可手术乳腺癌行新辅助化疗的研究

Clinical analysis of neoadjuvant chemotherapy in operable breast cancer

目的探讨不同新辅助化疗对可手术乳腺癌治疗的作用及与生物学指标的关系。方法选择88例新辅助化疗的乳腺癌患者，治疗前对原发灶用TSK sterieut针穿刺活检，并用免疫组化法检测ER、PR，联酶免疫法检测血清HER-2，所有患者采用CAF方案或TAC方案，疗程为4～6个周期，化疗后1～2周手术。结果 TAC方案总有效率（88％）高于CAF方案（66％）（P〈0．05），HER-2阳性者的有效率（85％）较阴性者（63％）高（P〈0．05），ER／PR阳性有效率（85％／88％）较阴性者（63％／62％）高（P〈0．05）。多因素分析显示，TAC方案、HER-2阳性独立地与新辅助化疗有效率相关。结论新辅助化疗在乳腺癌综合治疗中有重要的作用。TAC方案、HER-2阳性、ER／PR阳性者具有较高的缓解率。活检针穿刺可用于乳腺癌的术前病理诊断并测定生物学指标，联酶免疫法检测血清HER-2可能是一种较好的预测乳腺癌预后的生物学指标之一，紫杉醇对HER-2阳性患者有较好的效果。

Objective It is to observe the dfect of different neoadjuvant chemotherapies （NCT） in operable breast cancer and approach the relationship between response rate of NCT and tumor biomarkers. Methods 88 patients with breast cancer who received NCT were analyzed. Primary tumors were biopsied by TSK stericut needle for pathological diagnosis. The levels of ER, PR were detected by immunohistochemical （IHC）, and the level of serum HER -2 was detected by enzyme- linked immunosorhant test before NCT. All patients received 4 cycles NCT with CAF scheme or TAC scheme. Operations were performed after NCT finished for 1 to 2 weeks. Results The total effective rate of TAG scheme （88 % ） was higher than that of CAF （66 % ） （ P〈 0.05）. The total effective rate of patients with positive HER - 2 （85 % ） was higher than that of negative HER - 2 cases （63 % ）. The total effective rate of ER/PR positive （85 %/88 % ） were higher than that of negative cases （63 %/62 % ）. Logistic analysis indicated： TAC regimen and positive HER - 2 were correlated independently with the efficacy of NCT. Conclusion NCT play an important role in combined therapies of breast cancer. TAC regimen and HER - 2 positive have a higher total effective rate. Biopsy needles can be used in preoperative pathological diagnosis and obtain tumor biomarkers. HER - 2 may be one of the good tumor biomarkers to predict the prognosis of breast cancer.