原发性乳腺癌新辅助化疗的临床研究  

Neoadjuvant chemotherapy for primary breast cancer

作　　者：李金锋[1] 欧阳涛[1] 王天峰[1] 林本耀[1] 

机构地区：[1]北京大学临床肿瘤学院暨北京肿瘤医院乳腺中心,100036

出　　处：《中华肿瘤杂志》2004年第8期493-495,共3页Chinese Journal of Oncology

基　　金：北京市卫生局重点学科基金资助 ( 1998卫科重字 10号 )

摘　　要：目的　探讨以 5 氟脲嘧啶 (5 Fu)和蒽环类药物为主的联合化疗对原发性乳腺癌新辅助化疗的应用价值。方法　 111例患者的 114个原发性乳腺癌 ,于手术前应用 5 Fu和蒽环类药物 (吡柔比星或表柔比星 )为主的联合化疗 2～ 6个周期 ,观察其疗效和毒副反应 ,并分析疗效与肿瘤特征的关系。结果　全组总有效率为 87.7% ,其中临床完全缓解率为 39.5 % ,病理学完全缓解率为 2 3.7% ,疾病进展率为 0 .9%。吡柔比星方案较表柔比星方案疗效更佳 ,两方案病理学完全缓解者差异有显著性 (P <0 .0 5 )。吡柔比星方案的脱发反应轻微 ,但骨髓抑制较表柔比星方案严重。肿瘤激素受体表达与疗效有关 ,激素受体表达阴性者病理学完全缓解率为 33.3% ,而激素受体表达阳性者仅为 7.5 %(P <0 .0 0 5 )。肿瘤大小和HER 2表达与疗效无关。结论　 5 Fu和蒽环类药物为主的联合方案用于乳腺癌新辅助化疗 ,近期疗效满意 ,且副反应较轻。吡柔比星方案的疗效优于表柔比星方案 。Objective To evaluate the feasibility and effect of fluorouracil (5-Fu) in association with anthracycline-based regimen as neoadjuvant chemotherapy for primary breast cancer. Methods For one hundred and eleven primary breast cancer patients with 114 lesions who were to be operated, two to six cycles of 5-Fu (continuous infusion) in association with epirubicin or pirarubicin and cyclophosphamide (CEFci or CTFci regimen) were given before operation. The response rate, side effect and its relation with tumor characteristics were studied. Results The overall response rate was 87.7%, of which the complete clinical response was 39.5%, pathological complete response was 23.7%, only one patient (0.9%) showed progressive disease. The regimen containing pirarubicin was superior to epirubicin regimen in pathological complete response rate (P<0.05). Alopecia was mild in pirarubicin regimen as compared with epirubicin regimen but neutropenia was more severe in pirarubicin regimen than that in epirubicin regimen. Hormonal receptor expressions were significantly related to treatment response, the pathological complete response rate was 33.3% in oestrogen or progestin receptor negative tumors,but it was 7.5% in the positive tumors(P<0.005). No correlation was observed between treatment response and tumor size, as well as HER-2 expression. Conclusion CTFci / CEFci regimen as neoadjuvant chemotherapy is effective and safe for primary breast cancer. CTFci regimen is superior to CEFci regimen in response rate. The patients with negative hormonal receptor are more sensitive to the neoadjuvant chemotherapy.

关 键 词：原发性乳腺癌 辅助化疔 5-FU 5-氟脲嘧啶 蒽环类 

分 类 号：R737.9[医药卫生—肿瘤] R730.53[医药卫生—临床医学]