不同新辅助化疗方案治疗乳腺癌近期疗效观察

Efficacy of Different Neoadjuvant Chemotherapy Regimens for Breast Cancer

目的:本研究对比观察多西他赛联合表柔比星加/不加环磷酰胺(TE/TEC)两种新辅助化疗方案治疗乳腺癌的近期疗效和不良反应。方法:回顾性分析2007年6月～2009年3月间本院收治的174例Ⅱ、Ⅲ期的乳腺癌患者临床病理资料。依据患者术前接受新辅助化疗的方案将其分为TE组及TEC组,两组患者均在术前接受2～4个周期化疗,并在术后完成剩余化疗周期。TE方案:多西他赛(DOC)75 mg/m^2,第1天静脉滴注,表柔比星(EPI)60 mg/m^2,第1天静脉滴注;TEC方案:多西他赛(DOC)75 mg/m^2,第1天静脉滴注,表柔比星(EPl)60 mg/m^2,第1天静脉滴注,环磷酰胺(CTX)600 mg/m^2,第1天静脉滴注。以上方案均21天一个周期。结果:全组总有效率80.5%,其中TE组有效率77.4%,低于TEC组(84.0%),但差异无统计学意义(P=0.278)。TE组pCR为6.5%,低于TEC组7.4%,差异无统计学意义(P=0.804)。TE组和TEC组主要不良反应均为中性粒细胞减少、脱发、恶心呕吐、贫血、肝功能异常、心脏毒性。TEC组中性粒细胞减少发生率明显高于TE组,两组间差异有统计学意义(P=0.026)。结论:在Ⅱ、Ⅲ期乳腺癌患者新辅助化疗中,TE与TEC的3周方案近期疗效相近。但两组在中性粒细胞减少的发生率方面有显著性差异,TEC方案的发生率明显高于TE方案。

Objective： To evaluate and compare the efficacy and toxicity of the neoadjuvant chemotherapy of Docetaxel and Epirubicin combined with or without Cyclophosphamide in breast cancer patients. Methods： Data of 174 women with stage Ⅱ/Ⅲ breast cancer treated in Tianjin Medical University Cancer Institute and Hospital between June 2007 and March 2009 were retrospectively analyzed. These patients were divided into two groups based on the regimen of the neoadjuvant chemotherapy： 93 received TE regimen （ Docetaxel 75 mg/m2 and Epirubicin 60 mg/m2 ） and 81 received TEC （ Docetaxel 75 mg/m2, Epirubicin 60 mg/m2 and Cyclophosphamide 600 mg/m2 ）. Ⅳ drip infusion was administered in both groups for 2-4 cycles before surgery, with 3 weeks for each cycle. And the remaining course of treatment was completed after surgery. Results： The overall response rate （ ORR ） was 80.5%. The ORR in the TE group was 77.4%, lower than in the TEC group （ 84.0% ）, with no significant difference （ P = 0.278 ）. The pCR was 6.5% in the TE group, lower than in the TEC group （ 7.4% ）, with no significant difference （ P = 0.804 ）. The main toxic reactions in the two groups were neutropenia, alopecia, nausea and vomiting, anaemia, liver dysfunction and cardiac toxicity. The incidence of neutropenia was obviously higher in the TE group than in the TEC group, with a significant difference （ P = 0.026 ）. Conclusion： In females with stage Ⅱ / Ⅲ breast cancer treated with neoadjuvant chemotherapy, the short-term efficacy of the 3-week TE and TEC regimens is similar, but TEC regimen can cause higher incidence ofneutropenia.