新辅助化疗TE与CEF方案治疗乳腺癌的临床效果比较

目的比较新辅助化疗TE（紫杉类联合蒽环类）及CEF（环磷酰胺、表阿霉素、氟尿嘧啶）方案治疗乳腺癌的疗效，不良反应及其与组织病理学的关系；探讨新辅助化疗对ER、PR、HER-2、P53表达状况的影响。方法收集天津肿瘤医院2001年1月至2006年12月临床分期Ⅱ～Ⅲ期的行TE新辅助化疗患者167例，行CEF新辅助化疗患者256例。化疗皆以21d为1个周期。所有患者均完成3个周期以上的化疗后对两组患者临床效果的差异进行评价。结果乳腺癌原发肿瘤的总缓解率（RR），TE组为86％（144／167），CEF组为67％（172／256），两组间比较差异无统计学意义（P〈0．01）。临床完全缓解率（cCR），TE组为32％（54／167），CEF组为23％（59／256），两组间比较差异有统计学意义（P〈0．05）。病理完全缓解率（pCR），TE组为19％（32／167），CEF组为14％（36／256），两组间比较差异无统计学意义（P〉0．05）。两组各有2例患者出现疾病进展（PD）。主要不良反应为白细胞下降、胃肠道反应，TE组脱发较严重。两组化疗方案对ER、PR、HER-2、P53表达的差异均无统计学意义。结论新辅助化疗TE与CEF方案对乳腺癌均有较高的缓解率，且TE方案优于CEF方案。化疗的不良反应均在可耐受范围之内，而TE组患者的脱发等副反应要高于CEF组。两组新辅助化疗对ER、PR、HER-2、P53表达的影响无统计学意义。

Comparison of clinical effect of TE versus CEF regimens as neoadjuvant chemotherapy in the treatment of breast cancer

Objective To compare the efficacy and side effects of neoadjuvant chemotherapy with TE and CEF regimens in the treatment of breast cancer and their correlations with histological and pathological status, and to investigate the effect of the neoadjuvant chemotherapy on the expressions of ER, PR,HER-2 and P53 in breast cancer. Methods From January 2001 to December 2006, a total of 423 patients with clinical stage Ⅱ -Ⅲ breast cancer were admitted in Tianjin Cancer Hospital; among them 167 patients received neoadjuvant chemotherapy with TE regimen in one group, and 256 patients received neoadjuvant chemotherapy with CEF regimen in the other group. Patients in both groups received neoadjuvant chemotherapy at a interval of 21 days for at least 3 cycles. Clinical response and side effects were assessed in both groups. Results For primary breast carcinoma, the overall response rate （RR） was 86% （ 144/167 ） in TE arm and 67% （172/256） in CEF arm （P 〈0.01 ） ,and clinical complete response rate （cCR） was 32% （ 54/167 ） in TE arm and 23 % （ 59/256 ） in CEF arm （ P 〈 0.05 ）, and pathologic complete response rate （pCR） was 19% （32/167） in TE arm and 14% （36/256） in CEF arm （ P 〉 0.05 ）. There were two patients with progressing disease （PD） in each group. The major toxicities, including leucopenia and gastroenteric reactions were similar in both groups, but alopecia was more severe in TE arm. Neoadjuvant chemotherapy could not significantly change the expressions of ER, PR, HER-2 and P53. Conclusions TE and CEF regimens as neoadjuvant chemotherapy are both effective and safe for primary breast cancer. TE regimen is superior to CEF regimen in response rate, and side effects are all tolerable, but more alopecia occurred in TE arm. The effects of neoadjuvant chemotherapy on the expression of ER, PR, HER-2, and P53 are not obvious.