乳腺癌新辅助化疗患者依从性的单中心回顾性研究

Actual compliance with neoadjuvant chemotherapy in breast cancer:a retrospective single-center analysis

目的调查乳腺癌患者新辅助化疗的实际依从性并分析影响依从性的因素。方法收集2013年1月至2018年12月在我院接受新辅助化疗的Ⅱ和Ⅲ期乳腺癌患者的病例资料,分析患者特征、肿瘤临床特征及治疗策略等与治疗依从性的相关性。结果共有336例接受新辅助化疗的患者被纳入分析。206例(61.31%)完成既定的化疗周期数,130例(38.69%)患者因为各种原因未完成化疗。14例(4.17%)因不能耐受化疗不良反应降低药物剂量,30例(8.92%)患者拒绝医师推荐的方案改用其他方案;97例(28.86%)患者由于疗效欠佳肿瘤退缩不明显或个人原因要求中断化疗转为先行手术治疗;3例(0.89%)因为化疗中疾病进展进行手术治疗。统计分析显示,患者年龄≥60岁与<60岁患者,治疗完成率分别为35.82%和78.22%(P<0.001);患者的功能状态KPS评分90~100分、KPS 80分和KPS≤70分的患者中治疗完成率分别是61.46%,67.24%和13.33%(P=0.001)。HER2阳性患者的TCH方案组和AC-TH方案组完成率分别为91.49%和60.38%,(P<0.001)。HER2阴性患者的EC,AC-T和TA方案的完成率分别为67.31%,55.26%和45.45%,差异有统计学意义(P<0.001)。肿瘤T分期、肿瘤N分期、临床分期和ER/PR状态和依从性无关。疗效方面:AC-TH组、TCH组和AT组依从的患者达到病理完全缓解(pCR)优于不依从的患者(P<0.05),TA组、EC组和AC-T组中依从的患者ORR也优于不依从的患者(P<0.05)。结论新辅助化疗在乳腺癌患者中的依从性较低,与患者的年龄、功能状态及化疗方案的选择有相关性,患者的依从性对治疗效果有显著影响。因此肿瘤医师更要重视影响患者依从性的潜在因素,比如加强对患者的教育和沟通,消除患者顾虑、改善患者对疾病认知和对治疗策略及预后的了解,从而提高治疗依从性。

Objective This study aimed to investigate the actual compliance with neoadjuvant chemotherapy and analyze factors affecting the compliance in patients with breast cancer.Methods From February 2013 to December 2018,we collected data of patients with breast cancer who received neoadjuvant chemotherapy in our Hospital.Results We collected data of 336 patients in our institution.In all 336 patients with an indication to neoadjuvant chemotherapy,206(61.31%)patients completed the treatment and 130(38.69%)patients did not complete chemotherapy as planned.There were 14(4.17%)patients reduced the drug dose,and 30(8.92%)patients had to switch to other therapeutic regimens.97(28.86%)patients interruptted chemotherapy and switched to surgical treatment due to poor tumor regression or personal reasons;3(0.89%)patients underwent surgery due to disease progression during chemotherapy.Age,KPS,and chemotherapeutic regimen were factors that affected patient compliance.The compliance rate was higher for patient younger than 60 years(77.82%vs 35.82%,P<0.001).The compliance rates were 61.46%,67.24%and 13.33%for patients with a Karnofsky Performance Scale(KPS)of 90-100,80 and≤70,respectively(P<0.001).The completion rates were 91.49%and 60.38%for HER-2 positive patients underwent TCH regimen and AC-TH regimen respectively.For HER-2 negative patients,the completion rates for EC,AC-T and TA regimens were 67.31%,55.26%and 45.45%(P<0.001),respectively.Conclusion The compliance rate for neoadjuvant treatment was low in breast cancer patients.Age,performance status and patient preference for different chemotherapy regimens were factors influencing patients’compliance for neoadjuvant chemotherapy.Nevertheless,oncologists should be committed to raising patients’awareness of disease,treatment strategies and prognosis,which will improve treatment compliance.