摘要
目的:探讨表柔比星联合紫杉醇(E+T)新辅助化疗对乳腺癌保乳术患者的效果及安全性。方法:选取2014年1月-2018年1月收治的107例IIa^IIIa期女性原发性乳腺癌患者,患者均于保乳术前行3周E+T方案新辅助化疗,且患者化疗前均检测空芯针穿刺标本雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(HER-2)、Ki-67、p53及Bcl-2表达情况。评价临床及病理疗效并评估毒副反应情况。结果:所有患者均完成了4个或6个疗程的术前3周E+T新辅助化疗,5例IIIa期患者化疗后降期为IIb;患者均于化疗后12~16 d行乳腺癌保乳术治疗。临床有效率为89.72%,病理性完全缓解(p CR)率为17.76%,腋窝淋巴结转阴率为54.76%。不同ER、PR、Ki-67、p53表达状态患者间p CR率有统计学差异(均P<0.05),而不同HER-2、Bcl-2表达状态患者间p CR率无统计学差异(均P>0.05)。除出现IV度白细胞减少5例、IV度中性粒细胞减少5例外,其余毒性反应均可耐受。86例术后随访12~60个月,复发转移19例,死亡6例,2例出现对侧乳腺癌,其余患者均恢复良好。结论:E+T新辅助化疗方案治疗乳腺癌保乳术患者可获得较高的p CR率,毒副反应可耐受。ER、PR、Ki-67、p53可作为E+T新辅助化疗方案疗效的预测因子。
Objective:To investigate the efficacy and safety of neoadjuvant chemotherapy with epirubicin plus paclitaxel(E+T)in patients undergoing breast conserving surgery for breast cancer.Methods:One-hundred and seven female patients with 107 patients with stage IIa-IIIa primary breast cancer admitted from January 2014 to January 2018 were enrolled.All patients received 3-week E+T neoadjuvantchemotherapy before breast-conserving surgery,and all patients underwent detection of the expressions of estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor receptor 2(HER-2),Ki-67,p53 and Bcl-2 in the hollow needle aspiration specimens before neoadjuvant chemotherapy.The clinical and pathological outcomes were assessed,and the toxic and adverse effects were evaluated.Results:All patients completed 4 or 6 courses of 3-week E+T neoadjuvant chemotherapy before operation,and the tumor stage was downgraded to stage IIb in 5 stage IIIa patients after chemotherapy.All patients underwent breast-conserving surgery 12-16 d after neoadjuvant chemotherapy.The clinical effective rate was 89.72%,the pathological complete response(p CR)rate was 17.76%,and the negative conversion rate of the axillary lymph nodes(ALN)was 54.76%.There were significant differences in p CR rates between patients with positive and negative expressions of ER,PR,Ki-67 and p53(all P<0.05),but no significant differences in p CR rates between patients with positive and negative expressions of HER-2 and Bcl-2(both P>0.05).All toxic effects were tolerable,except for degree IV leukopenia in 5 cases and degree IV neutropenia in 5 cases.Eighty-six patients were followed up for 12-60 months,recurrence and metastasis occurred in 19 cases,death occurred in 6 cases,and contralateral breast cancer occurred in 2 cases,while the remaining patients recovered well.Conclusion:In breast cancer patients undergoing breast-conserving surgery,higher p CR rate can achieved by neoadjuvant chemotherapy of E+T regimen with tolerable toxic and adverse reactions.ER,PR,Ki-67,
作者
朱月梅
王国如
张沂
陈国锋
ZHU Yuemei;WANG Guoru;ZHANG Yi;CHEN Guofeng(Department of Pharmacy,Huaian First People’s Hospital Affiliated to Nanjing Medical University,Huai’an,Jiangsu 223300,China;Department of General Surgery,Huaian First People’s Hospital Affiliated to Nanjing Medical University,Huai’an,Jiangsu 223300,China)
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2019年第11期1406-1413,共8页
China Journal of General Surgery
关键词
乳腺肿瘤
放化疗
辅助
表柔比星
紫杉酚
Breast Neoplasms
Chemoradiotherapy,Adjuvant
Epirubicin
Paclitaxel
