新辅助化疗和辅助化疗治疗三阴性乳腺癌患者预后差异的回顾性研究

Prognosis of triple negative breast cancer patients receiving neoadjuvant chemotherapy versus adjuvant chemotherapy: a retrospective analysis

目的对比三阴性乳腺癌患者接受新辅助化疗和辅助化疗后的预后差异。方法本回顾性研究纳入2009年1月至2012年12月陆军军医大学附属西南医院乳腺外科收治的三阴性乳腺癌患者共214例,其中,行新辅助化疗114例,行辅助化疗100例。患者中位随访78.0个月(52.0~89.0个月),用Kaplan-Meier法进行生存分析,生存率比较采用Log-rank检验。结果辅助化疗组患者的DFS为65.8个月(40.6~91.9个月),新辅助化疗组为62.1个月(35.2~89.1个月),2组差异无统计学意义(χ~2=0.507,P=0.476);辅助化疗组患者的OS为70.5个月(45.1~96.0个月),新辅助化疗组为67.3个月(43.9~91.1个月),2组差异也无统计学意义(χ~2=1.587,P=0.208)。在新辅助化疗组的114例患者中,达到p CR的人数为21例(18.4%),未达到p CR的人数为93例(81.6%)。p CR组与非p CR组的年龄、淋巴结阳性数目、手术方式、T分期和临床分期比较差异均无统计学意义(χ~2=0.137、0.137、0.037;Z=0.528、0.468,P均>0.050)。p CR组患者的DFS为69.4个月(50.4~88.3个月),高于非p CR组的54.7个月(21.6~87.8个月)(χ~2=3.915,P=0.048);p CR组患者的中位OS为69.4个月(53.1~95.7个月),也高于非p CR组的63.8个月(37.7~89.9个月)(χ~2=4.632,P=0.031)。结论在三阴性乳腺癌中,新辅助化疗的预后可能与辅助化疗相似,新辅助化疗后达到p CR的患者预后比未达到p CR患者好。

Objective To compare the prognosis of triple-negative breast cancer patients receiving neoadjuvant chemotherapy versus adjuvant chemotherapy. Methods This retrospective study involved214 patients with triple negative breast cancer in the Department of Breast Surgery,Southwest Hospital,Army Medical University from January 2009 to December 2012. Among them,114 patients received neoadjuvant chemotherapy and 100 patients received adjuvant chemotherapy. The patients were followed up for median78. 0 months（ 52. 0-89. 0 months）. Survival analysis was performed using Kaplan-Meier method. The survival rates were compared by Log-rank test.Results The DFS was 65. 8 months（ range： 40. 6 to 91. 9 months） in adjuvant chemotherapy group,62. 1 months（ range： 35. 2 to 89. 1 months） in neoadjuvant chemotherapy group,indicating no significant difference（ χ~2= 0. 507,P = 0. 476）. The OS was 70. 5 months（ 45. 1 to96. 0 months） in adjuvant chemotherapy group,and 67. 3 months（ 43. 9 to 91. 1 months） in neoadjuvant chemotherapy group,indicating no significant difference（ χ~2= 1. 587,P = 0. 208）. Among 114 patients receiving neoadjuvant chemotherapy,21 patients（ 18. 4%） achieved p CR and 93（ 81. 6%） did not achieve p CR. There were significant differences in patient’s age,N stage,surgical method,T stage and clinical stage between p CR group and non-p CR group（ χ~2= 0. 137,0. 137,0. 037,Z = 0. 528,0. 468,all P〉0. 050）. The DFS in p CR group was 69. 4 months（ 50. 4-88. 3 months）,significantly higher than 54. 7 months（ 21. 6-87. 8 months） in non-p CR group（ χ~2= 3. 915,P = 0. 048）. The OS in p CR group was 69. 4 months（ 53. 1-95. 7 months）,significantly higher than 63. 8 months（ 37. 7-89. 9 months） in non-p CR group（ χ~2= 4. 632,P = 0. 031）. Conclusions In triple negative breast cancer,the prognosis of patients receiving neoadjuvant chemotherapy may be similar to that of patients receiving adjuvant chemotherapy. The prognosis of patients achieving p CR after neoadjuvant chemotherapy is better than that of patients without p CR.