cNCCN指南对Her-2过表达型乳腺癌治疗的指导意义

The Guiding Significance of c NCCN Guidelines for the Treatment of Her-2 Over-Expressing Breast Cancer

[目的]总结在c NCCN指导下的Her-2过表达型乳腺癌的临床特征、诊疗现状及相应预后;判定c NCCN指南对于Her-2过表达型乳腺癌临床治疗的指导价值。[方法]回顾性分析具有明确病理学诊断的530例Her-2过表达型乳腺癌患者资料,并进行预后因素分析。[结果]根据2007～2011各年c NCCN乳腺癌临床实践指南,紫杉类药物规范治疗组较非规范治疗组的OS延长（49.379个月vs 2.087个月,P=0.024）;而蒽环类规范治疗组与非规范治疗组的PFS及OS无统计学差异。对于AJCC分期Ⅲ期Her-2过表达型乳腺癌患者,紫杉规范治疗组较蒽环规范治疗组PFS明显延长（49.875个月vs 31.594个月,P=0.036）,而两组之间的OS无统计学差异（P=0.369）;AJCCⅠ期,Ⅱ期,Ⅳ期及淋巴结阴性的紫杉规范治疗组与蒽环规范治疗组的PFS及OS无统计学差异（P〈0.05）。规范放疗组较非规范放疗组延长了OS（54.360个月vs45.927个月,P=0.044）;赫塞汀规范治疗组较非规范治疗组的延长了PFS（66.758个月vs52.863个月,P=0.027）,但OS无统计学意义（P=0.059）。[结论 ]对于Her-2过表达型乳腺癌,规范的紫杉醇类化疗方案、规范放疗可延长患者的总生存,而赫塞汀规范应用可改善其无病生存期。

[Purpose] To summarized the clinical characteristics,treatment status and prognosis for breast cancer with Her-2 over-expression underling the c NCCN Guideline,and to determine the value of c NCCN Guideline on the therapy of breast cancer with Her-2 over-expression. [Methods]The clinical date of 530 cases with breast cancer with Her-2 over-expression pathologically proven were analyzed retrospectively. The prognostic factors of breast cancer with Her-2 over-expression were analyzed. [Results] According to the c NCCN breast cancer clinical practice guidelines of 2007～2011,patients who received standard taxane-based therapy had significantly longer OS compared with nonstandard taxane-based therapy group（49.379 months vs 2.087 months,P=0.024. The PFS and OS of patients with standard anthracycline-based therapy were not prolonged than those who had nonstandard anthracycline-based therapy. In AJCC stage Ⅲ patients,the PFS of standard taxane-based therapy group was significantly longer than standard anthracycline-based therapy group（49.875 months vs 31.594 months,P=0.036）,but OS was no difference（P=0.369）. And in AJCC stage Ⅰ, Ⅱ, Ⅳ and lymph node negative patients,there were no differences of PFS and OS between the two groups（P=0.059）. The standard radiotherapy was improved survival compared with non-standard radiotherapy（54.360 months vs 45.927 months,P=0.044）. Standard herceptin-based therapy group had significantly longer PFS compared with non-standard herceptin-based therapy group（66.758 months vs 52.863 months,P=0.027）,but OS was no difference（P=0.059）. [Conclusion] For breast cancer patients with Her-2 over expressing,the standard taxane-based therapy and radiotherapy improve OS,and the PFS is improved in the standard herceptin-based therapy.