多西他赛+卡铂联合曲妥珠单抗方案对早期人表皮生长因子受体2阳性乳腺癌的新辅助治疗效果

Docetaxel,carboplatin plus trastuzumab as neoadjuvant setting in patients with early-stage human epidermal growth factor receptor 2 positive breast cancer:a retrospective analysis

目的探讨多西他赛+卡铂联合曲妥珠单抗(TCH)方案对早期人表皮生长因子受体2(HER2)阳性乳腺癌的新辅助治疗效果。方法回顾性分析2013年1月至2018年12月北京大学第一医院乳腺疾病中心经治的522例早期HER2阳性乳腺癌患者的临床资料,占同期收治早期浸润性乳腺癌患者的21.80%(522/2 394)。其中113例接受TCH方案进行新辅助治疗,年龄[M(QR)]52(13)岁(范围:23~69岁)。记录TCH方案新辅助治疗后病理完全缓解(pCR,ypT0N0M0期)的例数,采用Miller-Payne标准进行病理学评价。采用Kaplan-Meier法计算无病生存率和总体生存率,采用Log-rank检验比较组间生存差异。结果接受曲妥珠单抗规范治疗患者(294例)的无病生存率优于未规范治疗患者(177例)(84.4%比72.4%,χ^(2)=4.095,P=0.046)。发生3~4级不良反应的患者占全部患者的15.9%(18/113),包括3~4级中性粒细胞减少12例,腹泻6例。31例患者获得pCR(ypT0N0M0),pCR率为27.4%(31/113)。pCR患者与非pCR患者的无病生存率和总体生存率无差异(91.8%比85.0%,92.5%比90.5%,P值均>0.05)。病理学评价为G4~5的患者无病生存率优于G1~3患者(89.6%比81.5%,χ^(2)=5.340,P=0.021),而总体生存率的差异无统计学意义(91.4%比89.1%,χ^(2)=1.008,P=0.315)。结论早期HER2阳性乳腺癌采用TCH方案行新辅助治疗的效果较好,新辅助治疗后病理学评价为G4~5的患者的无病生存率更高。

Objective To examine the efficacy of docetaxel,carboplatin plus trastuzumab regimen(TCH)as neoadjuvant setting in early-stage human epidermal growth factor receptor 2(HER2)positive breast cancer.Methods Totally 522 patients diagnosed with early-stage HER2 positive breast cancer at Breast Disease Center,Peking University First Hospital between January 2013 to December 2018 were enrolled,which constituted 21.8%(522/2394)of early-stage invasive breast cancer.Clinical pathological factors were retrospectively analyzed.There were 113 female patients underwent TCH neoadjuvant chemotherapy,aging 52(13)years(range:23 to 69 years).Pathologic complete pathological response(pCR)was defined as ypT0N0M0,and the rate of pCR was calculated.Kaplan-Meier method and Log-rank test were used for survival comparison.Results Patients who received trastuzumab-based therapy(n=294)had higher disease-free survival(DFS)compared with those who omitted trastuzumab(n=177)(84.4%vs.72.4%,χ²=4.095,P=0.046).Eighteen of 113 patients(15.9%)experienced grade 3 to 4 chemotherapy-realted toxicity.Grade 3 to 4 neutropenia occurred in 12 patients,while grade 3 to 4 diarrhea occurred in 6 patients.Thirty-one of 113(27.4%)patients achieved pCR.DFS and overall survival(OS)were similar between patients who achieved pCR and non-pCR(DFS:91.8%vs.85.0%,OS:92.5%vs.90.5%,all P>0.05).According to Miller-Payne system,patients who achieved G4 to G5 had improved DFS compared with G1 to G3(89.6%vs.81.5%,χ²=5.340,P=0.021),but they had similar OS(91.4%vs.89.1%,χ²=1.008,P=0.315).Conclusions TCH is an effective regimen in neoadjuvant setting for patients with HER2 positive breast cancer.Patients who achieved G4 to G5 had improved DFS.