目的：乳腺癌（BC）目前是全球女性死亡的主要原因。研究证实，妊娠是影响BC患者生存的独立因素。BC在怀孕期间发现,哺乳期,或分娩后不久就是我们过去认为的妊娠相关乳腺癌（PABC）。目前专家对这一概念的定义并不统一；然而，越来越多的证据表明，产后乳腺癌（PPBC）在生物学特征和预后方面与其他类型的BC不同，对诊断和治疗的关注略有不同。随着我国女性育龄人口的增加和生育政策的变化,PPBC患者越来越受到关注。这里,我们系统分析了PPBC患者的临床病理特征和化疗反应。我们回顾性分析临床病理资料,分子亚型,化疗方案,2012年1月1日至2023年5月31日，哈尔滨医科大学附属肿瘤医院1343例非转移性BC患者的病理完全缓解（pCR）率。采用Logistic回归模型对分类数据进行卡方检验和Fisher精确检验。将单因素分析中P<0.05的预测变量纳入多因素回归分析，以探讨不同年龄组与pCR的关系。
结果：本研究共有714名患者符合分析条件，667例患者有妊娠史,40例（5.6%）为PPBC患者。当被诊断为BC时，PPBC患者较年轻，更有可能接受保乳手术（BCS），更容易达到pCR(P<0.05)。在分子分型中，人表皮生长因子受体2(HER-2)阳性和三阴性乳腺癌(TNBC)的发病率更高.在整个队列中，HER-2表达和分娩状态是新辅助化疗（NAC）后BC患者pCR率的独立预测因素。
结论：我们的研究结果表明，产后状况是BC患者达到pCR的独立预测因素。PPBC比其他患者对化疗更敏感。我们需要更加关注这个群体，实现个体化治疗，这将有助于我们更好地治疗BC，并为我们的临床治疗提供新的目标和蓝图。
OBJECTIVE: Breast cancer (BC) is currently the leading cause of death in women worldwide. Studies have confirmed that pregnancy is an independent factor affecting the survival of BC patients. BC found during pregnancy, lactation, or shortly after delivery is what we used to think of as pregnancy-associated breast cancer (PABC). The current expert definition of this concept is not uniform; however, there is growing evidence that postpartum breast cancer (PPBC) differs from other types of BC in terms of both biological features and prognosis, with a slightly different focus on diagnosis and treatment. With the increase of female reproductive age population and changes in fertility policies in
China, patients with PPBC are receiving increasing attention. Here, we systematically analyzed the clinicopathological characteristics and chemotherapeutic response of patients with PPBC. We retrospectively analyzed the clinicopathological data, molecular subtypes, chemotherapy regimens, and pathological complete remission (pCR) rates of 1343 patients with non-metastatic BC at Harbin Medical University Cancer Hospital from January 1, 2012 to May 31, 2023. The categorical data were compared by chi-square test and Fisher exact test using logistic regression model. Predictor variables with P < 0.05 in the univariate analysis were included in the multivariate regression analysis to investigate the relationship between different age groups and pCR.
RESULTS: A total of 714 patients were eligible for analysis in this study, and 667 patients had a history of pregnancy, 40 (5.6%) of whom were PPBC patients. When diagnosed with BC, patients with PPBC were younger, more likely to undergo breast-conserving surgery (BCS), and more likely to achieve pCR (P < 0.05). In molecular typing, human epidermal growth factor receptor 2 (HER-2)-positive and triple-negative breast cancer (TNBC) were more frequent. In the entire cohort, HER-2 expression and delivery status were independent predictors of pCR rates in BC patients after neoadjuvant chemotherapy (NAC).
CONCLUSIONS: Our findings suggest that postpartum status is an independent predictor of pCR attainment in BC patients. PPBC is more sensitive to chemotherapy than other patients.We need to pay more attention to this group and achieve individualized treatment, which will help us treat BC better and provide new targets and blueprints for our clinical therapy.
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