乳腺癌6周期ET方案新辅助化疗的疗效及其影响因素分析

The effect of 6 cydes ET neoadjuvant chemotherapy regimen on breast cancer and its influencing factors

目的回顾性分析6周期ET方案（表阿霉素＋多西他赛）新辅助化疗对乳腺癌的疗效，探讨影响病理完全缓解（pathologicalcompleteresponse，pCR）率的因素。方法回顾性分析2009年6月至2011年9月完成6周期ET方案新辅助化疗的52例乳腺癌患者的完整病例资料，将触诊、超声对肿瘤化疗效果的评价与术后病理结果进行比较。结果乳腺癌6周期ET方案新辅助化疗总pCR率为42．3％（22／52）；化疗1周期后超声测量肿瘤最大径缩小30％及以上者pCR率显著高于肿瘤最大径缩小30％以下者（60．9％比27．6％，P〈0．05）；肿瘤最大径≤3cm者pCR率高于最大径〉3cm者（P〈0．05）；HER02阳性型及三阴性型乳腺癌pCR率高于Luminal型者（P〈0．05）；多因素分析结果显示，肿瘤大小和其对化疗的早期反应是预测pCR的独立因素（P〈0．05）。结论乳腺癌6周期ET方案新辅助化疗pCR率高，超声评价肿瘤对化疗的早期反应能够预测pCR，肿瘤大小、肿瘤分子生物学类型是影响pCR的重要因素。

Objective To explore the influencing factors in neoadjuvant chemotherapy on pathological complete response （ pCR ）, by analyzing the effect of 6 cycles epirubieine combined with doeetaxel（ET） regimen in breast cancer patients. Methods From June 2009 to September 2011, clinical date of 52Ⅱ, Ⅲ stage breast cancer patients treated with ET regimen for neoadjuvant chemotherapy for 6 cycles were retrospectively analyzed. The curative effect was evaluated by palpation and ultrasonography, and finally compared with postoperative pathological results. Results In these 52 patients, the total pCR rate was 42. 3% after 6 cycles chemotherapy. After the first circle of chemotherapy, pCR rate was higher in patients with tumor size reducing 〉 30% than those 〈 30% as measured by ultrasonography（60. 9% vs. 27. 6%, P 〈0. 05）. Higher pCR rate was obtained in patients with tumor size ~〈3 em than those in which the initial tumor size 〉3 era（52. 9% vs. 22.2% , P 〈0. 05） after 6 cycles ET neoadjuvant chemotherapy. PCR rate was higher in patients with positive HER-2 or triple negative breast cancer after 6 cycles than those with luminal type I breast cancer （77.8%, 75.0% and 25.7% , respectively, P 〈 0.05）. Logistic regression analysis showed that tumor size and its early response to neoadjuvant chemotherapy evaluated by ultrasonography were the significant predictive factors. Conclusions Higher pCR rate can be achieved after 6 cycles ET regimen neoadjuvant chemotherapy in stage I1 , I1[ breast cancer patients. Tumor＇s early response to chemotherapy as evaluated by ultrasonography could forecast the pCR. Tumor size and molecular type are important influencing factors on pCR in breast cancer patients.