三阴性乳腺癌新辅助化疗疗效及预后分析

Efficacy of neoadjuvant chemotherapy in patients with triple-negative breast cancer and prognostic analysis

目的 :探讨三阴性乳腺癌新辅助化疗的疗效以及与预后相关的因素。方法 :回顾性分析2006年1月—2008年12月接受新辅助化疗的三阴性乳腺癌患者的临床特征、新辅助化疗的疗效以及与预后相关的因素。结果 :80例三阴性乳腺癌患者接受新辅助化疗,临床完全缓解率为46.25%(37/80),病理完全缓解率(pathological complete response,pCR)为38.75%(31/80)。未获得pCR(non-pCR)患者的N分期较高、临床分期较晚以及应用不含蒽环类的化疗方案。pCR患者的5年无病生存率和总生存率分别为80.65%和93.55%,non-PCR患者的5年无病生存率和总生存率分别为53.06%和65.34%;pCR与non-pCR患者的5年无病生存率和总生存率的差异均有统计学意义(P=0.008,P=0.004)。多因素分析显示,新辅助化疗后pCR是影响三阴性乳腺癌患者无病生存和总生存率的独立预后因素(P<0.05)。结论 :三阴性乳腺癌患者对新辅助化疗较为敏感,含蒽环类的化疗方案更易获得pCR,而pCR患者的预后明显优于non-pCR患者。

Objective： To investigate the response to neoadjuvant chemotherapy in patients with triple- negative breast cancer （TNBC） and the prognostic factors. Methods： The clinicopathologic features, the response to neoadjuvant chemotherapy, the disease-free survival and overall survival, and the prognostic factors were retrospectively analyzed in 80 hospitalized patinets with TNBC receiving neoadjuvant chemotherapy between January 2006 and December 2008. Results： Of the 80 TNBC patients receiving neoadjuvant chemotherapy, the clinical complete response （cCR） and the pathological complete response （pCR） were 46.25% （37/80） and 38.75% （31/80）, respectively. The patients with non-pCR （61.25%） had a higher stage of lymph node and an advanced clinical stage before chemotherapy, and they were more likely to receive non-anthracyclin-based neoadjuvant regimens. The 5-year disease-free survival rates of pCR and non-pCR patients were 80.65% and 53.06%, respectively （P = 0.008）, and the 5-year overall survival rates of pCR and non-pCR patients were 93.55% and 65.34%, respectively （P = 0.004）. Multivariate analysis showed that pCR was an independent prognostic factor. Conclusion： Patients with TNBC were more sensitive to neoadjvant chemotherapy. The regimens including anthracycline is helpful to achieve pCR. TNBC patients with pCR may have a better prognosis than non-pCR.