乳腺癌新辅助化疗病理完全缓解的影响因素分析  

Analysis of the factors affecting pathologic complete response to neoadjuvant chemotherapy in breastcancer patients

作　　者：孙冰[1] 宋三泰[1] 江泽飞[1] 王涛[1] 张少华[1] 孟祥颖[1] 李晓兵[1] 尉承泽[1] 吴世凯[1] 

机构地区：[1]军事医学科学院附属医院乳腺肿瘤科,北京100071

出　　处：《中华肿瘤杂志》2013年第1期38-42,共5页Chinese Journal of Oncology

摘　　要：目的分析乳腺癌新辅助化疗后获得病理学完全缓解（pCR）的影响因素。方法收集141例新辅助化疗患者的临床资料，分析影响pCR的因素，比较治疗前后受体状态的变化。结果本组21例（14．9％）患者获得pCR，其中蒽环类联合紫杉类方案的pCR率为16．8％（19／113），单独以蒽环类为主方案的pCR率为7．1％（1／14）。葸环类药物的剂量强度与pCR率有关（P〈0．05），随着葸环类剂量强度的增加，pCR率增加。紫杉类药物相对剂量强度〈0．85组与≥0．85组pCR率比较，差异有统计学意义（P=0．02）。pCR的中位化疗周期数为6个周期（3～10个周期）。1～4个周期者的pCR率（8．2％）与〉4个周期者（20．0％）比较，差异无统计学意义（P=0．09）。〈6个周期者的pCR率（7．1％）与≥6个周期者（22．5％）比较，差异有统计学意义（P=0．01）。21例pCR患者中，雌激素受体（ER）和孕激素受体（PR）均阴性者14例，均阳性者7例。全组患者中，治疗前后ER、PR、人表皮生长因子受体2状态保持一致者较多，分别占74．2％、69．7％和87．7％。治疗前后ER、PR状态无变化者分别为49例（74．2％）和46例（69．7％）。在激素受体状态发生变化者中，ER由阴性转为阳性者13例（7．1％），其中11例部分缓解，2例疾病稳定；ER由阳性转为阴性者4例（12．9％），治疗前后的ER状态比较差异有统计学意义（P〈0．05）。PR由阴性转为阳性者13例（28．9％），由阳性转为阴性者7例（33．3％），二者比较差异无统计学意义（P〉0．05）。Cox多因素分析结果显示，查体测量肿瘤直径≤5cm和化疗周期数≥6个周期与pCR有关（均P〈0．05）。结论蒽环联合紫杉类方案的新辅助化疗可获得较高的pCR率；治疗前的淋巴结转移情况和受体状态不是决定pCR的主要因素，肿瘤直径≤5cm、化疗周期数≥6个周期、给药�Objective To analyze the factors affecting pathologic complete response （pCR） to neoadjuvant chemotherapy （NAC） in breast cancer patients. Methods A retrospective cohort study was carried out to analyze the clinical data of 141 breast cancer patients treated with neoadjuvant chemotherapy. The factors affecting pCR and the changes of tumor receptor status before and after treatment were analyzed. Results Among all the 141 patients, 21 patients （ 14.9% ） achieved pCR. The rate of pCR achieved by regimens of anthracycline combined with taxane was higher （16. 8%, 19/113） than that by anthracycline- containing regimens （7.1%, 1/14）. The dose intensity of anthracycline had a significant correlation with pCR rate （ P 〈 0.05）. The pCR rate in the relative dose intensity of taxane I〉0.85 arm was higher than that of 〈0.85 arm （P =0.02）. Eighty patients （56.7%） had completed more than 4 cycles of chemotherapy and the median time to achieve pCR was 6 （3 to 10） cycles. The pCR rate had a significant difference between patients 〈 6 and≥ 6 cycles （7.1% vs. 22.5%, P = 0.01 ）. Multivariate analysis showed that tumor size measured by palpation≤5 cm and ≥ 6 chemotherapy cycles were significantly related with DCRrate（P 〈0.05）. In all the 21 pCR patients, the pre-treatment ER （ - ）, PR （ - ）, HER-2 （ - ） statuses were in 14, 14 and 17 patients, respectively. The status of ER, PR, HER-2 of most patients （74.2%, 69.7% and 87.7% , respectively ） was not changed after treatment. Among the patients with changes in receptor status, ER changed from negative to positive was in the majority （37.1%, 13/35 vs. 12.9%, 4/ 31, P〈0.05）, and the percentage of changes in PR and HER-2 status had no significant differences. Conclusions The regimens of anthracyeline combined with taxane can achieve a higher pCR rate. The lymph node and receptor status before therapy have no significant correlation with pCR. Patients who have primary tumor size ≤5 cm, ≥6 chemotherapy cy

关 键 词：乳腺肿瘤 化学疗法 辅助 治疗结果 剂量效应关系 药物 

分 类 号：R737.9[医药卫生—肿瘤]