三阴性乳腺癌TAC方案治疗及预后分析  

The triple-negative breast cancer under the treatment of TAC chemotherapy and the prognosis analysis

作　　者：陈宏亮[1] 丁昂[1] 王富文[1] 宋晖[1] 孙建[1] 殷初阳[1] 

机构地区：[1]复旦大学附属妇产科医院乳腺外科,上海200011

出　　处：《复旦学报（医学版）》2014年第6期765-770,778,共7页Fudan University Journal of Medical Sciences

摘　　要：目的研究三阴性乳腺癌（triple-negative breast cancer,TNBC）应用TAC化疗方案的疗效,并分析其影响因素。方法回顾性研究本院自2006年至2013年应用TAC化疗方案治疗的TNBC 87例,中位随访25个月,描述临床病例资料[年龄、月经状况、肿瘤体积、组织学分级、淋巴结转移、脉管侵犯、化疗不良反应、2年的无病生存期（disease free survival,DFS）及总生存期（overall survival,OS）等],通过单因素及多因素分析方法分析生存预后的影响因素。结果 87例TNBC绝经前45例（51.7%）,绝经后42例（48.3%）;平均肿瘤大小（2.90±1.68）cm（1.0~11.0cm）,T1 35例（40.2%）、T2 45例（51.7%）、T3 7例（8.0%）;腋窝淋巴结转移率为41.4%,N051例（58.6%）,N126例（29.9%）,N27例（8.0%）,N33例（3.4%）;脉管侵犯率为25.3%;77例行全乳切除根治性手术（88.5%）,9例行保乳术（10.3%）;77例行辅助化疗（88.5%）,10例行新辅助化疗（11.5%）;TAC化疗方案主要不良反应是中性粒细胞减少。复发转移9例,77.8%的复发转移为内脏脏器的转移,死亡5例。2年DFS为87%,2年OS为94%。单因素分析得出肿瘤大小、淋巴结分期、脉管侵犯、化疗方式均是DFS和OS的影响因素（P〈0.05）。Cox回归多因素分析得出肿瘤大小是DFS的独立影响因素（P=0.003）,肿瘤大于5cm的复发转移风险是肿瘤小于2cm的23.52倍,以上各因素均不是OS的独立影响因素（P〉0.05）。结论 TNBC早期远处转移率高,肿瘤体积大者易早期发生复发转移。除了淋巴结转移途径外,可能存在其他重要机制促使肿瘤发生早期远处转移。Objective To （TNBC） and its prognosis evaluate the effect of TAC chemotherapy for triple-negative breast cancer influencing factors. Methods Eighty-seven cases of TNBC with TAC chemotherapy treated in our hospital between 2006 and 21）13 were included in our study. We described the clinicopathological characteristics （age, menopause status, tumor size, tumor histological grade, lymphnode metastasis, vascular invasion）, chemotherapy adverse effect, disease free survival （DFS） rate,and overall survival （OS） rate after a median follow-up of 25 months. The factors associated with prognosis were also evaluated by univariate and multivariate analysis. Results Forty-five out of 87 cases （51.7 % ） were pre-menopausal while 42 cases （48.3 %） post-menopause. Mean tumor size was （2.90＋1.68） cm （1.0- 11.0 cm） with T1 35 cases （40.2%）,T2 45 cases （51.7%）, T3 7 cases （8.0%）. Lymph node metastasis rate was 41.4% ,with N, 51 cases （58.6%）, N 26 cases （29.9%）,N2 7 cases （8. 0%）. N 3 cases （3. 4%）. Vascular invasion rate was 25. 3%. Seventy-seven cases （88.5 %） underwent mastectomy whereas 9 case （10. 3%） breast-conserving surgery. Seventy-seven cases （88. 5%） underwent TAC adjuvant chemotherapy and 1{I cases （11. 5%） TAC neoadjuvant chemotherapy. The main adverse effect of the chemotherapy was neutropenia which was not very serious. Recurrence or metastasis occurred in 9 cases, of which 7 were visceral metastasis, and 5 cases died. Two-year DFS and OS were 87% and 94%. Univariate analysis showed that T stage, N stage, vascular invasion and chemotherapy mode were related with DES and OS. Cox regression showed that only T stage was the independent factor of DES （P = 0. 11113） with T〉5 cm 23.52 times risk of T〈2 cm, whereas none of the factors above was the independent factor of OS （P〉O. 05）. Conclusions TNBC has a high risk of relapse within early time, and a tendency of distant metastasis. Tumor with big mass is more likely to relapse with

关 键 词：三阴性乳腺癌 TAC化疗 预后 

分 类 号：R655.8[医药卫生—外科学]