腋淋巴结转移阳性乳腺癌新辅助化疗临床意义的探讨  

Effect of neoadjuvant chemotherapy in treatment of locally advanced breast cancer with cytologically proven axillary node metastases

作　　者：黄欧[1] 陈灿铭[2] 胡震[2] 柳光宇[2] 吴炅[2] 陆劲松[2] 狄根红[2] 邵志敏[2] 沈镇宙[2] 沈坤炜[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院外科,上海200025 [2]复旦大学附属肿瘤医院乳腺外科,上海200032

出　　处：《中华肿瘤防治杂志》2009年第24期1939-1941,共3页Chinese Journal of Cancer Prevention and Treatment

基　　金：上海市教育委员会重点学科建设项目(J50208)

摘　　要：目的:探讨新辅助化疗对经细针针吸活检证实有腋窝淋巴结癌转移局部晚期乳腺癌的影响。方法:111例局部晚期乳腺癌经细针针吸活检确诊有腋窝淋巴结癌转移且空心针穿刺确诊为浸润性乳腺癌,接受≥2个周期标准剂量新辅助化疗后手术治疗。根据新辅助化疗后不同的腋窝淋巴结临床疗效和腋窝淋巴结病理状况,分组进行生存分析。结果:新辅助化疗后,腋窝淋巴结临床完全缓解(cCR)占60.4%(67/111),其中腋窝淋巴结病理完全缓解(pCR)占29.9%(20/67);未临床完全缓解(no-cCR)占39.6%(44/111),其中pCR占36.4%(16/44)。中位随访时间为65个月(13～76个月)。cCR与no-cCR两组的无病生存时间(DFS)和总生存时间(OS)差异均无统计学意义,P值分别为0.182和0.984。pCR患者具有较长DFS和OS,P值分别为0.036和0.038。pCR患者中,肿瘤原发灶pCR与no-pCR患者的DFS和OS差异均无统计学意义,P值分别为0.204和0.250。结论:对病理学确诊有腋窝淋巴结癌转移的局部晚期乳腺癌患者,单纯根据临床体检结合常规的腋窝B超检查评价腋窝淋巴结的临床疗效,可能难以准确地预测腋窝淋巴结的病理缓解状况和预后。腋窝淋巴结pCR患者的预后较好,与肿瘤原发灶是否达到pCR无关。OBJECTIVE：To evaluate the effect of neoadjuvant chemotherapy （NC） on locally advanced breast cancer with cytological proven axillary lymph node （ALN） metastases by fine needle biopsy. METHODS：From January 2000 to May 2006,111 patients with cytological proven ALN metastases by fine needle biopsy were identified,and these patients had received at least two cycles of NC in the standard dosage. The relationship between the clinical and pathological responses of ALN with disease-free survival （DFS） and overall survival （OS） was axalyzed. RESULTS：Of 111 patients,67 patients （60.4%） achieved clinical complete response （cCR） in ALN. 29.9% of 67 patients had pathologic complete response （pCR） in ALN. Of 44 patients who had not achieved cCR,36.4% patients had pCR. With a median follow-up of 65 months,compared with the group without ALN pCR,5-year DFS and OS improved in the patients achieving ALN pCR （P=0.036,P=0.038,respectively）. Residual primary tumor did not affect the outcome of those with ALN pCR. The clinical response of axillary lymph nodes after the neoadjuvant chemotherapy was not associated with DFS and OS （P=0.182,0.984）. CONCLUSIOS：In the patients with ALN positive before NC,pCR is associated with an excellent prognosis,regardless of a residual primary tumor. Only physical examination combined with axillary ultrasound test could not be the predictive and prognostic factors.

关 键 词：乳腺肿瘤/药物疗法 淋巴转移 预后 

分 类 号：R737.9[医药卫生—肿瘤]