乳腺癌新辅助化疗后病理缓解的临床意义

目的 探讨乳腺癌新辅助化疗后肿瘤和腋淋巴结及结外软组织病理缓解的影响因素及与预后的关系.方法 选择2000年10月至2001年8月在天津肿瘤医院乳腺科接受新辅助化疗、化疗后手术的196例ⅡB～ⅢB期乳腺癌患者.观察肿瘤、腋淋巴结及结外软组织病理缓解的程度,分析影响病理缓解的因素,及病理缓解与预后的关系.随访率100%,中位随访期61个月(4～70个月).结果 新辅助化疗后肿瘤的病理完全缓解pCR20例(10.2%),病理部分缓解pPR108例(55.1%),病理无变化pSD68例(34.7%),27.0%的转移淋巴结降期.病理缓解率与患者年龄、临床分期无关(P＞0.05),与肿瘤大小、激素受体状况、病理类型相关(P＜0.01).5年总生存率62.8%(P＜0.01),中位生存期为61个月(P＜0.01).结论 病理缓解率与肿瘤大小、激素受体状况、病理类型相关.新辅助化疗后原发瘤和转移淋巴结的降期是重要的预后因素.

Clinical significance of pathological response in the breast cancer after neoadjuvant chemotherapy

OBJECTIVE Discuss the influential factor of pathologic response of tumor, axillary lymph nodes and extranodal soft tissue extension (ETE) in breast cancer after neoadjuvant chemotherapy and patients survival. METHODS: 196 patients with II B to approximately III B stage breast cancer, all female, aged 47 (26-65), were treated by neoadjuvant chemotherapy, including intravenous injection of docetaxel and epirubicin for 21 days, followed by surgery. Then follow-up was conducted for 61 months (4-70 months). The influential factor of pathological response and relation between pathologic response and survival were analyzed. RESULTS: The follow-up rate of the 196 patients was 100%. 20 patients (10.2%) achieved pathological complete response (pCR), 108 patients (55.1%) achieved pathological part response (pPR), and 68 patients (34.7%) achieved pathological stable disease pSD. There was no correlation between pCR and clinical staging, and age of patients (both P > 0.05). But there was a correlation between pCR and the size of tumor, estrogen receptor (ER), progesterone receptor (PR), and pathological type (all P < 0.01). 27.0% of the metastatic axillary lymph-nodes showed down-staging. The overall 5-year survival rate was 62.8% (P < 0.01). The median period of survival was 61 month (P < 0.01). CONCLUSION: pCR is correlated with the size of tumor, ER, PR, and pathological type. Down-staging of primary tumor and metastatic axillary lymph-node are important prognosis factors.