6周期AT新辅助化疗治疗乳腺癌临床疗效及其影响因素的分析

Influence factors of neoadjuvant chemotherapy of 6 regimen cycles AT regimen in patients with breast cancer

目的:探讨6周期AT方案(蒽环类联合紫杉类)新辅助化疗在乳腺癌治疗中的疗效及影响pCR的因素。方法:回顾性分析159例顺利完成6周期AT方案患者的临床病理资料,对比治疗前后病理变化,评价其临床疗效及不良反应,并探究影响新辅助化疗达到pCR的因素。结果:159例完成6周期AT方案新辅助化疗的乳腺癌患者占同期进行新辅助化疗52.3%,总pCR为30.8%,降期率为76.1%。单因素及Logistic回归分析发现,肿瘤大小,组织学分级,ER、PR状态、HER-2表达、分子分型以及化疗的早期反应是影响pCR的重要因素,其中肿瘤≤3 cm、ER缺失、HER-2扩增、超声评价化疗早期反应阳性患者更容易达到pCR。结论:乳腺癌6周期AT方案新辅助化疗pCR率较高,超声评价的早期反应能够预测pCR,肿瘤大小以及肿瘤分子分型是影响pCR的重要因素,临床实践中需综合考虑影响因素,从而决定手术的最佳时机。

Objective： To explore the relative factors in neoadjuvant chemotherapy（ NCT） on pathological complete response（ pCR） in the treatment of 6 cycles Anthra-cycline combined with taxanes regimen in patients with breast cancer. Methods： 159 patients with diagnosed clinically Ⅱ,Ⅲ breast cancer by treating with Anthracycline combined with taxanes regimen in neoadjuvant chemotherapy for 6 cycles were retrospectively analyzed. Results： Among these159 patients,the total pCR rate was 30. 8% and 76. 1%,patents acquire a decent clinical stage after 6 cycles NCT.Logistic regression analysis showed that tumor initial size,histological grade,ER state,PR state,HER-2 overexpression,molecular subtype and its early response to NCT evaluated by ultrasonography were the significant affecting factors. The patients with smaller tumor size（ ≤3 cm） and ER deficiency and HER-2 overexpression and early response to NCT are more likely to obtain pCR. Conclusion： NCT of 6 cycles Anthracycline combined with taxanes regimen possed a high pCR rate in stage Ⅱ,Ⅲ breast cancer. Tumor＇s early response to chemotherapy evaluated by ultrasonography could be a good predictive solution to pCR. Molecular type and tumor size are also significant influencing factors on pCR in breast cancer patients.