白蛋白紫杉醇术后辅助化疗乳腺癌患者预后的单中心回顾性队列研究  

Prognosis of Postoperative Adjuvant Chemotherapy with Nanoparticle Albumin-Bound Paclitaxel in Patients with Breast Cancer:A Single-Center Retrospective Cohort Study

作　　者：樊婷 许彬 贺萍[1] 田廷伦 罗婷[1] 鄢希[1] 钟晓蓉[1] FAN Ting;XU Bin;HE Ping;TIAN Tinglun;LUO Ting;YAN Xi;ZHONG Xiaorong(Clinical Research Center for Breast Diseases,West China Hospital of Sichuan University,Chengdu,Sichuan,China 610041;Armed Police Force Hospital of Sichuan,Leshan,Sichuan,China 614000;West China School of Public Health,Sichuan University·West China Fourth Hospital of Sichuan University,Chengdu,Sichuan,China 610041)

机构地区：[1]四川大学华西医院乳腺疾病临床研究中心,四川成都610041 [2]武警四川省总队医院,四川乐山614000 [3]四川大学华西公共卫生学院·四川大学华西第四医院,四川成都610041

出　　处：《中国药业》2023年第1期115-120,共6页China Pharmaceuticals

基　　金：四川大学华西医院学科卓越发展1·3·5工程项目[ZYJC21035]。

摘　　要：目的基于四川大学华西医院的乳腺癌临床队列,探讨乳腺癌患者术后辅助化学治疗(简称化疗)紫杉类药物的选择和预后。方法收集四川大学华西医院乳腺癌信息管理系统2018年1月至2020年3月1537例经组织学确诊乳腺癌患者的临床资料,治疗方案包括术前未行新辅助化疗、行乳腺癌根治术或保乳手术,术后接受含紫杉类药物辅助化疗。按化疗方案的不同分为3组,即白蛋白紫杉醇组(260 mg/m^(2)每3周1次或125 mg/m^(2)每周1次)147例,多西他赛组(100 mg/m^(2)每3周1次)1285例,紫杉醇组(80 mg/m^(2)每周1次)105例。采用Kaplan-Meier法进行生存分析,Cox比例风险回归分析进行多因素分析,并根据年龄、临床分期和激素受体状态进行倾向性评分匹配。结果年龄≤40岁患者的比例白蛋白紫杉醇组、多西他赛组、紫杉醇组分别为25.17%,20.39%,17.14%,且白蛋白紫杉醇组显著高于多西他赛组(P=0.046)和紫杉醇组(P=0.003);肿瘤直径≥2 cm患者的比例分别为64.63%,56.96%,65.71%,白蛋白紫杉醇组显著高于多西他赛组(P=0.042);淋巴结阳性比例分别为58.50%,46.77%,60.00%,组间差异显著(P<0.001),且白蛋白紫杉醇组显著高于多西他赛组(P=0.026)。中位随访时间为23个月。白蛋白紫杉醇组、多西他赛组、紫杉醇组的2年无病生存(DFS)率分别为96.00%,97.80%,94.80%,组间无显著差异(P=0.095)。Cox单因素分析结果显示,与多西他赛组相比,紫杉醇组的复发风险显著升高[HR=2.3,95%CI(1.1,4.9),P=0.04],而白蛋白紫杉醇组的复发风险无显著差异[HR=1.3,95%CI(0.4,3.5),P=0.66]。多西他赛组和白蛋白紫杉醇组按1∶4匹配,多西他赛组和紫杉醇组按1∶4匹配,白蛋白紫杉醇组和紫杉醇组按1∶1匹配,当校正T分期、N分期、雌激素受体状态、Ki67混杂因素后,仍未发现不同治疗组间DFS的差异(P=0.70,0.35,0.53)。结论相对于多西他赛,年龄≤40岁、肿瘤直径≥2 cm、淋巴结阳性患者更倾向Objective To investigate the selection and prognosis of taxanes for the postoperative adjuvant chemotherapy of patients with breast cancer based on a clinical cohort of breast cancer in the West China Hospital of Sichuan University.Methods The clinical data of 1537 patients with histologically confirmed breast cancer from the breast cancer information management system of the West China Hospital of Sichuan University from January 2018 to March 2020 were collected.The treatment schemes for the above patients included no preoperative neoadjuvant chemotherapy,radical mastectomy or breast-conserving surgery and postoperative adjuvant chemotherapy with taxanes.According to different chemotherapy schemes,the patients were divided into three groups,including the nanoparticle albumin-bound paclitaxel(nab-paclitaxel)group[260 mg/m^(2)(once every three weeks)or 125 mg/m^(2)(once a week)],the docetaxel group[100 mg/m^(2)(once every three weeks)]and the paclitaxel group[80 mg/m^(2)(once a week)],with 147,1285 and 105 cases in each group,respectively.The Kaplan-Meier method was used for the survival analysis,the Cox proportional hazard regression model was used for the multivariate analysis,and the propensity score matching was performed according to the age,clinical stage and hormone receptor(HR)status.Results The proportion of patients with age≤40 years old in the nab-paclitaxel group,docetaxel group and paclitaxel group was 25.17%,20.39%and 17.14%respectively,and that in the nab-paclitaxel group was significantly higher than that in the docetaxel group(P=0.046)and that in the paclitaxel group(P=0.003).The proportion of patients with tumor diameter≥2 cm in the nab-paclitaxel group,docetaxel group and paclitaxel group was 64.63%,56.96%and 65.71%respectively,and that in the nab-paclitaxel group was significantly higher than that in the docetaxel group(P=0.042).The positive rate of lymph nodes in the nab-paclitaxel group,docetaxel group and paclitaxel group was 58.50%,46.77%and 60.00%respectively,with significant differenc

关 键 词：白蛋白紫杉醇 多西他赛 紫杉醇 乳腺癌 辅助化疗 预后 

分 类 号：R969.4[医药卫生—药理学] R979.1[医药卫生—药学]