粒细胞集落刺激因子在乳腺癌新辅助化疗中的疗效分析

Efficacy analysis of granulocyte colony stimulating factor in neoadjuvant chemotherapy for breast cancer

目的:探讨粒细胞集落刺激因子(G-CSF)在乳腺癌新辅助化疗(NAC)中的作用。方法:将接受NAC且骨髓抑制风险评估大于20%的56例Ⅱ、Ⅲ期原发性乳腺癌患者随机分为预防性治疗(n=26)组和常规治疗(n=30)组。预防性治疗组在化疗结束24 h后使用G-CSF进行骨髓支持治疗;常规治疗组在化疗后第1、3、5、7 d复查血常规,并对发生Ⅲ、Ⅳ级骨髓抑制的患者进行G-CSF升白细胞治疗。观察并比较两组在NAC后临床完全缓解(cCR)、部分缓解(PR)、疾病稳定(sD)、疾病进展(PD)、骨髓抑制程度以及不良反应等方面的差异。结果:两组在年龄、月经状况、病理类型及临床分期方面比较,差异无统计学意义(P>0.05)。预防性治疗组在骨髓抑制及其他不良反应方面显著少于常规治疗组(P<0.05)。常规治疗组在临床cCR、PR、sD和PD方面优于预防性治疗组(P<0.05)。结论:预防性骨髓支持治疗可明显减少NAC的骨髓毒性及其他不良反应,增加患者化疗耐受性,提高其生活质量。但是,与常规治疗相比较,预防性骨髓支持治疗可能降低NAC的临床疗效,其具体机制需进一步研究。

Objective：To investigate the efficacy of granulocyte colony-stimulating factor（G-CSF） in neoa,tiuvant chemotherapy （NAC） for breast cancer. Methods： A total of 56 stageⅡ, Ⅲ primary breast cancer patients who would receive NAC with bone marrow suppression risk assessment greater than 20% were randomly divided into preventive treatment（PT） group and conventional treatment （CT） group. The PT group patients （n = 26） received bone marrow support treatment of G-CSF in 24 hours after the chemotherapy. The CT group patients （n = 30） were reexamed blood routine test in 1,3,5 and 7 days after chemotherapy,and the patients who suffered grade IU and 1V bone marrow suppression would receive G-CSF treatment. The differences of clinical complete remission （cCR）, partial response （ PR）, stable disease （ sD ）, disease progression （ PD ）, bone marrow suppression and other side effects evaluation in the two zrouos were recorded and compared. Results：Two groups were comparable in age,menopausal status, pathological type and clinical stage （ P 〉 0.05 ）. The bone marrow suppression and other adverse effects in PT group were significantly less than CT group （ P 〈 0.05 ）. The clinical efficacy of conventional treatment was better than preventive treatment （ P 〈 0. 05 ） in clinical cCR, PR, sD and PD. Conclusion： Compared with conventional bone marrow support therapy, preventive bone marrow support therapy significantly relieves the bone marrow toxicity and other adverse effects, increases patients＇ chemotherapy tolerance, and improves their life quality,but it is worse than CT group in the clinical efficacy of NAC. The specific mechanism needs further research.