乳腺癌新辅助化疗前后常用化疗药物敏感性的变化

Change of chemosensitivity of routine chemotherapy drugs in breast cancer after neoadjuvant chemotherapy

目的 检测新辅助化疗前后乳腺癌对常用化疗药物敏感性的变化.方法 收集536例可手术的原发性乳腺癌的新鲜癌组织作为A组;选取同期行TAC方案（多西他赛75 mg/m^2＋吡柔比星45 mg/m^2＋环磷酰胺600 mg/m^2,每3周1次）或TEC方案（多西他赛75 mg/m^2＋表柔比星75 mg/m^2＋环磷酰胺600 mg/m^2,每3周1次）4 ～6周期新辅助化疗后未达到病理完全缓解（pCR）的114例乳腺癌的新鲜癌组织作为B组,采用胶原凝胶包埋培养法体外药敏检测技术（CD-DST）检测乳腺癌细胞对多西他赛（DOC）、吡柔比星（THP）、表柔比星（EPI）、长春瑞滨（NVB）及顺铂（CDDP）的敏感性.结果 A组药物的单药有效率分别为：DOC（46.5％）、EPI（42.9％）、THP（42.7％）、CDDP（42.5％）、NVB （34.0％）.B组药物的单药有效率分别为：DOC（31.6％）、EPI（28.9％）、THP（32.5％）、CDDP（46.5％）、NVB（36.8％）.新辅助化疗后,乳腺癌对DOC和蒽环类药物的敏感性降低（P＜0.05）,对CDDP和NVB的敏感性呈现上升趋势,但差异无统计学意义（P＞0.05）.结论 新辅助化疗后,乳腺癌对DOC和蒽环类药物产生耐药,对CDDP和NVB的敏感性具有上升趋势.

Objective To select optimal chemotherapy regimens for locally advanced breast cancer （LABC） pretreated with anthracyclines and taxanes so as to examine chemosensitivity of routine chemotherapy drugs by collagen gel droplet embedded culture-drug sensitivity test （CD-DST）.Methods A total of 536 fresh operable phosphate buffer（PBS） samples were collected as group A,114 fresh LABC smples that do not meet pCR after 4-6 cycles TAC or TEC neoadjuvant chemotherapy was selected as group B.Chemosensitivity of culture breast cancer cells to docetaxel （DOC）,epirubicin （EPI）,pirarubicin （THP）,vinorelbine （NVB） and cisplatin （CDDP） was examined by CD-DST.Results The single drug efficiency of chemotherapy drugs in group A is respectively DOC （46.5%）,EPI （42.9%）,THP （42.7%）,CDDP （42.5%） and NVB （34.0%）.The single drug efficiency of chemotherapy drugs in group B is respectively DOC （31.6%）,EPI （28.9%）,THP （32.5%）,CDDP （46.5%） and NVB （36.8%）.After neoadjuvant chemotherapy,the sensitivity of DOC and anthracyclines in breast cancer is declined （P 〈 0.05）,the sensitivity of CDDP and NVB is on the rise,but there was no significant difference （P 〉 0.05）.Conclusion After neoadjuvant chemotherapy,breast cancer is resistant to DOC and anthracyclines,and the sensitivity of CDDP and NVB has a rising trend.