3种新辅助化疗方案治疗乳腺癌的有效性和安全性比较

Effect and safety of three neoadjuvant chemotherapy regimens for breast cancer

目的探讨EC序贯wP方案(EC-wP)、T方案(EC-T)和TEC方案治疗乳腺癌的疗效和安全性。方法 108例Ⅱ~Ⅲ期单侧原发性乳腺癌患者均接受新辅助化疗,根据化疗方案分为EC-T组38例、TEC组36例和EC-wP组34例。比较3组临床疗效、病理完全缓解(pathologic complete remission, pCR)率和不良反应发生率,并比较不同分子分型对临床疗效和pCR的影响。结果 EC-T组、TEC组和EC-wP组临床有效率(81.6%、88.9%、79.4%)和pCR率(10.53%、8.33%、5.89%)比较差异均无统计学意义(P>0.05);TEC组患者中性粒细胞减少发生率(38.9%)高于EC-T组(23.7%)和EC-wP组(5.9%)(P<0.05),EC-T组高于EC-wP组(P<0.05);雌激素受体阴性者临床有效率(91.4%)和pCR率(10.3%)高于阳性者(74.0%、6.0%)(P<0.05),孕酮受体阴性者临床有效率(95.1%)和pCR率(11.5%)高于阳性者(68.1%、4.3%)(P<0.05),人表皮生长因子受体-2阳性者临床有效率(88.2%)和pCR率(11.8%)高于阴性者(78.9%、5.3%)(P<0.05),Ki-67>14%者临床有效率(93.3%)和pCR率(15.6%)高于Ki-67≤14%者(76.2%、3.2%)(P<0.05)。结论对Ⅱ~Ⅲ期乳腺癌患者的新辅助化疗,EC-T、TEC和EC-wP方案疗效相当,EC-wP方案中性粒细胞减少发生率较低。

Objective To compare the effect and safety of EC sequential wP regimen(EC-wP), T regimen(EC-T) and TEC regimen in the treatment of breast cancer. Methods Totally 108 patients with stage Ⅱ-Ⅲ unilateral primary breast cancer received neoadjuvant chemotherapy, and were divided into EC-wP group(n=34), EC-T group(n=38) and TEC group(n=36). The clinical effect, pathologic complete response(pCR) rate and incidence of adverse reactions were compared among three groups. The influences of different molecular types on clinical effect and pCR were compared. Results There were no significant differences in clinical response rates(81.6%, 88.9%, 79.4%) and pCR rates(10.53%, 8.33%, 5.89%) among EC-T group, TEC group and EC-wP group(P>0.05). The incidence of neutropenia was higher in TEC group(38.9%) than that in EC-T group(23.7%) and EC-wP group(5.9%)(P<0.05), and in EC-T group than that in EC-wP group(P<0.05). The clinical effective rate and pCR rate were higher in estrogen receptor negative patients(91.4%, 10.3%) than those in positive patients(74.0%, 6.0%)(P<0.05), in progesterone receptor negative patients(95.1%, 11.5%) than those in positive patients(68.1%, 4.3%)(P<0.05), in human epidermal growth factor receptor-2 positive patients(88.2%, 11.8%) than those in negative patients(78.9%, 5.3%)(P<0.05), and in Ki-67>14% patients(93.3%, 15.6%) than those in Ki-67≤14% patients(76.2%, 3.2%)(P<0.05). Conclusion For stage Ⅱ-Ⅲ breast cancer patients receiving neoadjuvant chemotherapy, these three regimens have similar efficacy, but EC-wP regimen has the lowest incidence of neutropenia.