Challenging Dogma: Radical Conservation Surgery for Early Stage Cervical Cancer in Order to Retain Fertility

INTRODUCTION

Cervical cancer is the second commonest cancer to affect women with over half a million cases world-wide yearly. Screening programmes have reduced the incidence and death rate dramatically in Western societies. At the same time, professional and social pressures may delay child bearing such that a significant number of women will present with early stage disease, but be anxious to retain their fertility potential. Standard treatment by radical hysterectomy or radiotherapy has good results, but inevitably renders the women infertile. The rationale for extensive surgery resecting parametrium or destructive radiotherapy treating the whole pelvis in all cases of cervical cancer has been questioned.

PATIENTS AND METHODS

Lessons learnt from the less radical surgical approach to breast cancer can be applied to cervical cancer whilst still observing Halstead''s principles of surgical oncology. Wide, local excision of early stage small tumours by radical vaginal trachelectomy combined with a laparoscopic pelvic lymphadenectomy utilises modern technology with traditional surgery. Radical vaginal trachelectomy comprises the distal half of a radical abdominal (Wertheim''s) or vaginal (Schauta''s) hysterectomy. An isthmic–vaginal anastomosis restores continuity of the lower genital tract after insertion of a cerclage that is necessary to maintain competence during future pregnancies.

RESULTS

A total of 142 cases were performed between 1994 and 2006, most (98%) in women with Stage 1B carcinoma of the cervix with a mean follow-up of 57 months. Twelve (9%) had completion treatment, 11 with chemo/radiotherapy and one radical hysterectomy. There were four recurrences (3%) among the women who did not have completion treatment, and two (18%) in those that did. There were 72 pregnancies in 43 women and 33 live births in 24 women. The 5-year accumulative pregnancy rate among women trying to conceive was 53%. Delivery was by classical caesarean section in a high-risk feto-maternal units with 8 babies (25%) born before 32 weeks.

CONCLUSIONS

Radical vaginal trachelectomy appears safe when performed in centres with appropriate experience of radical vaginal surgery and laparoscopic techniques. The impact of this new approach questions traditional teaching whilst preserving potential fertility in hitherto impossible circumstances.     

The Effect of Neoadjuvant Chemotherapy on Perioperative Outcomes in Patients Who Have Bladder Cancer Treated with Radical Cystectomy: A Population-based Study

Background

Although therapeutic guidelines recommend the use of neoadjuvant chemotherapy before radical cystectomy (RC) in patients who have muscle-invasive bladder cancer (MIBC), this approach remains largely underused. One of the main reasons for this phenomenon might reside in concerns regarding the risk of morbidity and mortality associated with neoadjuvant chemotherapy.

Objective

To compare perioperative outcomes between patients receiving neoadjuvant chemotherapy and those treated with RC alone.

Design, setting, and participants

Relying on the Surveillance Epidemiology and End Results–Medicare-linked database, 3760 patients diagnosed with MIBC between 2000 and 2009 were evaluated.

Intervention

RC alone or RC plus neoadjuvant chemotherapy.

Outcome measurements and statistical analysis

Complications occurred within 30 and 90 d after surgery. Heterologous blood transfusions (HBTs), length of stay (LoS), readmission, and perioperative mortality were compared. To decrease the effect of unmeasured confounders associated with treatment selection, propensity score–matched analyses were performed.

Results and limitations

Overall, 416 (11.1%) of patients received neoadjuvant chemotherapy. Following propensity score matching, 416 (20%) and 1664 (80%) patients treated with RC plus neoadjuvant chemotherapy and RC alone remained, respectively. The 30-d complication, readmission, and mortality rates were 66.0%, 32.2%, and 5.3%, respectively. The 90-d complication, readmission, and mortality rates were 72.5%, 46.6%, and 8.2%, respectively. When patients were stratified according to neoadjuvant chemotherapy status, no significant differences were observed in the rates of complications, HBT, prolonged LoS, readmission, and mortality between the two groups (all p ≥ 0.1). These results were confirmed in multivariate analyses, where the use of neoadjuvant chemotherapy was not associated with higher risk of 30- and 90-d complications, HBT, prolonged LoS, readmission, and mortality (all p ≥ 0.1). Our study is limited by its retrospective nature.

Conclusions

The use of neoadjuvant chemotherapy is not associated with higher perioperative morbidity or mortality. These results should encourage wider use of neoadjuvant chemotherapy when clinically indicated.

Patient summary

Chemotherapy before radical cystectomy in patients with muscle-invasive bladder cancer does not increase the risk of complications or death. The use of chemotherapy should be strongly encouraged, as recommended by clinical guidelines, given its benefits.     

Neoadjuvant Chemotherapy With P-ELF (Cisplatin, Etoposide, Leucovorin, 5-Fluorouracil) Followed by Radical Resection in Patients With Initially Unresectable Gastric Adenocarcinoma: A Phase II Study

Background: Gastric cancer is the most frequent gastrointestinal cancer in Mexico. Only 33% of cases are resectable. Our aim was to determine the activity and toxicity of the cisplatin, etoposide, leucovorin, and 5-fluorouracil combination in initially unresectable tumors and to determine its ability to permit resection.Methods: Sixty patients with unresectable gastric adenocarcinoma were treated with cisplatin 80 mg/m2, etoposide 80 mg/m2, leucovorin 25 mg/m2, and 5-fluorouracil 800 mg/m2 by central intravenous catheter for 4 consecutive days. Two courses of this combination were followed by surgical resection.Results: The overall response rate was 36.8% (20 partial responses and one complete response). By using logistic regression analysis, the tumor, node, and metastasis stage (risk ratio, 2.04; 95% confidence interval, 1.03–4.02; P 5.039) was identified as the response determinant to chemotherapy. Major toxicity was grade 3 or 4 neutropenia in 67% of patients. Ten resections were performed (17.5%); five were curative and five palliative. Operative morbidity and mortality rates were 40% and 10%, respectively. The median length of survival was 7.46 and 13.3 months for nonresponders and responders, respectively (P 5.011).Conclusions: The cisplatin, etoposide, leucovorin, and 5-fluorouracil combination is active in advanced gastric cancer and the toxicity level is acceptable. This treatment permits a 17.5% resection rate in previously unresectable tumors. A randomized trial of surgery vs. neoadjuvant chemotherapy plus surgery is warranted.     

乳腺癌新辅助化疗的研究进展

目的探讨乳腺癌新辅助化疗的研究进展。方法从乳腺癌新辅助化疗的理论基础、临床意义、适用范围、常用药物及方案、疗效预测因子及其与保乳手术、前哨淋巴结活检的关系等方面总结乳腺癌新辅助化疗的研究进展。结果新辅助化疗可降低临床分期,增加保乳手术机会,了解化疗药物敏感性,防止远处转移,但对前哨淋巴结活检的影响存在争议。结论新辅助化疗是乳腺癌全身治疗重要的部分,但在如何选择高效的化疗药物、制订个体化方案、预测治疗效果等方面仍需进一步研究。     

新辅助介入化疗联合微创手术治疗浸润性膀胱癌

目的 探讨新辅助介入化疗联合腔内手术治疗浸润性膀胱癌的临床效果.方法 对31例确诊为肌层浸润性膀胱癌（T2~4/G1~3）的患者行新辅助性介入化疗,先经股动脉入髂内动脉,尽可能到达供应肿瘤血管,给予丝裂霉素10 mg,吉西他宾1.0/m2,顺铂90 mg,明胶海绵暂时性封堵后拔管,1周后行经尿道膀胱肿瘤汽化电切术,术后即刻用丝裂霉素200 mg或吡柔比星40 mg膀胱灌注.结果 21例治疗1次,7例治疗2次（间隔1个月）,3例治疗3次（间隔1~2个月）.31例随访4个月~4年,平均36个月,2例术后6、10个月复发,再次重复治疗,1例因盆腔转移治疗2次后拒绝治疗,半年后死于肺转移,其余未见肿瘤复发.结论 对于局限浸润性膀胱癌的患者,采用新辅助性经髂内动脉插管介入化疗联合腔内手术治疗疗效满意.     

进展期胃癌新辅助化疗的研究进展

目的总结进展期胃癌新辅助化疗的研究进展。方法采用文献复习的方法,对有关进展期胃癌新辅助化疗研究进展的文献进行综述。结果进展期胃癌的新辅助化疗可显著提高R0切除率,提高远期生存率,降低死亡风险。对于无远处转移的局部进展期胃癌的新辅助化疗时间一般为6~9周,然后根据疗效评价结果决定是否进行手术治疗;进一步深入的临床研究及化疗敏感程度检测方法的改进有助于新辅助化疗标准的统一。结论进展期胃癌新辅助化疗的疗效已比较明确,但其在适应证、化疗方案、用药时限、疗效评价指标等方面尚无明确的统一标准,仍需要多中心、大型的临床试验进行深入的研究。     

乳腺癌新辅助化疗后局部区域外科处理进展

目的探讨乳腺癌新辅助化疗后对局部区域的外科处理策略。方法对近年来有关乳腺癌新辅助化疗降期后保乳治疗、同侧乳房复发的相关因素、原发肿瘤病理退缩模式以及前哨淋巴结活检等局部区域的外科处理的相关文献进行综述。结果①新辅助化疗可使乳腺原发肿瘤降期,提高保乳手术的比率,但通过新辅助化疗降期后保乳手术患者可能存在较高的同侧乳腺肿瘤复发风险。目前比较趋于一致的影响新辅助化疗降期后保乳治疗的同侧乳腺肿瘤复发率的相关因素为残余肿瘤呈多中心模式、残余肿瘤直径〉2cm。新辅助化疗后原发肿瘤病理退缩模式及相关因素尚不明确。②新辅助化疗前、后前哨淋巴结活检（SLNB）均是可行的并获得指南与专家共识的认可,初始腋窝淋巴结阴性患者更能从新辅助化疗后SLNB中获益,初始腋窝淋巴结阳性患者新辅助化疗转阴性后行SLNB替代ALND的前景可期,但需要获得临床认可的成功率和假阴性率及与ALND相似的局部区域复发率及总生存率。结论无论乳腺癌新辅助化疗的临床和影像学疗效如何,外科处理仍然是目前降低局部区域复发风险的重要治疗手段。分子分型时代,我们可以依据乳腺癌初始分期及新辅助化疗的疗效对乳腺癌患者施行个体化的局部区域外科处理     

FLEEOX新辅助化疗对进展期胃癌患者营养状况的影响

目的 研究FLEEOX新辅助化疗方案对进展期胃癌患者营养状况的影响.方法 根据纳入和排除标准,共选择2010年12月至2011年10月期间我科收治的难以手术切除并进行了新辅助化疗的48例胃癌患者,利用机体组成分析仪测定化疗前、后机体组成成分的变化,同时检测血液相关营养学指标.结果 患者化疗后,体重、细胞内液、体重指数、蛋白质、体脂肪、体细胞群及上臂周长均较化疗前表现为略下降,而细胞外液、身体水分含量、无机盐、骨骼矿物质含量、非脂群、骨骼肌及上臂无脂肪周长较化疗前均表现为略轻度上升,但各项指标差异均无统计学意义(P＞0.05);血液中白蛋白、前白蛋白、总蛋白、转铁蛋白及淋巴细胞均较化疗前出现不同程度下降,但差异均无统计学意义(P＞0.05).结论 进展期胃癌患者接受化疗期间营养状况无明显变化,FLEEOX新辅助化疗未加重患者营养不良的状况.     

Outcomes in Patients with Muscle-invasive Bladder Cancer Treated with Neoadjuvant Chemotherapy Followed by (Chemo)radiotherapy in the BC2001 Trial

BackgroundBC2001 demonstrated improved local control with the addition of chemotherapy to radiotherapy in 360 patients with muscle-invasive bladder cancer.ObjectiveTo establish whether such benefit remained in BC2001 patients who received prior neoadjuvant chemotherapy.Design, setting, and participantsA total of 117 patients (33%) received neoadjuvant chemotherapy and were randomised to radiotherapy with (48%) or without (52%) concomitant chemotherapy. Patients were recruited between August 2001 and April 2008 from 28 UK centres.InterventionPlatinum-based neoadjuvant chemotherapy, followed by radiotherapy with (cRT) or without (RT) synchronous 5-fluorouracil and mitomycin-C.Outcome measurements and statistical analysisToxicity, locoregional control (LRC), overall survival (OS), and quality of life (QoL) were measured.Results and limitationsOf the patients, 74% received gemcitabine plus cisplatin or carboplatin. Compliance rates with full-dose radiotherapy were cRT 93% and RT 92%. An excess of grade ≥3 toxicities while on (chemo)radiation occurred for cRT 33% versus RT 22%, although nonstatistically significant (p = 0.16). With 110 mo median follow-up for survival (interquartile range 96–123), cRT showed improved LRC though not statistically significant (adjusted hazard ratio [aHR] = 0.64, 95% confidence interval [CI] 0.33–1.23, p = 0.18). No differences in OS (aHR = 0.95, 95% CI 0.57–1.57, p = 0.8) were observed. No significant detriment in QoL was observed between cRT and RT in this subgroup of patients.ConclusionsNeoadjuvant chemotherapy does not compromise the delivery of radical curative treatment. Although underpowered due to a small sample size, the benefit of chemoradiotherapy to improve local control in this group of patients receiving neoadjuvant chemotherapy is consistent with that observed in the main trial. Although a nonsignificant excess of toxicity was observed, there was no evidence of impaired QoL.Patient summaryChemotherapy before radical chemo(radiotherapy) is feasible and well tolerated.     

Outcome of Patients Who Refuse Cystectomy after Receiving Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer

Objectives

To determine the outcome of patients who refuse cystectomy after receiving neoadjuvant chemotherapy for muscle-invasive bladder cancer.

Methods

Between 1995 and 2001, 63 patients were evaluated who declined to undergo a planned cystectomy, because they achieved a complete clinical response to neoadjuvant cisplatin-based chemotherapy. Patient, tumor, and treatment features were assessed prospectively, and correlated in univariate and multivariate analyses with overall survival. The median follow-up was 86 mo and all patients were followed for more than 5 yr.

Results

Forty patients (64%) survived, with 54% of them having an intact functioning bladder. The number and size of invasive tumors were strongly associated with overall survival. The most significant treatment variable predicting better survival was complete resection of the invasive tumor on re-staging transurethral resection before starting chemotherapy. Of 23 patients (36%) who subsequently died of disease, 19 (30%) relapsed with invasive cancer in the bladder. Over 90% of surviving patients had solitary, small, and low-stage invasive tumors completely resected, and 83% survived without relapses in the bladder.

Conclusions

Selected patients with muscle-invasive bladder cancers may survive after transurethral resection and neoadjuvant chemotherapy, and tumor features can identify which patients responding completely to chemotherapy may survive without cystectomy.     

新辅助化疗后腹腔镜辅助食管内翻拔脱术治疗颈段食管癌1例报告

本文报道2012年8月29日1例新辅助化疗后腹腔镜辅助食管内翻拔脱术治疗食管癌.患者男,58岁,吞咽困难进行性加重半年.经胃镜和活检病理诊断为颈段食管鳞状细胞癌.化疗3周期后,分期从T3N1M0降为T2N0M0,行腹腔镜辅助食管内翻拔脱术:腹腔镜下用超声刀游离胃、下段食管和膈食管裂孔,利用腔镜切割缝合器制成管状胃.同时,经颈部游离食管和清理颈部各组淋巴结.腹部悬吊,腹腔镜辅助食管内翻拔脱后,将管状胃牵至颈部,与食管残端吻合.手术时间2 h 50 min.术中出血量约210 ml.术后第7天进清流食,逐渐加量.术后第12天出院.住院期间未发生声嘶等并发症.术后病理:颈部各组淋巴结15枚,未见癌转移.术后3个月,酸反流4～6次/d,多在夜间.     

Total Microlaparoscopic Radical Hysterectomy in Early Cervical Cancer

Background and Objective:

In less than 2 decades, laparoscopy has contributed to modification in the management of early cervical cancer patients, and all comparisons between open and laparoscopic-based radical operations showed an identical oncological outcome. The aim of this study is to describe surgical instrumentations and technique to perform total microlaparoscopy radical hysterectomy in early cervical cancer patients and report our preliminary results in terms of operative time and perioperative outcomes.

Methods:

Between January 1, 2012, and March 25, 2012, 4 consecutive early cervical cancer patients were enrolled in this study.

Results:

We performed 3 type B2 and 1 type C1-B2 total microlaparoscopy radical hysterectomy, and in all cases concomitant bilateral salpingo-oophorectomy and pelvic lymphadenectomy were carried out. Median operative time was 165 minutes (range: 155 to 215) (mean: 186), and median estimated blood loss was 30 mL (range: 20 to 50). Median number of pelvic lymph nodes removed was 12 (range: 11 to 15). All procedures were completed without 5-mm port insertion and without conversion. No intraoperative or early postoperative complications were reported.

Conclusions:

This report suggests a role of microlaparoscopy in the surgical management of early cervical cancer with adequate oncological results, superimposable operative time, and perioperative outcomes with respect to standard laparoscopy.     

动静脉不同途径新辅助化疗对年轻局部晚期宫颈癌术后患者卵巢功能的影响

目的评价年轻局部晚期宫颈癌术前动脉、静脉不同途径新辅助化学治疗（化疗）对术后卵巢功能的影响。方法采用回顾性研究，确诊为局部晚期子宫颈鳞状细胞癌并行宫颈癌根治术且术中保留双侧卵巢的年轻（手术年龄＜45岁）女患者38例，按照新辅助化疗途径分为A组（动脉介入栓塞化疗）20例，B组（静脉化疗）18例，每例均进行一疗程TP方案化疗［注射用紫杉醇脂质体135～175 mg·（m2）－1，顺铂50 mg·（m2）－1］，术后行3个周期BOMP化疗。回顾性分析比较两组手术前后血清雌二醇（E2）、卵泡刺激素（FSH）、黄体生成素（LH） 变化以评估卵巢功能。分别比较两组化疗前、化疗后2～3周（术前）、术后1个月及术后6个月的E2、FSH及LH水平。结果A组化疗后2～3周（术前）及术后1个月E2水平较化疗前下降，FSH升高，差异有统计学意义（P＜0.05），B组各激素在不同时点比较均差异无统计学意义（P＞0.05） ，两组LH在不同时点及两组术后6个月与化疗前比较均差异无统计学意义（P＞0.05） 。A组术前E2水平明显低于B组，其余两组间差异无统计学意义（P＞0.05） 。随访中，无一例因卵巢转移复发。结论年轻局部晚期宫颈癌患者术前行动脉介入栓塞化疗对卵巢功能的影响是短暂、可逆的，术前静脉化疗对卵巢功能几无影响，宫颈癌根治术中保留双侧卵巢是保护年轻局部晚期宫颈癌患者内分泌功能安全有效的方法。     

诺维本加阿霉素在局部晚期乳腺癌新辅助化疗中的应用

目的：了解诺维本加阿霉素的新辅助化疗方案在局部晚期乳腺癌综合治疗中的作用。方法：３１例Ⅱｂ至Ⅲｂ期的乳腺癌病人,术前均经病理或细胞学检查证实。中位年龄４８岁,化疗用药为ＮＶＢ ４０ｍｇ ｄ１,８＋ＡＤＭ ４０ｍｇ ｄｌ,每３周为一疗程,术前用药２疗程,评估新辅助化疗后肿瘤的缓解情况和随访长期生存率。结果：本组总体化疗有效率为６７．７％,肿瘤原发灶完全缓解（ＣＲ）１例,部分缓解（ＰＲ）２０例,无变化（ＳＤ）１０例;腋淋巴结临床ＣＲ１２例,ＰＲ１４例,ＳＤ５例。术后中位随访期３６个月,术后死亡６例,复发９例,健在１６例。结论：诺维本加阿霉素的联合术前化疗能使局部晚期乳腺癌的原发灶和腋淋巴结缩小,肿瘤降期,亦能减少肿瘤复发和远处转移,且不良反应较轻。     

腹腔镜辅助小切口宫颈癌根治术临床研究

目的探讨腹腔镜辅助小切口宫颈癌根治术的可行性。方法 2009年1月～2010年7月,施行宫颈癌根治术24例,其中开腹13例,腹腔镜辅助小切口11例。2组年龄、术前分期差异无显著性（P〉0.05）。比较2组手术时间、术中出血量、切除淋巴结数量、术后恢复情况及手术并发症。结果 2组均顺利完成手术。与开腹组相比,腹腔镜辅助组清扫淋巴结数量差异无显著性[（24.5±5.5）个vs.（26.1±3.9）个,t=-0.807,P=0.428],术中出血量少[（296.7±42.1）ml vs.（594.4±87.7）ml,t=-10.878,P=0.000],术后排气时间早[（1.9±0.4）d vs.（2.8±0.6）d,t=-4.386,P=0.000],下床活动时间早[（2.1±0.5）d vs.（3.6±0.7）d,t=-6.110,P=0.000],术后住院时间短[（12.2±3.3）d vs.（17.6±4.8）d,t=-3.254,P=0.004],但手术时间长[（233.2±23.5）min vs.（215.6±11.9）min,t=2.247,P=0.035]。结论腹腔镜辅助小切口宫颈癌根治术出血少,术后恢复快,安全可行。     

Radical surgery following neoadjuvant chemotherapy for patients with stage IIIB cervical cancer

Background: We conducted a phase II trial of radical surgery following neoadjuvant chemotherapy in patients with stage IIIB cervical cancer. Methods: A total of 26 patients with stage IIIB cervical cancer were entered in this study. Patients were treated with a chemotherapeutic regimen consisting of intraarterial infusion of cisplatin and intravenous infusion of other anticancer agents, to a maximum of 3 courses. If the results of the evaluation indicated that surgery was feasible, radical surgery, including complete removal of pelvic vessels, partial resection of adjacent organs, and pelvic and paraaortic lymphadenectomy, was performed. Patients whose tumors showed no response received radiotherapy. We evaluated operability, survival rate, toxicities, and complications. Additionally, we examined prognostic variables by multivariate analysis in the patients treated by radical surgery. Results: Eighteen patients (69.2%) underwent radical surgery. The remaining eight patients received radiation therapy. The 3-year disease-free survival rate was 72.2% in patients who received surgery and 25.0% in those who received radiotherapy. Multivariate analysis did not show any independent prognostic factors in the patients who underwent surgery. Conclusion: Radical surgery following neoadjuvant chemotherapy may be feasible in two thirds of patients with stage IIIB cervical cancer; therefore, phase III trials can be recommended.     

SOX方案新辅助化疗联合腹腔镜辅助胃癌根治术的安全性及疗效评价

目的:探讨SOX方案新辅助化疗联合腹腔镜辅助胃癌根治术的安全性及疗效.方法:选取2017年1月—2019年1月期间我院收治的35例进展期胃癌患者为研究对象,根据患者及其家属意愿,将其分为腹腔镜辅助胃癌根治术治疗组(对照组,n=19)及SOX新辅助化疗联合腹腔镜辅助胃癌根治术治疗组(观察组,n=16).记录两组患者化疗相...     

不同新辅助化疗方案治疗结肠癌临床对照观察研究

目的:观察两种不同新辅助化疗方案联合手术治疗结肠癌的疗效。方法:收集结肠癌患者42例,根据随机数字表分配分为治疗组(23例)和对照组(19例)。治疗组术前静脉滴注奥沙利铂联合替吉奥口服,术后2周开始追加4个周期的化疗。对照组术前静脉滴注奥沙利铂联合5-氟尿嘧啶及甲酰四氢叶酸口服,术后2周开始追加4个周期的化疗。随访3年,从不良反应、化疗前后瘤体直径变化、手术时间、术中出血量、实体肿瘤疗效评价标准RECIST等方面进行疗效评价。结果:化疗前治疗组肿瘤直径20～32 mm(25.87±3.37) mm,对照组19～34 mm(26.58±3.83) mm。化疗后治疗组肿瘤直径15～22 mm(17.22±2.41) mm,对照组18～30 mm(23.00±3.26) mm,两组经化疗前后瘤体缩小程度组内及组间对比均存在统计学差异(P0.001)。两组手术时间、术中出血量无差异。结论:新辅助化疗对于缩小结肠癌瘤体有效,可认为奥沙利铂联合替吉奥用于新辅助化疗在减少骨髓抑制、消化道反应发生率及降期效果上优于奥沙利铂联合FL。     

乳腺癌新辅助化疗疗效与分子分型的关系

目的探讨乳腺癌分子分型与表柔比星联合多西他赛（TE）方案新辅助化疗疗效的关系。方法根据纳入和排除标准,共纳入我院2011年5月至2012年12月期间至少接受过3周期TE方案治疗的乳腺癌患者共239例,其各项临床指标均完整。根据免疫组织化学雌激素受体（ER）、孕激素受体（PR）、人表皮生长因子受体2（HER-2）及Ki-67表达水平将患者分为4种亚型,分别为luminal A型、luminalB型、HER-2阳性型和三阴型。分析不同亚型乳腺癌患者的各项相关指标,如病理完全缓解（pCR）率、年龄、月经状态等。结果239例患者中,luminalA型67例（28．03％）,luminalB型84例（35．15％）,HER．2阳性型21例（8．79％）,三阴型67例（28．03％）。4型乳腺癌患者的年龄、月经状态、肿瘤大小、淋巴结状态等临床病理指标差异均无统计学意义（P〉0．05）。三阴型对TE方案的新辅助化疗的pCR率（14．93％）最高,其次依次为luminalB型（7．14％）、HER-2阳性型（4．76％）及luminalA型（1．49％）,差异有统计学意义（P=0．027）。结论三阴型相对luminalA型、luminalB型和HER-2阳性型对TE方案的新辅助化疗治疗更敏感,pCR率最高,治疗时需根据患者不同的分子亚型来选用特定的治疗方案。