区域靶向化疗治疗激素受体与HER-2三阴性乳腺癌的临床疗效观察

Effect of local targeted chemotherapy in triple-negative breast cancer

目的:探讨立体超选择动脉灌注区域靶向新辅助化疗治疗雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)和HER-2表达均为阴性(以下简称"三阴")乳腺癌的临床疗效以及预后影响。方法:"三阴"乳腺癌患者47例,其中Ⅱ期29例,Ⅲ期13例,Ⅳ期5例。随机分为两组:靶向化疗组(24例),术前行立体超选择动脉灌注化疗,其中10例采用MEF方案,14例采用EP方案;对照组(23例),分别采用CMF、CEF和EP方案进行常规新辅助化疗。观察其治疗周期、病灶变化和预后情况。结果:靶向化疗组平均周期15d,病灶缓解率(CR+PR)为91.67%;对照组平均周期31d,病灶缓解率为60.87%。靶向化疗组平均周期明显低于对照组(P<0.01)。47例患者9例在2年内死亡,其中靶向化疗组2例(均为Ⅳ期患者),对照组7例(Ⅱ期2例,Ⅲ期4例,Ⅳ期1例)。结论:立体超选择动脉灌注新辅助靶向化疗作为"三阴"乳腺癌的辅助治疗,具有效果好、治疗周期短和预后佳等优点,是一种有效的靶向治疗方法。

OBJECTIVE： To evaluate the clinical effect and prognosis of preoperative solid superselective intra-arterial targeted neoad- juvant chemotherapy in triple-negative breast cancer characterized by negative estrogen receptor, progesterone receptor and HER-2 receptor. METHODS： Forty-seven cases of triple-negative breast cancer patients（ including stage Ⅱ 29 cases, stage Ⅲ 13 cases and stage Ⅳ 5 cases） were randomly selected to two groups： targeted chemotherapy group （24 cases） and control group （23 cases）. The patients of the targeted chemotherapy group received preoperative solid superselective intra-arterial chemotherapy of MEF （10 cases） and EP （14 cases） and the patients of the control group received routine neoadjuvant chemotherapy of CMF, CEF and EP, respectively. The course of treatment, the change of focus and the prognosis were observed. RESULTS： The average course of treatment was 15 days in the targeted chemotherapy group which was significantly lower than that in the control group （31 days, P〈0.01）. The remission rate of focus （CR＋PR） was 91.6o/oo in the targeted chemotherapy group and 85% in the control group respectively. Among these patients, 9 cases died in two years, which conclude 2 cases （both Ⅳ stage） of the targeted chemotherapy group and 7 cases （stage Ⅱ 2 cases, stage Ⅲ 4 cases and stage Ⅳ 1 case） of the control group. CONCLUSION： As an assistant therapy method, the solid superselective intra-arterial neoadjuvant chemotherapy is an effective targeted therapy method of triple-negative breast cancer, which has the advantage of shorter course of treatment, better effect and prognosis.