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1.

目的:探讨乳腺癌组织中DNA拓扑异构酶IIα(Topo IIα)和β微管蛋白III(TUBB3)的表达与蒽环类和紫杉类药物新辅助化疗疗效的关系。方法:选取64例女性原发性乳腺癌患者,随机接受蒽环类方案(20例),紫杉类方案(20例)或蒽环类联合紫杉类方案(24例)的新辅助化疗,3~4周期后评价疗效。用免疫组化的方法检测化疗前患者穿刺组织标本中癌细胞Topo IIα和TUBB3的表达。结果:蒽环类方案的化疗有效率为50.00%,紫杉类方案为35.00%,联合方案为70.83%,但3种方案间的疗效差异无统计学意义(P=0.128)。接受蒽环类方案的Topo IIα表达阳性患者疗效优于阴性患者(P=0.023),而紫杉类方案疗效与Topo IIα的表达情况无关(P=0.642);接受紫杉类方案的TUBB3阳性表达患者疗效较阴性者差,但差异未达统计学意义(P=0.057),Topo IIα和TUBB3共阳性表达患者对于蒽环类方案敏感,而在Topo IIα表达阳性和TUBB3表达阴性时,紫杉类方案的疗效较好(P=0.015);联合方案疗效与Topo IIα及TUBB3的表达情况均无关(P>0.05)。结论:Topo IIα表达阳性乳腺癌患者在使用蒽环类药物化疗时能获得更好的化疗疗效,故其可能成为制定乳腺癌个体化化疗方案的预测指标之一。TUBB3是否可以作为制定乳腺癌个体化化疗方案的预测指标尚需要更大样本量的研究来验证。

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2.
三阴性乳腺癌是一类特殊类型的乳腺癌,由于缺乏治疗靶点,化疗是目前主要的治疗方法。三阴性乳腺癌患者接受新辅助治疗并获得病理完全缓解,则预后明显改善。目前三阴性乳腺癌新辅助治疗方案仍以蒽环类药物和紫杉类药物化疗为主,但随着对三阴性乳腺癌分子本质认识的深入,新辅助治疗方案不断地获得探索和优化,包括铂类药物的优化,免疫检查点抑制剂、多聚二磷酸腺苷核糖聚合酶抑制剂的使用,均获得较好效果。  相似文献   

3.
新辅助化疗诱导的粒细胞减少症对乳腺癌预后的影响   总被引:1,自引:0,他引:1  
目的 探讨新辅助化疗诱导的粒细胞减少症与采用蒽环类联合紫杉类新辅助化疗方案进行新辅助化疗患者的疗效及远期生存率之间的关系.方法 对接受4个周期蒽环类联合紫杉类新辅助化疗方案治疗的211例乳腺癌患者的资料进行回顾性分析.结果 211例中51(24.2%)例为嗜中性粒减少症患者,160(75.8%)例为非嗜中性粒细胞减少症患者.嗜中性粒细胞减少症患者组的新辅助化疗反应较非嗜中性粒细胞减少症组患者为好(P<0.05).嗜中性粒细胞减少症患者5年无病生存率为82.4%,5年总生存率为90.2%,而非嗜中性粒细胞减少症患者的5年无病生存率为60%,5年总生存率为67.5%,两者相比差异均有统计学意义(均P<0.01).结论 蒽环类联合紫杉类新辅助化疗方案诱导的嗜中性粒细胞减少症与可手术乳腺癌患者的预后有良好的相关性,可用来评估肿瘤对此类化疗药物的敏感性,并为个体化的治疗方案提供依据.  相似文献   

4.
目的研究蒽环类联合紫杉类方案对三阴型乳腺癌进行新辅助化疗的疗效,应用动态增强磁共振成像(MRI)及组织病理学进行疗效评价。方法选择2008年1月至2011年12月北京大学第一医院乳腺疾病中心初始实施蒽环类联合紫杉类新辅助化疗并完成手术的三阴型乳腺癌病人为研究对象。疗效评价包括动态增强MRI临床评价及组织病理学评价。定义MRI评价包括临床完全缓解、临床部分缓解为临床评价有效,计算临床有效率;定义病理分级G3~G5为病理评价有效,计算病理有效率。结果共诊治1190例新发乳腺癌,其中三阴型乳腺癌129例(占10.8%),41例符合入组标准,新辅助治疗临床评价有效率为65.85%(27/41),病理评价有效率为85.37%(35/41),其中病理完全缓解率(pCR)为36.59%(15/41),新辅助治疗MRI评价与病理评价符合率为77.1%。结论蒽环类联合紫衫类方案是治疗三阴型乳腺癌的有效方法。动态增强MRI能准确评价三阴型乳腺癌新辅助化疗疗效,并与病理评价相符合。  相似文献   

5.
目的 探讨乳腺癌原发病灶肿瘤组织Ki67表达与葸环类联合紫杉类新辅助化疗疗效之间的相关性.方法 2008年1月至2009年6月共129例乳腺癌患者接受蒽环类联合紫杉类新辅助化疗,采用免疫组化方法前瞻性检测乳腺原发病灶粗针病理切片Ki67的表达水平,采用实体肿瘤疗效评价标准(RECIST 2000)及Miller-Payne病理学分级标准分别对新辅助化疗疗效进行MRI及病理学评价,并在此基础上进行临床疗效综合评价;探讨Ki67不同表达水平与疗效之间的相关性.结果 129例患者行新辅助化疗后经MRI评价87例(67.4%)有效,经组织病理学评价99例(76.7%)有效,经临床疗效综合评价110例有效(85.5%).Ki67表达≤10%组上述三种疗效评价方法的有效率分别为50.0%、62.5%及71.9%;Ki67表达>10%组则分别为73.2%、81.4%及89.7%;两组比较差异均有统计学意义(P值分别为0.020、0.030、0.010).经统计检验,Ki67的表达水平与临床综合疗效呈线性相关.结论 Ki67高表达的乳腺癌患者行蒽环类联合紫杉类新辅助化疗效果更好.  相似文献   

6.
目的探讨Her-2阴性乳腺癌中激素受体、Ki-67、P53的表达与蒽环类新辅助化疗疗效的关系。方法应用免疫组化法测定78例Her-2阴性乳腺浸润性导管癌蒽环类新辅助化疗前ER、PR、Ki-67、P53的表达。四个周期CEF或AC方案化疗后进行临床及病理疗效评价。结果激素受体双阳或单阳组与激素受体双阴组相比,临床总有效率及术后病理有效率有显著性差异(P0.05);Ki-67阳性组与Ki-67阴性组相比,临床总有效率无显著性差异(P0.05),术后病理有效率有显著性差异(P0.05);P53阳性组与P53阴性组相比,临床总有效率及术后病理有效率均未见显著性差异(P10.05)。结论激素受体阴性、Ki-67阳性对Her-2阴性乳腺癌患者蒽环类新辅助化疗的敏感性较高,激素受体状态、Ki-67可能成为判断Her-2阴性乳腺癌蒽环类新辅助化疗疗效的重要指标。  相似文献   

7.
目的:探讨两种不同的化疗方案对蒽环和紫杉类药物治疗后复发的三阴性乳腺癌(TNBC)患者的效果。方法:选取河北中石油中心医院收治的60例蒽环和紫杉类药物治疗后复发的TNBC患者,采用前瞻性研究方式,应用随机数字表将其分为GP组(吉西他滨联合顺铂)和NP组(长春瑞滨联合顺铂)各30例。比较两组的疗效、预后及血清miR-21、miR-200a、miR-200b水平。结果:治疗后,两组患者的血清miR-21、miR-200a水平较本组治疗前均显著降低(P<0.05),两组患者的血清miR-200b水平较本组治疗前均显著升高(P<0.05);NP组患者在化疗过程中的白细胞降低、血红蛋白降低程度较GP组更严重,差异有统计学意义(P<0.05);GP组患者的肿瘤无进展生存中位时间为34.0个月,长于NP组的28.0个月(P<0.05)。结论:吉西他滨联合顺铂与长春瑞滨联合顺铂方案治疗对蒽环和紫杉类药物耐药复发的TNBC患者效果差异不大,但吉西他滨联合顺铂方案的毒副反应较少,可有效延长患者的肿瘤无进展生存时间。  相似文献   

8.
目的探讨乳腺癌新辅助化疗疗效及ER/PR,HER2,Ki67,CyclinA2的疗效预测价值。方法 2004年10月~2009年12月50例Ⅰ~Ⅲ期原发性乳腺癌,采用含紫杉类(TP/TC或TE/PE/TEC方案)或蒽环类(EC/FEC方案)联合方案,术前化疗2~6周期,45例接受手术,术后完成规定化疗,应用B超结合触诊判断临床疗效。结果化疗前后肿瘤中位最大径分别为3.6 cm和2.2 cm,有统计学差异(Z=-5.723,P=0.000)。临床疗效:CR 3例(6%),PR 35例(70%),SD 11例(22%),PD 1例(2%),临床RR 76.0%(38/50)。45例接受手术,术后3例pCR(3/45,6.7%),3例tpCR(3/45,6.7%)。4年无病生存期(DFS)为86.2%,4年总生存率为93.1%,中位DFS 62.4月[SE:2.535,95%CI(57.450~67.388)]。不同情况下肿瘤缩小比例并无统计学差异,包括月经状态(绝经前vs.绝经后,46.4%vs.40.6%,P=0.536)、激素受体状况(阳性vs.阴性,43.0%vs.42.2%,P=0.929)、HER2(阳性vs.阴性,41.3%vs.43.9%,P=0.774)、Ki67(阳性vs.阴性,47.2%vs.43.1%,P=0.363)、CyclinA2(阳性vs.阴性,34.3%vs.50.0%,P=0.375)、分化程度(高分化vs.中分化vs.低分化,44.1%vs.42.9%vs.41.3%,P=0.983)以及不同化疗方案(TP/TC vs.TE/PE/TEC vs.EC/FEC,52.7%vs.39.8%vs.38.9%,P=0.440)。结论紫杉类及蒽环类药物联合方案用于浸润性乳腺癌的术前化疗,可有效控制肿瘤。ER/PR,HER2,Ki67,CyclinA2的状态与肿瘤缩小比例之间并无统计学意义的关联性。  相似文献   

9.

目的:探讨三阴性乳腺癌(TNBC)新辅助化疗的疗效。 方法:回顾性分析2009年1月―2013年1月收治的63例I~III期TNBC患者临床资料,其中31例术前行新辅助化疗(新辅助化疗组),32例行直接手术后辅助化疗(术后辅助化疗组),新辅助化疗与术后的辅助化疗均采用蒽环类为主序贯紫杉类方案。分析新辅助化疗组患者术前获益情况,并比较两组患者术后复发转移与生存率情况。 结果:新辅助化疗组31例患者术前总获益率为100%,其中完全缓解达61.29%(19/31);3年内发生局部复发和远处转移者新辅助化疗组13例(41.94%),术后辅助化疗组22例(68.75%),两组差异有统计学意义(χ2=4.585,P<0.05)。新辅助化疗组和术后辅助化疗组的3年无病生存率分别为48.38%、25.00%;5年总生存率分别为38.71%、9.78%,新辅助化疗组两者均明显优于术后辅助化疗组(χ2=4.870,P=0.027;χ2=7.469,P=0.006)。 结论:蒽环类为主序贯紫杉类方案的新辅助化疗能使TNBC患者明显获益,且远期疗效优于术后辅助化疗。

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10.
摘   要 背景与目的:剂量密集型的新辅助化疗在局部晚期乳腺癌中使用越来越广泛。但在剂量密集型的新辅助化疗方案中,使用紫杉醇脂质体的研究较少。本研究探讨剂量密集型蒽环序贯紫杉醇脂质体对比蒽环序贯多西紫杉醇在局部晚期HER-2阴性乳腺癌新辅助化疗中的安全性和疗效。 方法:回顾性分析2017年1月—2018年12月可手术的局部晚期HER-2阴性的女性乳腺癌患者资料。该研究人群均行8周期新辅助化疗,其中196例采用蒽环序贯多西紫杉醇方案(多西紫杉醇组),48例采用剂量密集型蒽环序贯紫杉醇脂质体方案(紫杉醇脂质体组)。采用倾向性评分匹配(PSM)方法,按照1:1匹配两组基线特征差异后,比较两组患者病理完全缓解(pCR)与临床疗效情况以及不良事件发生率。 结果:通过1:1 PSM匹配后,两组各48例患者。两组间pCR率无统计学意义(22.9% vs. 18.8%,P>0.05);多西紫杉醇组客观缓解率(ORR)93.7%、疾病控制率(DCR)100.0%,紫杉醇脂质体组ORR与DCR均为100.0%,组间差异无统计学意义(P>0.05)。多西紫杉醇组III~IV度白细胞及中性粒细胞减少症的发生率以及III~IV度恶心、呕吐、乏力和口腔黏膜炎发生率均高于紫杉醇脂质体化疗组(均P<0.05),两组其他毒副反应的发生率比较,均无统计学意义(均P>0.05)。 结论:在局部晚期HER-2阴性乳腺癌新辅助化疗中,蒽环序贯多西紫杉醇与剂量密集型蒽环序贯紫杉醇脂质体的疗效相当。紫杉醇脂质体化疗组毒副反应明显优于多西紫杉醇化疗组。紫杉醇脂质体可作为HER-2阴性乳腺癌新辅助化疗方案中紫杉醇类药物的优选。  相似文献   

11.
BackgroundPatients with triple-negative primary breast cancer (TNBC) who have residual invasive carcinoma after neoadjuvant chemotherapy have poor prognosis. Proven adjuvant approaches to reduce the risk of recurrence and improve outcome in patients with non-pathological complete response (non-pCR) are limited.MethodsFrom our institutional registry, a consecutive case series of patients with operable, unilateral, primary invasive noninflammatory early TNBC of stage I-IIIB and pathologically verified residual cancer cells (no pathological complete response) after neoadjuvant chemotherapy underwent adjuvant treatment with gemcitabine plus cisplatin combined with regional hyperthermia. For quality assurance, we analyzed feasibility, efficacy, and toxicity of all treated patients. Outcome was evaluated for the entire group of patients as well as for the subgroups of patients with or without lymph node involvement at baseline (cN0/ cN+).ResultsFrom August 2012 to January 2019, we offered this treatment to 53 patients at our center as part of routine care. The median follow-up was 38 months. The majority of patients (64.2%) had cT2 tumors at baseline. Twenty-four patients (45%) were clinically node positive as evaluated by sonography. Thirty-nine patients (74%) had grade 3, and 14 patients (26%) had grade 2 tumors. Forty-one patients (76%) showed a regression grade 1 according to Sinn. Patients received a median of six treatment cycles of gemcitabine and cisplatin (range 1–6) combined with 12 applications of regional hyperthermia (median 12, range 2–12). Disease-free survival (DFS) at 3 years was 57.5%. In patients with no lymph node involvement at baseline (cN0), DFS at 3 years was significantly higher than in initially node-positive (cN+) patients (80 vs. 31%; p = 0.001). Overall survival (OS) at 3 years was 81.6%. In patients with no lymph node involvement at baseline (cN0), OS at 3 years was significantly higher than in node-positive (cN+) patients (93 vs. 70.4%; p = 0.02). Overall, grade 3/4 toxicities were leukopenia (38%), thrombocytopenia (4%), and anemia (4%).ConclusionAfter standard neoadjuvant chemotherapy containing anthracycline plus cyclophosphamide followed by taxanes, addition of adjuvant gemcitabine plus cisplatin in combination with regional hyperthermia was safe and effective in TNBC patients with non-pCR.  相似文献   

12.
Adjuvant chemotherapy for breast cancer   总被引:2,自引:0,他引:2  
BACKGROUND: Over the past three decades significant advances have been made in the adjuvant treatment of breast cancer. Despite and increasing incidence of breast cancer, mortality has undergone a gradual decline. This decline in mortality is likely due to numerous factors, including earlier stage at diagnosis, advances in local therapy, and advances in systemic treatment of breast cancer. This article review the background and implementation of the current use of chemotherapy in adjuvant setting. METHODS: The authors reviewed data from published randomized trials and meta-analyzes to analyze the rationale behind the current use of systemic chemotherapy in the adjuvant setting. Recent data regarding the use of taxanes as well as neoadjuvant chemotherapy in also presented. CONCLUSION: Numerous randomized trial and the data obtained from the Early Breast Cancer Trialists' Collaborative Group confirm that both pre- and postmenopausal woman benefit from adjuvant chemotherapy. Anthracycline- containing regimens are superior to those hot containing anthracycline, and should be incorporated into the care of most patients with operable breast cancer. The decision to use chemotherapy should be based upon the potential benefits and theoretical risks associated with therapy and individualized for each patient.  相似文献   

13.
Abstract: Neo‐adjuvant chemotherapy is used for locally advanced breast cancer patients with significant variation in tumor response. Our objective is to determine the clinicopathologic effect of neo‐adjuvant chemotherapy on invasive lobular carcinoma. A review of a single‐institution data base of women diagnosed with breast cancer identified 30 patients from 1999 to 2009 with operable invasive lobular carcinoma who received neo‐adjuvant chemotherapy. Patient demographics and clinicopathologic data were reviewed. Cases were reviewed by a single pathologist (NNE). Residual cancer burden class was determined for each case. Median patient age was 50 years (range 25–79). All tumors were hormone receptor positive and clinical stage II or III carcinomas. Most patients (53.3%) had combination anthracycline‐ and taxane‐based chemotherapy. Therapy‐related changes were noted within the tumor bed in 25 (83.3%) patients. Six (30%) of 20 patients with residual axillary disease had therapy‐related nodal changes. There were 11 patients with moderate residual disease (class II) and 18 (60%) with extensive (class III); there were no complete pathologic responses (class 0). Only one patient (3.3%) converted from mastectomy to breast‐conserving surgery. Four (13.3%) patients developed distant metastases; all had pleomorphic‐type, clinical stage III tumors with residual cancer burden III classification and developed distant disease in the 2 years after surgery (range 0–26 months). Median follow‐up time was 29.5 months (range 7–132). Patients with locally advanced pleomorphic‐type lobular carcinoma appear to develop early post‐treatment metastatic disease. Neo‐adjuvant chemotherapy did not appear to have significant impact on the surgical treatment of patients with invasive lobular carcinoma.  相似文献   

14.
Q X Han 《中华外科杂志》1992,30(5):287-9, 317
From Jan. 1978 to Dec. 1987, 221 patients of stage III breast cancer were treated by surgery combined with adjuvant chemotherapy and/or radiation therapy. The overall 5-year survival rate was 50.4%. The 5-year survival rate in patients with negative lymph node was 72.3% as compared with 37.5% in patients with more than 7 lymph nodes involved (P < 0.05). In patients who received postoperative adjuvant chemotherapy, the 5-year survival rate in premenopausal or postmenopausal group was 62.1% and 41.4% respectively (P < 0.05). The regional lymph node recurrence rate was 4.0% in patients who received postoperative radiotherapy as opposed to 9.6% for those without radiotherapy postoperatively. The distant metastasis rate was 19.1% in lymph node negative group as compared with 45.9% in patients with more than 7 lymph nodes involved (P < 0.05). To decrease the distant metastasis will improve the survival rate in the treatment of breast cancer. We believe that preoperative chemotherapy combined with radical surgery and postoperative adjuvant therapy may improve the survival rate in stage III breast cancer.  相似文献   

15.
目的:探讨我科12例局部晚期伴有皮肤侵犯导致溃疡形成的乳腺癌患者,术前行新辅助化疗后行改良根治术,即刻应用背阔肌肌皮瓣即时修复组织缺损的疗效观察。方法:12例患者均于术前行4~6周期新辅助化疗TEC方案,后达到临床部分缓解(PR)、创面缩小后,行乳腺癌改良根治术、即刻背阔肌肌皮瓣转移修复胸壁组织缺损。结果:12例患者手术均成功,接受新辅助化疗和术后放疗。随访l0~24个月,术后远处转移l例,无局部复发和死亡病例。结论:局部晚期乳腺癌新辅助化疗后,应用背阔肌肌皮瓣转移至胸壁修复组织缺损切实可行。  相似文献   

16.
目的 探讨三阴性乳腺癌与HER-2过表达乳腺癌患者的l临床病理特征及预后.方法 回顾1997年1月至2007年1月行手术治疗的725例原发性乳腺癌的临床资料,根据免疫组化染色结果确定三阴性和HER-2过表达乳腺癌表型,并对2组的临床病理学资料进行比较和生存分析.结果 三阴性和HER-2过表达乳腺癌分别占12.29%及24.96%;三阴性乳腺癌有恶性肿瘤家族史者占18.4%,明显高于HER-2过表达组的5.5%(P=0.001);组织学分级3级者占54.0%,也高于HER-2过表达组42.0%(P=0.01);三阴性乳腺癌(74.7%)较HER-2过表达乳腺癌(64.6%)更易发生淋巴结转移(P=0.045);在2年内复发、转移及脑转移(分别为25.3%及8.0%)明显高于HER-2过表达乳腺癌(分别为8.8%和2.2%)(P<0.05),其5年无病生存率(55.6%)明显低于HER-2过表达乳腺癌(69.8%)(P=0.041).2组在年龄、月经状态、肿瘤大小、病理分期、手术方式、病理类型、辅助放化疗、肝肺骨转移比例和总生存率之间差异均无统计学意义(P>0.05).结论 与HER-2过表达乳腺癌相比,三阴性乳腺癌更多有恶性肿瘤家族史,肿瘤恶性度更高,更易发生淋巴结和脑转移,无病生存期更短,预后差.  相似文献   

17.
There is little information available on the patterns of chemotherapy regimens administered in daily practice to patients with early stage and metastatic or recurrent breast cancer. To determine the trends in type of chemotherapy regimens used in breast cancer patients, newly diagnosed breast cancer patients in the period 2000–2008 who received chemotherapy were identified from the Eindhoven Cancer Registry (ECR) and linked to the PHARMO RLS, including data on, e.g., in‐ and outpatient drug use. Chemotherapy regimens were classified based on the received combinations and sequences. Trends in the distribution of adjuvant chemotherapy regimens (for early‐stage breast cancer) and palliative chemotherapy regimens (for metastatic or recurrent breast cancer) were determined and stratified by Her2/neu status when possible. In this study, 422 patients diagnosed with early‐stage breast cancer received adjuvant chemotherapy. The use of CMF (cyclophosphamide, methotrexate, and 5‐fluorouracil) decreased from 90% in 2000 to almost none since 2005. Administration of regimens that included anthracyclines increased from 4% in 2000 to 96% in 2005, but decreased to 68% in 2008. The use of trastuzumab‐ and taxane‐containing regimens (with or without anthracyclines) increased from 2005 onwards to 24% and 34%, respectively, in 2008. Among the 82 breast cancer patients who received palliative chemotherapy at diagnosis or after breast cancer recurrence, the use of CMF and anthracyclines (without taxanes) decreased, while the use of taxanes (with or without anthracyclines) increased (26% in 2008). Trastuzumab was used as palliative chemotherapy from 2003 onwards, with 22% of the metastatic breast cancer patients receiving trastuzumab‐containing regimens in 2008, and bevacizumab was administered since 2007 with 19% of the patients receiving bevacizumab‐containing regimens in 2008. In conclusion, major changes have taken place in the chemotherapeutic treatment of patients with early and recurrent breast cancer. These changes reflect the key findings from large clinical trials, as incorporated in the Dutch guidelines.  相似文献   

18.
SUMMARY: Background: Docetaxel and paclitaxel are among the most active substances for the treatment of breast cancer. As both drugs are used today in adjuvant regimens, efficacy data from pivotal trials in the metastatic setting in taxane-naive populations cannot reliably be used as references. Patients and Methods: The Taxane Re-Challenge Cohort Study identified participants from 6 prospective (neo-)adjuvant taxane-based studies with recurrent disease and collected data on their subsequent treatment. Out of 381 recurrent patients, 106 (27.8%) were re-challenged with a taxane-based treatment as first- or later-line therapy for recurrent disease. Results: Taxanes were used as first-line therapy in 74 patients and showed a response rate of 48.6% (including complete responses in 27.0%). The response rate was dependent on the disease-free interval (<1 year: 34.8%; 1-2 years: 42.9%; >2 years: 63.3%; p = 0.04) and visceral metastasis (present: 62.5%; not present 32.4%; p = 0.01). Patients without visceral metastasis and with a disease-free interval of >2 years achieved the longest overall survival. Hormone and HER2 receptor status were not predictive; however, triple-negative tumors responded in 50.0%. The overall response rate of later-line taxane-based treatment was 28.2%. Conclusion: Re-challenging taxanes appears to be effective and therefore represents a reasonable option in this population.  相似文献   

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