含THP乳腺癌不同辅助化疗方案疗效评价及预后分析

Evaluation on Effect of Different Adjuvant Chemotherapies with THP Regimens for Breast Cancer and Analysis of Prognosis

目的:探讨AC、PA乳腺癌辅助化疗方案的临床疗效和不良反应,以及预后影响因素。方法:对2003年12月至2005年12月乳癌辅助化疗AC方案102例、PA方案192例进行无瘤生存率(DFS)、生存率(OS)及不良反应分析,对可能预后因素进行分层分析。结果:AC方案DFS为93.1%,OS为98.0%;PA方案DFS为73.4%,OS为90.1%。2cm以下与2cm以上、阳性淋巴结枚数0～3与4以上、Ⅰ+Ⅱ期与Ⅲ期患者之间复发率、死亡率均有显著性差异(P=0.005,P<0.001,P<0.001),激素受体阴性与阳性患者之间复发率差异显著(P=0.045)。Cox分析显示淋巴结状态、病理分期、激素受体状态是独立预后因素。Ⅲ度以上不良反应,骨髓抑制、脱发、胃肠道反应、心脏事件AC方案分别为10%、2%、11%、0%,PA方案分别为33%、90%、13%、1%。结论:AC×4～6、PA×6方案疗效肯定、不良反应可接受,是值得推荐的乳腺癌辅助化疗方案,淋巴结状态、病理分期及激素受体状态,可作为乳腺癌的独立预后指标。

Objective： To investigate the clinical effect and adverse reaction of AC （pirarubicin/cyclophosphamide） and PA （paclitaxel/pirarubicin） adjuvant chemotherapeutic regimens for patients with resectable breast cancer and analyze the influencing factors of prognosis. Methods： The disease-free survival （DFS）, overall survival （OS） and adverse effect in 102 of the 294 patients with adjuvant chemotherapeutic AC regimen and the other 192 with PA regimen for breast cancer during a period from December 2003 to December 2005 were discussed, and a stepwise analysis of possible prognostic factors was conducted. Results： DFS rate of the patients administered with the AC and PA regimens achieved 93.1% and 73.4% respectively, and the OS rate was 98.0% and 90.1% in turn in the two groups. There were statistically significant differences in the relapse and OS rates between the patients with T1 and T2 （or above）, those with 0-3 LN positive and 4 LN positive plus, and those with stage Ⅰ＋Ⅱ and stage Ⅲ breast cancers （P=0.005, P〈0.001, P〈0.001）. There were also significant differences in the relapse rates between the patients with hormone receptor-positive and-negative disease （P = 0.045）. Cox analysis showed the number of positive lymph nodes, clinico-pathologic staging and hormone receptor status were the in- dependent prognostic indicators. Adverse effect of grade III and above, bone marrow depression, alopecia, gastrointestinal reaction and cardiac accident were respectively 10%, 2%, 11% and 0% in the cases with AC regimen, and 33%, 90%, 13% and 1% in cases with PA regimen. Conclusion： The curative effects of the AC regimen with 4 to 6 courses and PA regimen with 6 courses are positive to the patients with operable breast cancer, and the drug toxicity is acceptable. Thus, these regimens are the recommended methods of adjuvant chemotherapy for breast cancer. The LN status, TNM staging and hormone receptor status are the independent prognostic indicators.