TAC方案在可手术乳腺癌新辅助化疗中的疗效及不良反应

Effect and adverse effect of TAC for primary systemic chemotherapy in the operable breast cancer

目的探讨TAC方案在可手术乳腺癌新辅助化疗中的临床疗效及毒性反应。方法 210例经空芯针穿刺活检确诊的可手术乳腺癌患者,术前均接受新辅助化疗,设CAF方案为对照组。TAC组140例,多西他赛75mg/m2,吡柔比星50mg/m·2dL,CTX500mg/m2,静脉滴入d1。CAF组70例,CTX500mg/m2,吡柔比星50mg/m2,5-Fu500mg/m2,静脉滴入d1。两组均为每21d1个疗程。结果两组患者均经2～4周期化疗后接受手术治疗,其中保乳手术25例,改良根治术185例。TAC组pCR35例、RR87.14%,降期率47.14%(66/140);CAF组pCR9例、RR78.57%、降期率32.86%(23/70),两组pCR、RR、降期率相比差异均有显著性(P值分别为0.042、0.034、0.048)。TAC组128例与CAF组60例经临床预判同侧腋窝淋巴结有转移的患者中,淋巴结阴转率分别为35.94%(46/128)和23.33%(14/60),两组相比差异有显著性(P<0.05)。两组化疗方案对于雌激素受体及C-erbB2表达的分层分析中未显示明显统计学差异。TAC组与CAF组除在Ⅲ～Ⅳ度骨髓抑制方面差异有显著性(P=0.043)外,其他毒性反应差异无显著性,两组均无化疗相关性死亡事件。结论对于可手术乳腺癌患者TAC方案近期疗效显著优于CAF方案,且耐受性良好,尤其对淋巴结有转移患者推荐使用TAC方案化疗,并可适当延长术前化疗周期。

【Objective】To explore the TAC program in neoadjuvant chemotherapy for operable breast cancer in the clinical efficacy and toxicity.【Methods】 210 patients with core-needle biopsy histopathology in patients with operable breast cancer diagnosed before surgery were receiving neoadjuvant chemotherapy,set CAF program the control group.TAC group of 140 cases,docetaxel 75 mg/m2;pirarubicin 50 mg/m2;CTX 500 mg/m2,intravenous infusion dL.CAF group of 70 cases,CTX 500 mg/m2;pirarubicin 50 mg/m2;5-Fu 500 mg/m2,intravenous infusion dL.Two groups were a course of treatment every 21 days.【Results】Two groups of patients received surgery after 2～4 cycles of chemotherapy,in which breast-conserving surgery in 25 cases,185 cases of Auchincloss.TAC group pCR35 cases,RR87.14%,down period of the rate of 47.14%（66/140）;CAF group pCR9 cases,RR78.57%,down period of the rate of 32.86%（23/70）,pCR,RR and downstaging rate in two groups were significant differences（P values were 0.042,0.034,0.048）.TAC group of 132 patients with CAF group,60 patients with clinical pre-contracting the ipsilateral axillary lymph node metastasis in patients,lymph node negative conversion rates were 35.94%（46/128） and 23.33%（14/60）,compared with differences between the two groups statistically significant（P 0.05）.Two chemotherapy regimens for hormone receptor and C-erbB2 expression in stratified analysis did not show significant statistical difference.TAC group and the CAF group,except in grade Ⅲ～Ⅳ differences with regard to bone marrow suppression was statistically significant（P =0.043）,other toxic reac tions were no significant differences between the two groups.No chemotherapy related deaths happened in two groups.【Conclusion】 For patients with operable breast cancer,TAC program was significantly better than CAF program about short-term effect,and well-tolerated.especially in patients with lymph node metastasis is recommended TAC program,and may be appropriately extended cycle of preoperative chemotherapy.