TEC及TE方案在乳腺癌新辅助化疗中的近期疗效及不良反应的对比分析  

Contrastive analysis of short-term efficacy and adverse reaction between TEC and TE neoadjuvant chemotherapy for breast cancer patients

作　　者：李瑶[1] 齐晓伟[1] 杨新华[1] 张毅[1] 范林军[1] 张帆[1] 陈莉[1] 姜军[1] 

机构地区：[1]第三军医大学西南医院乳腺外科,重庆400038

出　　处：《中华乳腺病杂志（电子版）》2014年第6期17-22,共6页Chinese Journal of Breast Disease(Electronic Edition)

摘　　要：目的对比分析以紫杉醇类及蒽环类为基础加/不加环磷酰胺（TEC/TE）两种化疗方案在乳腺癌新辅助化疗中的疗效及不良反应。方法回顾性分析2012年1月至2014年4月本院收治的共139例Ⅱ~Ⅲ期浸润性导管癌患者的临床病理资料。所有患者均接受4个周期的新辅助化疗,其中TEC方案（多西他赛75 mg/m2＋表柔比星60 mg/m2＋环磷酰胺500 mg/m2）共68例,TE方案（多西他赛75 mg/m2＋表柔比星60 mg/m2）共71例。以RECIST标准判断临床疗效,完全缓解（complete response,CR）＋部分缓解（partial response,PR）为临床有效,以Miller Payne标准判断病理疗效,Ⅲ级＋Ⅴ级＋Ⅳ级为病理学有效,同时观察恶心、呕吐等不良反应。等级资料的比较采用非参数检验,计数资料采用χ2检验。结果 TEC组的p CR率、CR率分别为13.85%（9/68）和10.29%（7/68）,TE组为11.27%（8/71）和5.63%（4/71）,但差异无统计学意义（Z=-1.804、-1.336;P=0.071、0.181）。TEC组的病理有效率为78.46%（51/65,3例缺失病理数据）,显著高于TE组的61.97%（44/71）（χ2=4.382,P=0.036）,但两组的临床有效率差异无统计学意义[72.06%（49/68）比61.97%（44/71）,χ2=1.596,P=0.206]。TEC组及TE组的保留乳房率分别为5.88%（4/68）、8.45%（6/71）,差异均无统计学意义（χ2=0.066,P=0.797）。两组的常见不良反应为恶心呕吐、粒细胞减少症及心脏毒性,差异均无统计学意义（Z=-1.670、-0.667、-1.326;P=0.095、0.505、0.185）。结论与TE方案比较,患者接受TEC方案新辅助化疗更易获得病理学缓解,且不增加不良反应。TEC方案在新辅助化疗中有一定的应用前景。Objective To compare the efficacy and adverse reaction of the two neoadjuvant chemotherapy regimens on the basis of docetaxel and epirubisin with or without cyclophosphamide（TEC/TE） for breast cancer patients. Methods The clinicopathological data of totally 139 patients with stage H-m breast invasive ductal cancer treated in our hospital from January 2012 to April 2014 were retrospectively analyzed. All patients received four cycles of neoadjuvant chemotherapy, including 68 with TEC regimen （docetaxel 75 mg/m2 ＋ epirubicin 60 mg/m2 ＋ cyclophosphamide 500 mg/m2） and 71 with TE （docetaxel 75 mg/m2＋ epirubicin 60 mg/m2）. RECIST criteria were used to evaluate the clinical efficacy, and the patients with complete response （CR） and partial response （PR） were considered as clinically effective cases. MillerPayne criteria were used to evaluate the pathological efficacy, and the patients in stage Ⅴ ＋ Ⅳ ＋ Ⅲ were considered as pathologically effective cases）. Moreover, the adverse reactions including nausea, vomiting, granulocytopenia and cardiac toxicity were also compared between two groups. Rank data were compared using non-parametric test. count data usinz χ2 test. Results The Datholozical complete resvonse （DCR） rate and CR rate in TEC group were 13.85% （9/68） and 10. 29% （7/68） respectively, higher than 11.27% （8/71） and 5.63% （4/71） in TE group, but the difference was not statistically significant （Z =-1. 804, -1. 336; P = 0. 071, 0. 181 ）. The pathologically effective rate was 78. 46% （51/65,3 cases were lost） in TEC group, significantly higher than 61.97% （44/71） in TE group （X2 =4. 382 ,P=0.036） , but there was no significant difference in clinically effective rate between both groups [72. 06% （49/68） vs 61.97% （44/71） ,χ2 = l. 596, P=0. 206]. The breast-conserving rates were 5.88% （4/68） in TEC group and 8. 45% （6/71） in TE group, and the difference was not significant （ χ2 = 0. 066, P = 0. 797 ）. The common side effe

关 键 词：乳腺肿瘤 化学疗法 辅助 表柔比星 蒽环类 多西他赛 

分 类 号：R737.9[医药卫生—肿瘤]