多西他赛联合表柔比星/比柔比星新辅助治疗乳腺癌临床分析

目的 评价多西他赛联合表柔比星(EPI)或比柔比星(THP)新辅助治疗乳腺癌的临床疗效和毒性反应,探讨影响化疗疗效的相关因素.方法 2006年3月至2008年4月,160例Ⅱ～Ⅲ期原发性乳腺癌患者在术前接受新辅助治疗,方案为多西他赛联合表柔比星或比柔比星的3周方案,术前化疗2～6个周期,观察近期疗效和毒副反应,分析相关因素与疗效的关系.结果 原发病灶临床有效率(RR)为90%(144/160),其中临床完全缓解(CR)为26%(41/160),临床部分缓解(PR)为64%(103/160),疾病稳定(SD)为8%(13/160),疾病进展(PD)为2%(3/160).术后病理完伞缓解(pCR)为7%(11/160),原发病灶完全缓解(tpCR)为2%(1.3/160).单因素分析结果 显示:临床疗效与肿瘤大小、临床分期、是否为三阴性乳腺癌,以及化疗周期有关.肿瘤体积小临床缓解率高,临床分期早肿瘤缓解率高,三阴性乳腺癌肿瘤缓解率高,化疗3周期的肿瘤缓解率明显高于2周期,而与年龄、组织学分级、ER/PR、Her-2等无明显关系.多因素分析显示,临床分期是影响乳腺癌近期疗效的主要因素.常见的毒性反应有:骨髓抑制、脱发、恶心呕吐、口腔溃疡.结论 多西他赛联合表柔比星或比柔比星新辅助治疗乳腺癌疗效较好,耐受性可以接受.临床分期是影响乳腺癌近期疗效的主要因素.

Effects of neoad juvant chemotherapy of docetaxel combined with and epirubicin or pirarubicin on breast cancer: clinical analysis of 160 cases

Objective To evaluate the effects and toxicity of the neoadjuvant chemotherapy of docetaxel combined with epirubicin or piranbicin on breast cancer, and to investigate the influencing factors of the response to neoadjuvant chemotherapy. Methods 160 patients with stage Ⅱ/Ⅲ breast cancer, all females, aged 47 (22-66), were treated with docetaxel plus epirubicin or piraubicin with 3 weeks as a cycle. Two to six cycles of treatment were given before surgery. The clinical efficacy and toxicity of the treatment were evaluated, and the correlation between the influencing factors and the clinical parameters with treatment response was analyzed. Results The clinical response rate (RR) was 90% (144/160), the complete response (CR) rate was 26% (41/160), the partial response (PR) rate was 64 % (103/160). The stable disease (SD) rate was 8 % (13/160). The progress disease (PD) rate was 2% (3/160), the pathologically complete remission (pCR) rate was 7% (11/160), and the tumor-pathologlcal complete response (tpCR) rate was 2% (1.3/160).Univariate analysis showed that the tumor size, clinical stage, triple negative phenotype might be the meaningful parameters influencing the clinical response. The patients with smaller tumor size, low stage tumor, and being triple-negative were more likely to achieve CR (P=0.0371, 0.0013, and O. 0019 respectively). Age, histological rading, ER/PR atio, Her-2 status did not significantly influence the early response. Multivariate analysis showed that the disease stage might be the meaningful factors for better response (P = 0. 0030 ). The major toxic reactions of the therapy included neutropenia,　alopecia, nausea, and vomiting. Conclusion The combination neoadjuvant chemotherapy with　ocetaxel and epirubicin or piraruhicin is an effective method to treat breast cancer with tolerable toxicity. The meaningful parameter influencing the early response is clinical stage.