多西他赛、表柔比星联合环磷酰胺对局部晚期乳腺癌辅助化学治疗不同周期的疗效研究

Comparison of therapeutic effects between different cycles of docetaxel, epirubicin and cyclophosphamide regime on adjuvant chemotherapy of locally advanced breast cancer

目的·比较TEC方案(多西他赛+表柔比星+环磷酰胺)8周期和6周期对局部晚期乳腺癌术后辅助化学治疗(化疗)效果和不良反应的差异。方法·回顾性分析2008年4月-2015年4月于上海交通大学医学院附属国际和平妇幼保健院治疗的腋窝淋巴结转移≥4枚的局部晚期乳腺癌患者66例。按照化疗周期的不同将患者分为2组,观察组(TEC×8组)(n=31)和对照组(TEC×6组)(n=35)。比较2组患者的3年总生存率、无病生存率的差异,以及2组患者发生骨髓抑制、发热及肝功能异常等不良反应的差异。组间比较采用χ~2检验,生存分析采用Kaplan-Meier法。结果·观察组的3年总生存率为93.5%,对照组为91.4%,2组比较差异无统计学意义(P=0.716)。观察组的3年无病生存率为87.1%,对照组为85.7%,2组比较差异无统计学意义(P=0.855)。观察组患者Ⅲ度或Ⅳ度骨髓抑制的发生率为90.3%,对照组为65.7%,2组比较差异有统计学意义(P=0.017)。观察组发热的发生率为16.1%,对照组为14.3%,2组比较差异无统计学意义(P=0.835)。观察组肝功能异常发生率为77.4%,对照组为85.7%,2组比较差异无统计学意义(P=0.383)。结论·TEC×8方案与TEC×6方案相比,未能提高局部晚期乳腺癌患者的总生存率和无病生存率,2组发热和肝功能异常的发生率也无差异,但TEC×8方案显著增加Ⅲ度或Ⅳ度骨髓抑制的发生率。

Objective·To compare the therapeutic effects and adverse effects between regimes TEC(docetaxel,epirubicin and cyclophosphamide)×8 and TEC×6 on the adjuvant chemotherapy of locally advanced breast cancer patients.Methods·Sixty-six locally advanced breast cancer patients with at least 4 positive lymph nodes were retrospectively selected in the International Peace Maternity and Child Health Hospital,Shanghai Jiao Tong University School of Medicine from April 2008 to April 2015.Patients were divided into TEC×8 regime group(n=31)and TEC×6 regime group(n=35)according to the cycles that were given to the patients.Three-year overall survival(OS)and 3-year disease free survival(DFS)rate of patients in these two groups were compared.The incidence of myelosuppression,fever and liver function injury were also compared between patients in TEC×8 regime group and TEC×6 regime group.Chi square test(χ2)was used for comparison between two groups.Kaplan-Meier method was adopted to perform survival analysis.Results·No significant difference was found in 3-year OS rate between TEC×8 regime group(93.5%)and TEC×6 regime group(91.4%)(P=0.716),and no significant difference was found in 3-year DFS rate between TEC×8 regime group(87.1%)and TEC×6 regime group(85.7%)(P=0.855).The incidence of grade Ⅲ/Ⅳmyelosuppression of patients in TEC×8 regime group(90.3%)was significantly higher than that in TEC×6 regime group(65.7%)(P=0.017).No significant difference was found in the incidence of fever between TEC×8 regime group(16.1%)and TEC×6 regime group(14.3%)(P=0.835).There was no significant difference in the incidence of liver function injury between TEC×8 regime group(77.4%)and TEC×6 regime group(85.7%)(P=0.383).Conclusion·There is no significant difference in OS or DFS rate between TEC×8 regime and TEC×6 regime in adjuvant chemotherapy of locally advanced breast cancer,neither is in the incidence of fever and liver function injury.However,grade Ⅲ/Ⅳmyelosuppression more frequently occurs in TEC×8 regime group.