Kang Jian, Xiong Huifen, Jiang Xiaoliu, Huang Zhaohui, Guo Yonghong, Cao Yali, Ding Jingxian
Department of Radiation Oncology, The Breast Cancer Institute, Nanchang People's Hospital, Nanchang, Jiangxi 330025, P.R. China.
Department of Radiation Oncology, Affiliated Rehabilitation Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China.
Oncol Lett. 2025 May 27;30(1):366. doi: 10.3892/ol.2025.15112. eCollection 2025 Jul.
Neoadjuvant chemotherapy (NAC) is widely used to treat breast cancer and a pathological complete response (pCR) following NAC is associated with an optimal prognosis; however, pCR rates vary significantly. In the present study, the effects of clinicopathological factors and the administration of different taxanes on pCR rates in patients with resectable breast cancer were assessed. A total of 552 patients with breast cancer who received NAC between May 2019 and June 2024 were included in the present study. The clinicopathological traits of the patients were retrieved from medical records and their association with the pCR rate was evaluated using univariate and multivariate regression analyses. The efficacy of nanoparticle albumin-bound (Nab)-paclitaxel, docetaxel and paclitaxel liposomes in different subtypes of breast cancer were further evaluated. A total of 189 of 552 (34.2%) patients achieved pCR following NAC. The pCR rate varied significantly among different molecular subtypes as follows: 58.9% (96/163), 40.7% (37/91), 35.6% (37/104) and 9.8% (19/298) among patients with hormone receptor (HR) negative (-) human epidermal growth factor receptor 2 (HER2) positive (+), HRHER2, HRHER2 and HRHER2 breast cancer, respectively. The factors estrogen receptor (ER), progesterone receptor and HER2 status, Ki-67 index and taxane regimen were all significantly associated with pCR in the univariate analysis. In the multivariate regression analysis, ER, HER2, Ki-67 index ≥30% and Nab-paclitaxel were independent predictors of pCR. The multivariate regression analysis model had an area under the receiver operating characteristic curve area under the curve of 0.774 (95% confidence interval, 0.735-0.813). The pCR rates were 41.3, 38.2 and 25.1% among the Nab-paclitaxel, docetaxel and paclitaxel liposome groups, respectively. Patients with ER, HER2, Ki-67 index ≥30% were associated with high pCR rates. Moreover, patients who received Nab-paclitaxel and docetaxel were more likely to achieve pCR compared with paclitaxel liposomes, particularly for those with HER2 and HRHER2 statuses. In conclusion, molecular subtypes (ER/HER2 status, high Ki-67) and different taxanes significantly influence pCR likelihood. Nab-paclitaxel and docetaxel were identified as effective taxanes, highlighting their potential clinical preference, especially in HER2 and HRHER2 breast cancer.
新辅助化疗（NAC）被广泛用于治疗乳腺癌，NAC后的病理完全缓解（pCR）与最佳预后相关；然而，pCR率差异很大。在本研究中，评估了临床病理因素和不同紫杉烷类药物的使用对可切除乳腺癌患者pCR率的影响。本研究纳入了2019年5月至2024年6月期间接受NAC的552例乳腺癌患者。从病历中检索患者的临床病理特征，并使用单因素和多因素回归分析评估其与pCR率的关联。进一步评估了纳米白蛋白结合型（Nab）紫杉醇、多西他赛和紫杉醇脂质体在不同亚型乳腺癌中的疗效。552例患者中有189例（34.2%）在NAC后达到pCR。不同分子亚型的pCR率差异显著，如下所示：激素受体（HR）阴性（-）人表皮生长因子受体2（HER2）阳性（+）、HRHER2、HRHER2和HRHER2乳腺癌患者的pCR率分别为58.9%（96/163）、40.7%（37/91）、35.6%（37/104）和9.8%（19/298）。在单因素分析中，雌激素受体（ER）、孕激素受体和HER2状态、Ki-67指数和紫杉烷类药物方案均与pCR显著相关。在多因素回归分析中，ER、HER2、Ki-67指数≥30%和Nab-紫杉醇是pCR的独立预测因素。多因素回归分析模型的受试者工作特征曲线下面积为0.774（95%置信区间，0.735-0.813）。Nab-紫杉醇、多西他赛和紫杉醇脂质体组的pCR率分别为41.3%、38.2%和25.1%。ER、HER2、Ki-67指数≥30%的患者pCR率较高。此外，与紫杉醇脂质体相比，接受Nab-紫杉醇和多西他赛的患者更有可能实现pCR，尤其是对于HER2和HRHER2状态的患者。总之，分子亚型（ER/HER2状态、高Ki-67）和不同的紫杉烷类药物显著影响pCR的可能性。Nab-紫杉醇和多西他赛被确定为有效的紫杉烷类药物，突出了它们潜在的临床优势，尤其是在HER2和HRHER2乳腺癌中。
