表阿霉素联合多西紫杉醇新辅助化疗治疗三阴乳腺癌的疗效及预后评价

Curative effects and prognostic evaluation on neoadjuvant chemotherapy of epirubicin combined with docetaxel for treating triple negative breast cancer

目的探讨三阴乳腺癌(TNBC)与非三阴乳腺癌(non-TNBC)接受表阿霉素联合多西紫杉醇方案(ET方案)的化疗敏感性及预后方面的差别。方法对接受ET新辅助化疗方案治疗的249例乳腺癌患者进行回顾性分析。依据免疫组化雌激素受体(ER)、孕激素受体(PR)、表皮生长因子受体2(HER2)表达水平将乳腺癌分为三阴乳腺癌及非三阴乳腺癌两类,分析三阴与非三阴乳腺患者接受ET新辅助化疗方案后,二者病理疗效及远期生存的差别。结果 249例患者中,54(21.7%)例为三阴乳腺癌,195(78.3%)例为非三阴乳腺癌。三阴乳腺癌的病理完全缓解(pCR)率为25.9%,明显高于非三阴乳腺癌的12.3%(P=0.019)。三阴乳腺癌患者,特别是新辅助化疗后仍有癌残留的患者,其5年无病生存率(DFS)及5年的总生存率(OS)均明显低于非三阴乳腺癌(P值均<0.05)。获得pCR的乳腺癌患者5年的DFS和OS均明显高于化疗后仍有癌残留的患者(P值均<0.05)。获得pCR的三阴乳腺癌与非三阴乳腺癌患者的DFS(P=0.837)及OS(P=0.398)均无统计学差异。结论本研究结果表明,相比于非三阴乳腺癌患者,三阴乳腺癌患者具有更高的病理完全缓解率,但预后却较差。

Objective To compare the response to neoadjuvant epirubicin plus docetaxel chemotherapy and survival in patients with Triple-negative breast cancer （TNBC） and non-TNBC. Methods Two hundred and forty-nine patients treated with neoadjuvant chemotherapy were included in this retrospective study. All the patients were classified as TNBC and non-TNBC according the immunohistochemieal results of estrogen receptor （ER）, progesterone receptor （PR） and HER2 status. TNBC is defined as the lack of ER, PR, and HER-2 expression. The pathological response and long time survival were compared between TNBC patients and non-TNBC patients. Results Among all 249 cases, 54 （21.7%）were TNBC patients, 195 （78.3%）were non-TNBC patients. Compared with non- TNBC patients, the pathological complete response （pCR） rate of patients with TNBC was 25.9%,＇ which was significantly higher than that of patients with non-TNBC （P=0.019）. Patients with TNBC especially for those with residual disease after chemotherapy had decreased 5 years＇ disease-free survival （DFS） and 5 years＇ overall survival （OS） compared with those with non-TNBC（P〈0.05）. The 5 years＇ DFS and OS of patients who achieve pCR were significantly higher than that of patients with residual disease after chemotherapy （P〈0.05）. Patients with TNBC and non-TNBC had similar DFS and OS if pCR achieved. Conclusion Patients with TNBC were more sensitive to neoadjuvant docetaxel plus epirubicin chemotherapy. Compared with non-TNBC patients, TNBC patients had increased pCR rate, but were associated with significantly worse survival.