Photoshop software.The 3D model of residual tumors was reconstructed with 3D-Doctor software to evaluate the shrinkage model.
Rseult 
Of the 19 Luminal A types, concentric shrinkage mode(CSM) was 9(47.4％). non-concentric shrinkage mode(NCSM)was 10(52.6％). Of 28 Luminal B (HER2-)types, concentric shrinkage mode was 15(53.6％). non-concentric shrinkage mode was 13(46.4％). Of the 19 Luminal B (HER2+)types, concentric shrinkage mode was 15(78.9％). non-concentric shrinkage mode was 4(21.1％). Of 10 HER2+ types, concentric shrinkage mode was 8(80％). non-concentric shrinkage mode was 2(20％).Of 26  basal-like types, concentric shrinkage mode was 21(80.8％). non-concentric shrinkage mode was 5(19.2％).There was a ststistically significant diference in the tumor shrinkage pattern brtween molecular subtypes(P＜0.05).
Conclusion 
Luminal B (HER2+)types, HER2+ types and basal-like types were more likely to have concentric shrinkage mode (78.9%, 80% and 80.8% respectively). The Luminal A type and Luminal B (HER2-) type had no significant difference in primary tumor regression pattern (concentric shrinkage 47.4%, 53.6%). Molecular typing is helpful to predict the regression mode of primary tumor after neoadjuvant chemotherapy in breast cancer, and help to further select the appropriate breast conserving therapy and reduce the local recurrence rate after neoadjuvant chemotherapy.
Subject words:
Breast Cancer; Neoadjuvant chemotherapy; Molecular typing ；Shrinkage Modes;

目  录
目  录    I
摘要    III
ABSTRACT    IV
主要符号表    VI
第一章  绪  论    1
第二章  材料与方法    3
2.1 临床资料    3
2.1.1 纳入标准：    3
2.1.2 排除标准    5
2.1.3 受试者资料：    7
2.1.4 新辅助化疗方案    7
2.1.5钼靶检查    9
2.1.6免疫组化    10
2.2 主要试剂和仪器    11
2.3 研究方法    12
2.3.1 次连续病理大切片制作：    12
2.3.2 病理三维重建：    15
2.3.3 三维重建：    18
2.3.4 残余肿瘤三维测量：    19
2.3.5 NAC后三维退缩模式    21
2.3.6 统计学分析    22
第三章  实验结果    23
3.1 NAC后临床病理资料    23
3.2 病理退缩模式    25
3.3 临床⁃病理退缩模式    26
第四章  讨论    31
4.1 NAC后原发肿瘤退缩模式的意义    31
4.2 MRI及病理三维重建评估残余肿瘤的准确性    33
4.3 分子分型与NAC后原发肿瘤退缩模式的相关性    35
4.4 不同分子分型原发肿瘤NAC后的退缩模式不同    39
第五章  结论    42