Oncoplastic Breast Surgery after Neoadjuvant Chemotherapy Replacing Mastectomy in Locally Advanced Breast Cancer (LABC): Single Institute Experience

Background: Integration of neoadjuvant chemotherapy (NCT) in early 70s resulted that many LABC tumors become resectable but with total mastectomy especially those with partial response, oncoplastic techniques give better oncological outcome with better cosmetic results. Objective: We evaluate the oncological safety of oncoplastic breast surgery (OS) in LABC showing partial response to NCT. Methods: We prospectively analyzed the data of 32 out of 58 patients with LABC who showed partial response to NCT and could have conservative surgery with advanced oncoplastic techniques rather than total mastectomy. Results: Out of 58 patients with LABC, received neoadjuvant chemotherapy, complete response was observed in 8 patients (13%), partial response reported in 32 (55.1%) cases, 12 patients (20%) had stable disease and 6 patients (10%) showed progressive disease. Data of 32 cases were studied (mean age 44.84 ± 9.10 years;range 26 - 59 years). Inferior pedicle was performed in 9 cases, mini LD flap in 3 patients, 5 had Grissotti technique, 6 with superomedial pedicle, 4 had V mammoplasty and 3 with J mammoplasty and 2 had vertical mammoplasty. Margins were positive in 5 cases (15.6%) with mean margin width 9.63 ± 5.72 (range 0 - 22 mm), and the local recurrence was reported in 2 cases (6.2%). Complications were reported in 3 cases (9.3%). The follow up was 1.67 ± 1.03 (range 0 - 3.3 years). Conclusions: Integration of neoadjuvant chemotherapy together with advanced oncoplastic techniques opens a new way for management of LABC especially those showing partial response with avoidance of total mastectomy, and comparable oncological safety in addition to better aesthetic and psychological outcome.

Evaluation of dynamic contrast-enhanced MRI in monitoring early response of locally advanced breast cancer to neoadjuvant chemotherapy

Objective： The aim of our study was to assess the value of dynamic contrast-enhanced magnetic resonance imaging （DMRI） in predicting early response to neoadjuvant chemotherapy （NAC） in patients with locally advanced breast cancer （LABC） and to assess the accuracy of DMRI in evaluating residual disease after NAC. Methods： DMRI were per- formed in 43 women with LABC （44 lesions, all were invasive ductal carcinoma） before, after the first and final cycle of NAC. Tumour volume, early enhanced ratio （El）, maximum enhanced ratio （Emax）, and maximum enhanced time （Tmax）, dynamic signal intensity-time curve were obtained during treatment. Residual tumour volumes obtained using DMRI were compared with pathological findings to assess the accuracy of DMRI. Results： After 1st cycle of NAC, the mean volume of responders decreased insignificantly, P 〉 0.05, but after NAC, mean volume of residual tumor decreased significantly （P 〈 0.01）. Morphol- ogy change： 29 cases showed a concentric shrinkage pattern while 7 cases showed a dendritic shrinkage pattern. Significant differences were found in El, Emax and Tmax between responders and non-responders （P 〈 0.05）. After 1st cycle of NAC, El, Emax and Tmax of responders changed significantly （P 〈 0.001）; while there is no significant change in non-responders （P 〉 0.05）. After NAC, dynamic signal intensity-time types were changed in responders, and tended to be significantly flat- tening, while no significant change was found in non-responders. The residual tumour volume correlation coefficient between DMRI and pathology measurements was very high （r = 0.866, P = 0.000）. Conclusion： DMRI is useful to evaluate the early response to NAC in LABC. The presence and volume of residual disease in LABC patients treated with NAC could be ac- curately evaluated by DMRI.

Evaluation of the effect of neoadjuvant chemotherapy on tumor and axillary lymph nodes in locally advanced breast cancer: a study of 50 patients

Objective： The purpose of the study was to correlate between effect of pre-neoadjuvant chemotherapy （NACT） and post-NACT clinical, sonographic and pathologic features of the tumor and axillary lymph nodes （ALNs） and to raise the possibility of applying the concept of sentinel lymph node biopsy （SLNB） in patients with initially positive ALNs before NACT. Methods： A prospective study of 50 female patients with locally advanced breast cancer （LABC） with clinically palpable.and cytologically （under ultrasonographic guidance） positive ALNs. All patients received NACT and then referred for ultrasono- graphic assessment of the axilla regarding any detectable sonographic criteria of metastatic deposits in ALNs as well as the tumor size in relation to its prechemotherapy size, All patients were then subjected either to modified radical mastectomy or breast conserving surgery. The clinical, sonographic and pathological response of the tumor and the ALNs were documented, classified and correlated with each other. Results： Patients＇ mean age was 47.7±9.1 years. The mean clinical tumor size was 6.7 ± 1.4 cm; stage IliA that was presented in 32 patients （64%） and IIIB was presented in 18 patients （36%）. Chemotherapy was given for a median of 4 cycles, there was reduction of the mean clinical tumor size from 6.7 ± 1.4 cm to 4.3 ± 2.7 cm （P 〈 0.001）. Clinical response was complete in 5 （10%） tumors, complete pathological tumor response （post-neoadjuvant） was detected in 6 （16%） of patients. Complete clinical nodal response （post-neoadjuvant） in 23 （46%） axillae, on sonographic assessment of the axilla, response was complete in 17 （34%） axillae. Complete pathological nodal response occurred in 16 （32%） axillae. Out of 17 axillae that showed complete sonographic response 11 axillae showed complete pathological nodal response （P 〈 0.001）. Conclusion： Formal axillary lymph node dissection can be avoided and replaced by SLNB post NACT in patients with LABC with metastatic ALNs if there were complete clinical and sonographic criteria of nodal response as well as complete pathological tumor response.

Decrease in the Ki67 index during neoadjuvant chemotherapy predicts favorable relapse-free survival in patients with locally advanced breast cancer

Objective: The purpose of this study was to explore the optimal cutoffs of the three parameters of Ki67 during NAC for predicting patient prognosis and investigate whether the optimal cutoffs of the Ki67 values were associated with relapse-free survival(RFS) or breast cancer-specific survival(BCSS).Methods: A total of 92 patients with locally advanced breast cancer(LABC), who had residual disease after NAC were retrospectively investigated.The optimal cutoff values of the Ki67 parameters were assessed by the online algorithm Cutoff Finder.Kaplan-Meier analysis, the log-rank test and Cox regression analysis were carried out to analyze survival.Results: The optimal cutoff values for the postsurgical Ki67 level and the decrease in the Ki67 level during NAC were defined as 25% and 12.5%, respectively.According to the univariate survival analysis, a higher Ki67 level in residual disease was associated with poor RFS(P = 0.004) and BCSS(P = 0.014).In addition, a Ki67 expression decrease > 12.5% during NAC was related to favorable RFS(P = 0.007), but was not related to BCSS(P = 0.452).Cox regression analysis showed that the Ki67 expression decrease(> 12.5% vs.≤ 12.5%) and histological grade(grade 3 vs.grade 1-2) were the independent factors associated with RFS(P =0.020 and P = 0.023, respectively), with HR values of 0.353(95% CI: 0.147-0.850) and 3.422(95% CI: 1.188-9.858), respectively.Conclusions: The Ki67 decrease was one of the independent factors associated with RFS in LABC patients with residual disease after receiving NAC.

Weekly taxane-anthracycline combination regimen versus tri-weekly anthracycline-based regimen for the treatment of locally advanced breast cancer:a randomized controlled trial

Background:Extensive studies have confirmed the efficacy of taxanes in combination with anthracycline-based chemotherapy on breast cancer.However,few studies have assessed the efficacy of weekly taxane-anthracycline regimens on locally advanced breast cancer.This study was to compare the efficacy and safety of a weekly taxaneanthracycline regimen with those of tri-weekly anthracycline-based regimen in patients with locally advanced breast cancer.Methods:Patients with locally advanced breast cancer were randomized to receive 4-6 cycles of neoadjuvant chemotherapy with tri-weekly 5-fluorouracil-epirubicin-cyclophosphamide(FEC) regimen or weekly paclitaxel-epirubicin(PE) regimen.The primary endpoint was the pathologic complete response(pCR) rate.Other endpoints included the clinical tumor response,breast-conserving surgery rate,and adverse events.Results:Between March 2010 and September 2013,293 patients were randomized to the FEC(n=151) and PE(n=142) arms.The overall clinical response rate was significantly higher in the PE arm than in the FEC arm(76.06%vs.59.95%,P=0.001).Consistently,the post-chemotherapy pathologic T and N stages were significantly lower in the PE arm than in the FEC arm(P<0.001).However,the pCR rate was similar in the two arms(10.61%vs.12.31%,P=0.665).Overall,36(27.27%) patients in the FEC arm and 6(35.28%) in the PE arm were qualified for breast-conserving surgery.Most adverse events were comparable in both arms,with more severe neutropenia in the PE arm than in the FEC arm(11.97%vs.5.96%,P=0.031).Conclusions:In patients with locally advanced breast cancer,weekly PE was not superior to FEC in terms of pCR.However,weekly PE has a higher response rate and superior down-staging effects.On this account,the PE regimen may be considered an alternative option for locally advanced breast cancer.Long-term follow-up data are needed to confirm the efficacy of this regimen on locally advanced breast cancer.Trial registration Chinese clinical trial registry,ChiCTR-TRC-10001043,September 21。

Skin Sparing Mastectomy in Locally Advanced Breast Cancer: A Possibility?

Breast cancer is the second most common cause of cancer death in women in India in spite of advances in the adjuvant treatment of breast cancer. Locally advanced breast cancer (LABC) still represents the major presenting picture in many urban and rural institutions in our country. Skin Sparing Mastectomy (SSM) and primary reconstruction is a popular option for patients with breast cancer. There are similar local and distant recurrences in SSM compared to the traditional non-skin sparing mastectomy. A 57-year-old lady presented with a locally advanced left breast cancer. After undergoing neoadjuvant chemotherapy and a PET-CT to accurately detect residual disease in breast and axilla, she underwent skin sparing mastectomy with nipple-areola complex preservation and primary reconstruction with silicon prosthesis implant over a latissimus dorsi myocutaneous flap for primary reconstruction. SSM in LABC has not been reported in the literature so far. This patient is disease free for the past 24 months.

Correlation between the proportion of breast volume involved by locally advanced tumors and invasion of the skin and posterior structures

AIM: To evaluate any differences between the percentages of involved breast volume, pathologic attributes,and tumor marker expression of T3 and T4a-c tumors in locally advanced breast cancers(BC).METHODS: All patients with T3 N > 0 and T4a-c BC without evidence of distant metastasis(M0), presenting to the Breast Clinic from 1980 to 2010, were examinedto determine whether their BC's involved ≥ 50% of their breast volumes, defined by gross replacement of at least one hemisphere. Core needle biopsy or postmastectomy specimens from tumors involving a known percent of breast volume were evaluated for:(1)pathological grades and lympho-vascular invasion(LVI);(2) hormone receptor(ER/PR) expression > 0; and(3)epidermoid growth factor 2(her2) over-expression(3+)by immune-histochemical staining or fluorescent in situ hybridization.RESULTS: The data base included 98 patients with T3N> 0 M0 and 120 with T4a-c, any N disease, M0 disease. T3 tumor masses involved 50% or more of the breast in 23/98(24%), and T4a-c tumors 65/120(54%)(P < 0.001). Only 1% of T3 tumors and 23% of T4a-c tumors presented with total breast replacement. There were no significant differences between the pathological attributes and marker expression of the T3 and T4a-c tumors.CONCLUSION: These data suggest that erosion of the overlying skin or underlying chest wall by some BC may be due to neglect and delay, rather than inherent biological aggressiveness.

从“引火归元”论治局部晚期乳腺癌

“引火归元”是从相火立论认识和解释人体生理和病理变化的重要理论。从“引火归元”的视角认识局部晚期乳腺癌,认为乳房多气多血的生理特点决定了其易于从阳化火的特点。相火妄动,与乳房局部的病理因素搏结,则杂合形成邪火,整个病理过程中包含相火妄动、邪火炽盛、阴阳两虚三方面,且三者常互为因果、彼此纠缠。临证可选用引火汤、封髓丹等内治法改善机体状态,并酌用外治法清散邪火。

基于SEER数据库的不同分子分型局部晚期乳腺癌临床治疗决策对长期生存结局的影响

目的探讨临床治疗决策对不同分子分型局部晚期乳腺癌(locally advanced breast cancer,LABC)长期生存的影响,促进临床医生制定针对LABC更加有效、个体化治疗方案的发展。方法通过SEER数据库检索2010~2015年病理学确诊为LABC的病例。通过绘制Kaplan-Meier曲线估计乳腺癌特异性生存期(Breast cancer specific survival,BCSS)和总生存期(overall survival,OS),在调整年龄、TNM分期、分级和治疗方式后,确定LABC的获益人群。结果总体保乳病人的5年OS与BCSS分别为77.43%、84.34%,全乳切除病人的5年OS与BCSS分别为68.03%、76.90%;Luminal A型LABC保乳病人的5年OS与BCSS分别为79.91%、87.23%,全乳切除病人的5年OS与BCSS分别为71.78%、81.16%;Luminal B型LABC保乳病人的5年OS与BCSS分别为79.30%、83.14%,全乳切除病人的5年OS与BCSS分别为70.37%、76.92%;三阴性LABC保乳病人的5年OS与BCSS分别为60.77%、68.13%,全乳切除病人的5年OS与BCSS分别为47.13%、55.94%;HER2阳性LABC保乳病人的5年OS与BCSS分别为75.42%、82.05%,全乳切除病人的5年OS与BCSS分别为67.05%、75.01%;三阳性LABC保乳病人的5年OS与BCSS分别为86.12%、91.63%,全乳切除病人的5年OS与BCSS分别为74.54%、82.56%。对于高分化、N0期、三阳性LABC化疗病人5年OS、BCSS分别为88.24%、76.91%,不化疗病人5年OS、BCSS分别为88.24%、90.91%(BCSS:P=0.812;OS:P=0.311)。结论LABC行保乳手术病人OS、BCSS均显著优于全乳切除,当对不同分子分型和分期LABC进行OS、BCSS比较时,保乳手术仍优于全乳切除。对于高分化、N0、三阳性LABC可以考虑豁免化疗。

背阔肌肌皮瓣在新辅助化疗后cT4局部晚期乳腺癌创面修复中的应用

目的:探讨背阔肌肌皮瓣(LDMF)在新辅助化疗(NAC)后cT4局部晚期乳腺癌(cT4-LABC)创面修复中的应用效果。方法:回顾性分析2017年12月至2020年08月间我科收治14例cT4-LABC患者,在经过抗感染和NAC达到临床获益(PR+SD)后,局部行乳腺癌根治性切除术,并即刻应用LDMF修复胸壁缺损。结果:14例患者中13例(13/14,92.9%)完成既定周期的NAC,1例仅完成2周期NAC(剔除研究)。在纳入研究的13例患者中,无CR和PD病例,PR 12例(12/13,92.31%),SD 1例(1/13,7.69%),NAC临床获益率100%(13/13)。13例患者均成功完成手术,手术时间4~6小时,术中出血200~300 mL,术后2例皮肤缺血坏死(2/13,15.38%),通过换药自行愈合,拔管后8例供区出现少量血清肿(8/13,61.54%),通过抽液、加压包扎处理后消失。随访1~36个月,中位随访22个月,1例局部复发(1/13,7.69%)、3例远处转移(3/13,23.08%)、2例死亡(2/13,15.38%),所有患者背阔肌功能良好,上肢活动基本正常。结论:cT4-LABC在保证全身治疗有效后,局部手术时应用LDMF即刻修复胸壁缺损切实可行,效果确切,值得推广。

人表皮生长因子受体2在三阴性早期/局部晚期乳腺癌患者中的表达及与疗效和复发转移的关系

目的 探讨人表皮生长因子受体2(HER2)在三阴性早期/局部晚期乳腺癌患者中的表达及与疗效和复发转移的关系。方法 收集接受新辅助化疗的98例三阴性早期/局部晚期乳腺癌患者的临床资料,分析不同HER2表达水平患者的临床特征,采用二元Logistic回归分析和Cox回归分析对三阴性早期/局部晚期乳腺癌患者完全缓解和预后的影响因素进行分析。结果 HER2低表达患者中腋窝淋巴结转移及术后淋巴结分期为N3期患者的比例均高于HER2表达为0的患者,差异均有统计学意义(P﹤0.05)。临床分期为cT_(3~4)期、HER2低表达均是三阴性早期/局部晚期乳腺癌患者完全缓解率的危险因素(P﹤0.01)。新辅助化疗后非完全缓解、HER2表达较高、术后淋巴结分期较高均是三阴性早期/局部晚期乳腺癌患者无病生存率(DFS)的危险因素(P﹤0.05)。结论临床分期为cT_(3~4)期、HER2低表达均是三阴性早期/局部晚期乳腺癌患者完全缓解的影响因素,且新辅助化疗后非完全缓解、HER2表达较高、术后淋巴结分期较高的患者预后较差,HER2表达水平可作为预测三阴性早期/局部晚期乳腺癌患者疗效及复发转移的指标。

局部晚期乳腺癌行即刻乳房再造术的远期生存及预后因素研究

目的:探讨局部晚期乳腺癌(locally advanced breast cancer,LABC)行即刻乳房再造术(immediate breast reconstruction,IBR)的肿瘤学安全性。方法:回顾性分析2001年9月至2016年3月于天津医科大学肿瘤医院被诊断为LABC并行IBR的114例患者的临床资料,分析总体生存(overall survival,OS)率、无局部复发生存(local recurrence-free survival,LRFS)率和无远处转移生存(distant metastasis-free survival,DMFS)率。采用Cox比例风险回归模型分析影响预后的因素。结果:中位随访时间为55.0个月,总队列5年OS率、LRFS率和DMFS率分别为78.9%(95%CI:69.1%~85.9%)、95.8%(95%CI:89.2%~98.4%)和78.9%(95%CI:69.1%~86.0%)。肿瘤直径>5 cm较肿瘤直径≤5 cm患者更易局部复发(P=0.023)。Cox比例风险回归模型多因素分析显示,肿瘤直径>5 cm(HR=3.60,95%CI:1.40~9.10,P=0.007)与淋巴结病理分期N3(HR=4.20,95%CI:1.60~11.0,P=0.004)是患者死亡的独立危险因素。结论:LABC行IBR术式的总体肿瘤学安全性可靠。肿瘤直径>5 cm或淋巴结病理分期为N3的LABC患者应慎行IBR。

去甲长春花碱加表柔比星新辅助化疗方案治疗局部晚期乳腺癌的临床研究

目的:了解诺维本加表柔比星(表阿霉素)的联合新辅助化疗方案在局部晚期乳腺癌治疗中的疗效和毒性反应。方法:2001年9月～2003年2月,76例Ⅱb期至Ⅲb期的局部晚期乳腺癌病人入组本次临床试验。入组病例术前接受的新辅助化疗方案为:诺维本25 mg/m2,第1、8天;表阿霉素60 mg/m2,第1天,每三周为1个疗程,共3个疗程。分别观察新辅助化疗后肿瘤原发病灶和区域淋巴结的缓解情况,并观察新辅助化疗的毒性反应。结果:原发病灶临床有效率为84.2％,其中完全缓解(CR)19.7％,部分缓解(PR)64.5％,疾病稳定(SD)14.5％,疾病进展(PD)1.3％;病理完全缓解率为14.5％(11/76)。32例化疗前细针穿刺活检明确区域淋巴结转移阳性的病人中,9例(28.1％)术后病理腋淋巴结转移阴性。毒性反应主要为白细胞减少症、脱发和恶心/呕吐,共有39例(54.2％)病人发生了Ⅲ到Ⅳ度的白细胞减少症,但未有因此而发生的败血症和死亡病例。结论:诺维本加表阿霉素的新辅助化疗方案在局部晚期乳腺癌的治疗中疗效显著,耐受性良好。

局部晚期乳腺癌的治疗进展

新辅助化疗后再手术和(或)放疗已成为治疗局部晚期乳腺癌的治疗模式。本文综述新辅助化疗的依据、疗程方案、影响疗效及预后相关因素及其优缺点,同时介绍了局部晚期乳腺癌诊断,局部治疗及内分泌治疗等方面的进展。

TAC与AT方案新辅助化疗治疗局部晚期乳腺癌疗效分析

目的:观察多西他赛、吡柔比星联合环磷酰胺方案(TAC)与多西他赛联合吡柔比星方案(AT)新辅助化疗治疗局部晚期乳腺癌近期疗效和毒副反应。方法:回顾性分析72例局部晚期乳腺癌新辅助化疗患者资料,TAC组(38例)为观察组,AT组(34例)为对照组,每周期化疗前行疗效评估及毒副反应分析,第4周期化疗结束后总体评价疗效。结果:观察组治疗局部晚期乳腺癌总有效率为89.47%,对照组为70.59%,观察组优于对照组,差异有统计学意义(P<0.05);化疗毒副反应严重程度观察组较对照组重,两组之间差异无统计学意义(P>0.05)。结论:TAC与AT方案新辅助化疗治疗局部晚期乳腺癌均有较好疗效,TAC方案优于AT方案。

局部进展期乳腺癌新辅助化疗前后生物标志物表达变化与疗效的相关性

目的:探讨局部进展期乳腺癌行新辅助化疗前后相关生物标志物的表达变化情况与化疗疗效的相关性。方法:采用免疫组化方法检测102例新辅助化疗前后局部进展期乳腺癌组织中雌激素受体(ER)、孕激素受体(PR)、人类表皮生长因子受体-2(HER-2)、p53和增殖细胞核抗原(Ki-67)等表达,分析化疗前后生物标志物表达变化与化疗疗效的相关性。结果:ER阴性组、PR阴性组、Ki-67高表达组的新辅助化疗有效率分别为50.0%、49.1%、51.4%,高于ER阳性组26.0%、PR阳性组25.5%、Ki-67低表达组9.4%(P<0.05)。Logistic多因素回归分析显示,ER、Ki-67的表达水平是评估化疗疗效的独立因素(P<0.05)。Luminal型乳腺癌总生存期高于non-Luminal型(Long-rank检验,P<0.05)。结论:ER、Ki-67、分子亚型可作为局部进展期乳腺癌新辅助化疗疗效判断的重要预测指标。

局部晚期乳腺癌改良根治术后两种辅助放化疗模式的疗效与成本效果分析

目的:结合疗效从经济学角度对局部晚期乳腺癌改良根治术后FEC-T后程同步放疗和序贯放疗模式进行分析,为术后辅助治疗模式选择提供参考。方法:采用成本-效果分析对155例改良根治术后接受FEC-T后程同步放疗或序贯放疗的局部晚期乳腺癌病例进行疗效评价及成本效果分析。结果:中位随访39个月。与序贯模式比较,后程同步放疗模式未增加不良反应;缩短平均治疗时间6.2周,改善3年无复发生存率(92.3%vs 81.8%,P=0.046),有改善3年的无疾病进展生存率和总生存率趋势;3年无疾病进展生存率的成本-效果比,后程同步模式为999.96元/%,序贯模式为1 349.31元/%,增量成本-效果比为-889.38元/%。结论:改良根治术后FEC-T后程同步放疗模式及序贯放疗模式都具有良好耐受性及疗效。后程同步放疗模式有更好的疾病控制及成本-效果比,可作为局部晚期乳腺癌的改良根治后辅助治疗模式的良好选择。

不同新辅助化疗方案治疗局部晚期乳腺癌的疗效比较

目的探讨新辅助化疗不同的治疗方案对局部晚期乳腺癌的患者的疗效。方法72例接受新辅助化疗的乳腺癌(ⅢA期)患者随机分为3组:即TA组(n=24)(紫杉醇联合吡柔比星):TXL 135 mg/m2静滴,d1,THP 40 mg/m2静推,d2。CAF组(n=24)(吡柔比星联合环磷酰胺,5-氟尿嘧啶):THP 40 mg/m2静推,d1,CTX 600 mg/m2,静推,d1.8,5-FU 12 mg/kg,d1-5,静滴。CMF组(n=24)(环磷酰胺联合5-氟尿嘧啶,氨甲喋呤):CTX 600 mg/m2静推d1.8,5-FU 12 mg/kg,静滴,d1-5,MTX 0.4 mg/kg,d1,静推。21 d为一个周期,2个周期后对乳腺癌原发病灶及腋窝淋巴结状态进行观察及分析。结果TA组总有效率为83%,CAF组总有效率为63%,CMF组总有效率25%。TA组与CMF组相比较有显著差异(P<0.05),CAF组与CMF组相比较有显著差异(P<0.05),TA组与CAF组相比较无统计学意义(t=0.022,P>0.05)。结论TA组和CAF组在局部晚期的乳腺癌新辅助治疗的过程中疗效满意,毒副反应可以耐受,值得推广。

新辅助化疗对局部进展期乳腺癌患者T淋巴细胞亚群及NK细胞免疫功能的影响

目的:探讨局部进展期乳腺癌患者新辅助化疗前、后T淋巴细胞亚群及NK细胞免疫功能的变化。方法:采用流式细胞术检测54例局部进展期乳腺癌患者新辅助化疗前后的静脉血T淋巴细胞亚群及NK细胞免疫功能。美国癌症联合会(American Joint Commitree on Cancer,AJCC)肿瘤分期为Ⅱb期(仅T3N0M0)和Ⅲ期(不包括N3),静脉血于第1周期新辅助化疗治疗前及第3周期化疗后21日抽取,淋巴细胞亚群检测包括:T(CD3+,CD4+,CD8+),NK(CD56+,CD16+),经过3周期新辅助化疗CEF方案(表柔比星、环磷酰胺和5-氟尿嘧啶),根据新辅助化疗临床效果评价分为2组,化疗有效组38例(CR和PR),化疗无效组16例(SD和PD),并与正常体检健康者(40例)作比较。结果:乳腺癌患者治疗前CD4+、CD4+/CD8+明显低于对照组(P<0.01),NK细胞明显低于对照组(P<0.05),新辅助化疗后,有效组总CD3+、CD4+、CD4+/CD8+、NK细胞较治疗前均显著升高(P<0.05),CD8+降低(P<0.05);无效组CD3+、CD4+/CD8+及NK细胞较治疗前显著降低(P<0.05),而CD8+升高(P<0.05)。结论:局部进展期乳腺癌患者免疫功能低下,有效的辅助化疗能提高患者的免疫功能,定期监测免疫功能对指导临床治疗有意义。

局部晚期乳腺癌新辅助化疗每周方案与三周方案疗效分析

目的探讨比较局部晚期乳腺癌采用剂量密集法和非剂量密集法行新辅助化疗的近期疗效。方法45例ⅢA期乳腺癌患者随机进入密集化疗组(A组)和非密集化疗组(B组)。A组:紫杉醇70mg/m2,表阿霉素30mg/m2,每周1次,连用3周,4周为1个周期。B组:紫杉醇135mg/m2,第1天,表阿霉素80mg/m2,第1天,3周为1个周期。如无疾病进展,共治疗3个周期。结果A组获CR7例(31.82%),PR12例(54.54%),SD3例(13.64%),pCR5例(22.73%),有效率(RR)为86.36%。B组获CR6例(26.09%),PR11例(50%),SD6例(26.09%),pCR3例(13.04%),RR为73.91%。A组的RR、CR、pCR均优于B组,但无统计学意义。进一步分层分析,不同基因型乳腺癌新辅助化疗的疗效相当,无论A组或B组,其IuminalB型、Basal-like型和HER-2阳性型三者之间新辅助化疗的RR、cCR、PR、pCR的差别无统计学意义。两组3～4级毒副反应发生率除中性粒细胞减少外均相近。两组随访期间全部存活,OS正在进一步随访中。结论紫杉类每周方案与标准的三周方案相比,可作用于不同增殖动力学的肿瘤细胞,剂量密度增加,更易于与其他化疗药物配伍,且每周方案较三周方案有更高的疗效,急性毒性无明显增加。