TP与EC-T化疗方案在三阴性乳腺癌新辅助化疗中疗效与BRCA1突变关系  

TP and EC-T chemotherapy regimens in neoadjuvant chemotherapy for triple negative breast cancer and the relationship between platinum and BRCA1 mutation

作　　者：杨涛[1] 马秀芬[1] 毛红岩[1] 独晓燕[1] 张旭[1] 卫翀羿 隆建萍[1] YANG Tao;MA Xiufen;MAO Hongyan;DU Xiaoyan;ZHANG Xu;WEI Chongyi;LONG Jianping(Department of Breast Surgery,Gansu Provincial Maternity and Child-Care Hospital,Gansu Lanzhou 730050,China)

机构地区：[1]甘肃省妇幼保健院乳腺一科,甘肃兰州730050

出　　处：《现代肿瘤医学》2022年第10期1776-1780,共5页Journal of Modern Oncology

基　　金：甘肃省自然科学基金(编号:17JR5RA030)。

摘　　要：目的:探讨TP与EC-T化疗方案在三阴性乳腺癌新辅助化疗中的疗效,并探索铂类与BRCA1突变关系。方法:选取2016年5月-2020年5月在我院诊断三阴性乳腺癌需新辅助化疗的122例患者,均行BRCA检测,将BRCA1胚系突变患者及未突变患者随机分为两组,一组给予TP(62例)方案新辅助化疗,一组给予EC-T(60例)方案新辅助化疗;按照不同因素分析两组pCR差异。结果:TP组pCR率为56.5%,EC-T组pCR率36.7%,差异有统计学意义(P=0.029);对于ypT_(0/is)或ypN_(0)TP组对比EC-T组仍然具有明显优势(分别为64.5%vs 43.3%,P=0.019;69.4%vs 41.7%,P=0.002);对于BRCA1突变患者,TP组与EC-T组pCR率无统计学差异(50.0%vs 44.4%,P=0.343),对TP组内BRCA1突变与未突变人群pCR率无统计学差异(50.0%vs 57.7%,P=0.224),对EC-T组内BRCA1突变与未突变人群pCR率无统计学差异(44.4%vs 35.3%,P=0.248)。122例患者的不良反应以1-2级较常见。EC-T组和TP组患者1-2级恶心/呕吐的发生率分别为71.7%和38.7%(P=0.0003),3-4级恶心/呕吐的发生率分别为21.7%和3.2%(P=0.002);TP组和EC-T组患者1-2级血小板减少症的发生率分别为32.3%和8.3%(P=0.001),3-4级血小板减少症的发生率分别为9.7%和0%(P=0.008)。其他3-4级不良反应少见。结论:TP方案对比EC-T方案明显提高三阴性乳腺癌pCR率,BRCA1是否突变未发现影响铂类方案疗效,整体两组不良反应可以耐受,其中TP组血小板减少发生率较高。Objective:To investigate the effect analysis of TP and EC-T chemotherapy regimens in neoadjuvant chemotherapy for triple negative breast cancer,and to explore the relationship between platinum and BRCA1 mutation.Methods:A total of 122 patients were randomly divided into two groups,the BRCA1 mutant group and the BRCA1 non-mutant group,the BRCA1 mutant group received TP(62 cases)regimen of neoadjuvant chemotherapy,and the BRCA1 non-mutant group received EC-T(60 cases)regimen of neoadjuvant chemotherapy.The pCR rate between the two groups were analyzed according to different factors.Results:The pCR rate was 56.5%in the TP group and 36.7%in the EC-T group,the difference was statistically significant(P=0.029).Compared with EC-T group,ypT_(0/is) or ypN_(0),TP group still had significant advantages(64.5%vs 43.3%,P=0.019;69.4%vs 41.7%,P=0.002).For patients with BRCA1 mutations,there was no statistically significant difference in pCR rate between the TP group and the EC-T group(50.0%vs 44.4%,P=0.343).There was also no statistically significant difference in pCR rate between the TP group and the non-mutant group(50.0%vs 57.7%,P=0.224).There was no statistically significant difference in pCR rate between the BRCA1 mutations and the non-mutant group(44.4%vs 35.3%,P=0.248).The adverse reactions of 122 patients were of grade 1-2.The incidence of grade 1-2 nausea/vomiting was 71.7%in the EC-T group and 38.7%in the TP group(P=0.0003),and the incidence of grade 3-4 nausea/vomiting was 21.7%and 3.2%(P=0.002),respectively.The incidence of grade 1-2 thrombocytopenia was 32.3%in the TP group and 8.3%in the EC-T group(P=0.001),while that of grade 3-4 thrombocytopenia was 9.7%and 0%(P=0.008).Other grade 3-4 adverse reactions were rare.Conclusion:Compared with EC-T,TP significantly increased the pCR rate of triple negative breast.BRCA1/2 mutation is not found to affect the efficacy of the platinum,and the adverse reactions of the two groups are tolerable,but the TP group had a higher incidence of thrombocytopenia.

关 键 词：三阴性乳腺癌 BRCA1基因突变 TP EC-T 病理完全缓解 

分 类 号：R737.9[医药卫生—肿瘤]