摘要
目的探讨乳腺癌新辅助化疗疗效及ER/PR,HER2,Ki67,CyclinA2的疗效预测价值。方法 2004年10月～2009年12月50例Ⅰ～Ⅲ期原发性乳腺癌,采用含紫杉类（TP/TC或TE/PE/TEC方案）或蒽环类（EC/FEC方案）联合方案,术前化疗2～6周期,45例接受手术,术后完成规定化疗,应用B超结合触诊判断临床疗效。结果化疗前后肿瘤中位最大径分别为3.6 cm和2.2 cm,有统计学差异（Z=-5.723,P=0.000）。临床疗效：CR 3例（6%）,PR 35例（70%）,SD 11例（22%）,PD 1例（2%）,临床RR 76.0%（38/50）。45例接受手术,术后3例pCR（3/45,6.7%）,3例tpCR（3/45,6.7%）。4年无病生存期（DFS）为86.2%,4年总生存率为93.1%,中位DFS 62.4月[SE：2.535,95%CI（57.450～67.388）]。不同情况下肿瘤缩小比例并无统计学差异,包括月经状态（绝经前vs.绝经后,46.4%vs.40.6%,P=0.536）、激素受体状况（阳性vs.阴性,43.0%vs.42.2%,P=0.929）、HER2（阳性vs.阴性,41.3%vs.43.9%,P=0.774）、Ki67（阳性vs.阴性,47.2%vs.43.1%,P=0.363）、CyclinA2（阳性vs.阴性,34.3%vs.50.0%,P=0.375）、分化程度（高分化vs.中分化vs.低分化,44.1%vs.42.9%vs.41.3%,P=0.983）以及不同化疗方案（TP/TC vs.TE/PE/TEC vs.EC/FEC,52.7%vs.39.8%vs.38.9%,P=0.440）。结论紫杉类及蒽环类药物联合方案用于浸润性乳腺癌的术前化疗,可有效控制肿瘤。ER/PR,HER2,Ki67,CyclinA2的状态与肿瘤缩小比例之间并无统计学意义的关联性。
Objective To explore the efficacy of neoadjuvant chemotherapy for breast cancer and predictive value of ER/PR,HER2,Ki67,and CyclinA2 in women with local advanced breast cancer（LABC）. Methods From October 2004 to December 2009,50 patients with stage Ⅰ-Ⅲ primary breast cancer received 2-6 cycles of neoadjuvant chemotherapy with anthracycline（EC/FEC） or taxanes-based（TP/TC or TE/PE/TEC） in our hospital.Forty-five of them were followed by definitive surgery and adjuvant chemotherapy.Estrogen receptor（ER）/progesterone receptor（PR）（50 cases）,HER2（48 cases）,Ki67（26 cases） and CyclinA2（18 cases） were examined with immunohistochemistry before the neoadjuvant chemotherapy.Clinical responds,tumor lessen ratio,and toxicity of the treatment were estimated by ultrasonography and palpation afterwards.Results The medium maximum diameter of the tumors was 3.6 cm before neoadjuvant chemotherapy,and 2.2 cm after the treatment,no significant changes were observed（Z=-5.723,P=0.000）.The clinical response rate was 76.0%（38/50） in the patients [6%（3/50） CR and 70%（35/50） PR],and SD was 22%（11/50）,PD 2.0%（1/50）.In the 45 patients who underwent surgery,pCR was found in 3 cases（3/45,6.7%）,and tpCR in 3（3/45,6.7%）.The 4-year disease-free survival（DFS） rate was 86.2%,and total survival rate was 93.1% [medium DFS 62.4 months,SE： 2.535,95%CI（57.450-67.388）].No significant difference was observed in tumor lessen ratio between pre-menopause and post-menopause patients（46.4% vs.40.6%,P=0.536）,patients with positive and negative hormone receptors（43.0% vs.42.2%,P=0.929）,patients with positive and negative HER2（41.3% vs.43.9%,P=0.774）,Ki67（47.2% vs.43.1%,P=0.363）,and CyclinA2（34.3% vs.50.0%,P=0.375）,or among those with high,moderate or low differentiation（44.1%,42.9%,and 41.3%;P=0.983） or different chemotherapy regimen（TP/TC 52.7%,TE/PE/TEC 39.8%,and EC/FEC 38.9%,P=0.440）. Conclusions Patients with stage Ⅰ-Ⅲ invasive breast cancers can benefit from taxanes/anthracycline-based neoadjuvant chemotherapy with well-tolerated toxic.No evidence showing any relationship between tumor lessen ratio and expression levels of ER/PR,HER2,Ki67 and CyclinA2.
出处
《中国微创外科杂志》
CSCD
2011年第2期163-167,共5页
Chinese Journal of Minimally Invasive Surgery
基金
国家自然科学基金(30672424)资助
