TP与AP方案在三阴性乳腺癌新辅助化疗中的疗效及预后分析

Efficacy and Prognosis Analysis of TP and AP Regimens in Neoadjuvant Chemotherapy for Triple-negative Breast Cancer

目的:比较紫杉醇联合顺铂(TP)和紫杉醇联合多柔比星(AP)两种方案在三阴性乳腺癌(TNBC)新辅助化疗(NAC)中的临床疗效,以及分析病理完全缓解与预后的关系。方法:回顾性分析2018年1-8月就诊于沧州市中心医院的46例三阴性乳腺癌患者的临床资料,依据治疗差异分为含铂组(26例)与非含铂组(20例)。比较两组的手术时长、出血量、术后并发症发生率、客观缓解率(ORR)、病理完全缓解(pCR)率;分析pCR与3年无病生存(DFS)率和总生存(OS)率的关系。结果:含铂组手术时长[(44.96±7.56)min vs(80.50±8.61)min]短于非含铂组,出血量[(128.65±9.03)ml vs(245.50±8.91)ml]少于非含铂组,差异有统计学意义(P<0.05);含铂组并发症发生率(11.5% vs 45.0%)低于非含铂组(P<0.05),含铂组ORR (76.9% vs 35.0%)、pCR率(42.3% vs 15.0%)高于非含铂组,差异均有统计学意义(P<0.05)。NAC后,完全缓解(CR)17例,部分缓解(PR)10例,疾病稳定(SD)14例,疾病进展(PD)5例,pCR率为30.4%,3年DFS率和OS率分别为41.3%和56.5%;其中pCR患者的3年DFS率和OS率分别为64.3%和78.6%,明显高于非pCR患者的31.3%和46.9%(P<0.05)。单因素分析发现,pCR和患者3年内DFS率与OS率均有关(P<0.05),多因素分析发现,pCR是3年DFS率的独立影响因素(P=0.042)。生存分析发现,46例患者中发生死亡20例(pCR 3例,非pCR 17例),无病生存19例。全部患者3年无病生存时间11~36个月,其中含铂组为(31.15±6.40)个月,长于非含铂组的(23.00±8.35)个月(P<0.05);含铂组的3年DFS率为61.5%,高于非含铂组的15.0%(P<0.05)。全部患者总生存时间16~44个月,其中含铂组为(36.73±3.65)个月,长于非含铂组的(29.60±8.95)个月(P<0.05);含铂组的OS率为76.9%,高于非含铂组的30.0%(P<0.05)。结论:TNBC对TP方案较敏感,患者近期疗效及预后较好;获得pCR患者预后较好,pCR可作为预后观察指标。

Objective:To compare the clinical efficacy of Paclitaxel combined with Cisplatin (TP) and Paclitaxel combined with Doxorubicin (AP) in neoadjuvant chemotherapy (NAC) of triple-negative breast cancer (TNBC) and analyze the relationship between pathological complete remission and prognosis.Method:The clinical data of 46 patients with triple negative breast cancer in Cangzhou Central Hospital from January to August 2018 were retrospectively analyzed.According to treatment differences,they were divided into platinum-containing group (26 cases) and non-platinum-containing group (20 cases).The operation time,blood loss,postoperative complication rate,objective response rate (ORR),pathological complete response (pCR) rate were compared between the two groups.The relationship between pCR and 3 years disease free survival (DFS) rate and overall survival (OS) rate were analyzed.Result:The operation time[(44.96±7.56) min vs (80.50±8.61) min]in the platinum-containing group was shorter than that in the non-platinum-containing group,the blood loss[(128.65±9.03) ml vs (245.50±8.91) ml]was less than that in the non-platinum-containing group,and the differences were statistically significant (P<0.05).The complication rate in the platinum-containing group (11.5% vs 45.0%) was lower than that in the non-platinum-containing group (P<0.05).The ORR (76.9% vs 35.0%) and pCR rate (42.3% vs 15.0%) in the platinum-containing group were higher than those in the non-platinum-containing group,and the differences were statistically significant (P<0.05).After NAC,there were 17 cases of complete remission (CR),10 cases of partial remission (PR),14 cases of stable disease (SD),and 5 cases of disease progression (PD),pCR rate was 30.4%,3 years DFS rate and OS rate were 41.3% and 56.5% respectively.Among them,the 3 years DFS rate and OS rate of pCR patients were 64.3% and 78.6% respectively,which were significantly higher than those of non pCR patients (31.3% and 46.9%) (P<0.05).Univariate analysis showed that pCR was associated with both DFS rate and OS rate within 3 years (P<0.05),multivariate analysis showed that pCR was an independent factor for 3 years DFS rate (P=0.042).Survival analysis showed that among the 46 patients,20 cases died (3 cases with pCR and 17 cases with non-pCR),and 19 cases died without disease.The 3 years disease free survival time of all patients was 11-36 months,the platinum-containing group was (31.15±6.40) months,which was longer than (23.00±8.35) months in the non-platinum-containing group (P<0.05).The 3 years DFS rate in the platinum-containing group was 61.5%,which was higher than that in the non-platinum-containing group (15.0%) (P<0.05).The overall survival time of all patients was 16-44 months,the platinum-containing group was (36.73±3.65) months,which was longer than the non-platinum-containing group (29.60±8.95) months (P<0.05).The OS rate of the platinum-containing group was 76.9%,which was higher than that of the non-platinum-containing group (30.0%) (P<0.05).Conclusion:Triple-negative breast cancer is more sensitive to the TP regimen,and the short-term curative effect and prognosis of patients are better.The prognosis of patients with pCR is better,and pCR can be used as a prognostic indicator.