紫杉类与蒽环类药物联合治疗三阴性乳腺癌疗效分析

目的：比较紫杉类和蒽环类药物联合与单纯蒽环类药物治疗三阴性乳腺癌的疗效。方法：585例三阴性乳腺癌患者中,术后行紫杉联合蒽环类辅助化疗228例,蒽环类辅助化疗357例,分析其复发、转移和生存情况。结果：紫杉联合蒽环类组与蒽环类组患者复发率、转移率与死亡率分别为7.9%与13.2%、21.9%与35.9%、18.0%与28.6%（P＜0.05）,与蒽环类方案相比,紫杉联合蒽环类方案延长了临床II、III期、非特殊型浸润性癌、淋巴结阳性患者的总生存期,提高了总生存率。结论：紫杉类与蒽环类药物联合辅助化疗,对于具有晚临床分期、非特殊型浸润性癌及淋巴结阳性特征的三阴性乳腺癌有显著的治疗效果。     

Utility of neoadjuvant chemotherapy in the treatment of operable breast cancer

Neoadjuvant chemotherapy (NAC) is a legitimate alternative to first‐line surgical therapy for the treatment of breast cancer patients, as level one evidence shows the effect on overall survival is equivalent to that of adjuvant chemotherapy. In the treatment of women with operable breast cancer, NAC provides a number of potential advantages including: improving the chance of achieving breast‐conserving surgery, improving cosmesis after breast‐conserving surgery, downstaging the breast and axilla, allowing time to fully consider surgical options, time for genetic testing and facilitating breast reconstruction in otherwise high‐risk patients. However, in Australia, NAC is poorly utilized with less than 3% of women with operable breast cancer receiving NAC. This review discusses the potential harms and benefits of NAC, discusses areas of controversy in the use of NAC and describes how we have used NAC in our own practice. We conclude that if it is obviously necessary for the newly presenting breast cancer patient to have chemotherapy as part of the treatment, it is worth considering NAC. In many patients, the potential benefits of NAC outweigh the harms. However, maximizing these benefits is closely aligned with appropriate patient selection and timely multidisciplinary team communication.     

Development of malignant breast microcalcifications after neoadjuvant chemotherapy in advanced breast cancer

The increased interest in the use of neoadjuvant chemotherapy for patients with locally advanced or large tumors at initial presentation necessitates the recognition of sequelae of this therapy. This article describes the interval appearance of malignant, linear-branching, microcalcifications during neoadjuvant chemotherapy for locally advanced breast cancer. Mammographically the malignant microcalcifications appeared only in the region of the breast where the primary tumor was found. Pathologically only a subpopulation of malignant cells responded to the chemotherapy, demonstrating viability of the majority of the tumor, with cell death only in the subpopulation. With the increased use of neoadjuvant chemotherapy, it is important to recognize previously undescribed mammographic findings secondary to this therapeutic approach.     

Sentinel lymph node mapping following neoadjuvant chemotherapy for breast cancer

The purpose of this study was to evaluate the feasibility of sentinel lymph node mapping in patients undergoing neoadjuvant chemotherapy for breast carcinoma prior to lumpectomy or mastectomy and sentinel lymph node mapping followed by complete axillary dissection. A retrospective analysis of 14 patients from February 1998 to July 2000 with stage I to stage IIIB breast cancer diagnosed by core biopsy underwent neoadjuvant chemotherapy (doxorubicin/cyclophosphamide) prior to definitive surgery, including lumpectomy or mastectomy and sentinel lymph node mapping, followed by full axillary dissection. Thirteen of 14 patients had successful sentinel lymph node identification (93%), and all 14 underwent full axillary dissection. An average of 2.2 sentinel nodes and a median of 16 axillary lymph nodes (including sentinel nodes) were found per patient. Of the 13 patients in whom a sentinel lymph node was identified, 10 were positive for metastases (77%). Only 4 of the 10 had further axillary metastases (40%). Three patients had negative sentinel lymph nodes shown by hematoxylin and eosin and cytokeratin stainings and had no axillary metastases (0% false negative). The single patient in whom a sentinel lymph node could not be identified had stage IIIA disease with extensive lymphatic tumor emboli. Sentinel lymph node mapping is feasible in neoadjuvant chemotherapy breast cancer patients and can spare a significant number of patients the morbidity of full axillary dissection. Further study to evaluate sentinel lymph node mapping in this patient population is warranted.     

新辅助化疗对ⅡB期乳腺癌的疗效对比研究

目的 研究新辅助化疗治疗ⅡB期乳腺癌的临床作用.方法 选取2002年1月至2004年11月ⅡB期女性乳腺癌330例,全部单侧患病,随机分成2组.新辅助化疗组152例(年龄32～73岁,平均42.6岁;左侧78例,右侧74例),给予紫杉类、蒽环类为主的联合化疗,每2个周期后评价疗效,4个周期后实施手术.非新辅助化疗组17...     

分子标记物表达预测乳腺癌蒽环类新辅助化疗疗效价值研究

目的探讨局部晚期乳腺癌病人肿瘤组织分子生物学标记物的表达及其与新辅助化疗有效率的关系。方法采用免疫组化的方法检测2000年1月至2010年12月复旦大学附属肿瘤医院乳腺外科收治的420例乳腺癌新辅助化疗病人化疗术后标本中雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(HER-2)/neu、p53、Cathepsin-D、p27、cyclinD1、Bax、Ki67、TOPOII、GSTπ、MDR和Bcl-2等分子标记物的表达情况,分析这些分子标记物的表达与新辅助化疗疗效之间的关系。结果 p53或cathepsin-D或GSTπ阴性的病人化疗疗效要显著优于阳性的病人,多因素回归分析提示GSTπ和p53是独立的新辅助化疗疗效预测指标。结论 GSTπ和p53可作为判定乳腺癌蒽环类新辅助化疗方案敏感性的两个独立预测指标。     

Prognostic impact of neoadjuvant chemotherapy induced neutropenia on operable breast cancer

Objective To evaluate the relationship between neoadjuvant chemotherapy (combination of taxanes and anthracyclines) induced-neutropenia and the efficacy of neoadjuvant chemotherapy and longterm survival in operable breast cancer patients. Methods Two hundred and eleven patients received 4 cycles of neoadjuvant chemotherapy     

TAC新辅助化疗方案治疗三阴性乳腺癌的疗效及预后

【摘要】目的 探讨TAC新辅助化疗方案治疗三阴性乳腺癌（triple-negative breast cancer,TNBC）的临床疗效。方法 对接受4～6个周期TAC新辅助化疗方案治疗的63例TNBC进行回顾性研究,分析近远期化疗疗效。结果 63例患者总有效率(RR)96.83%,其中完全缓解(CR)57.14%（36/63),部分缓解(PR)39.68%(25/63）。主要不良反应中性粒细胞减少36例（57.14%）,中性粒细胞减少性发热25例（39.68%）,恶心呕吐33例（52.38%）,腹泻14例（22.22%）,口腔黏膜炎13例（20.63%）,乏力虚弱10例（15.87%）。术后死亡7例,局部复发8例,远处转移21例,3年生存率88.89%。结论 应用TAC新辅助化疗方案能提高TNBC治疗效果,改善患者生活质量,提高3年生存率。     

Sentinel lymphadenectomy after neoadjuvant chemotherapy for breast cancer may reliably represent the axilla except for inflammatory breast cancer

Background After neoadjuvant chemotherapy, women with locally advanced breast cancer (LABC) undergo a modified radical mastectomy or lumpectomy with axillary lymph node dissection (ALND) and radiotherapy. Sentinel lymphadenectomy (SL) is accepted for axillary evaluation in early breast cancer. We assessed the feasibility and predictive value of SL after neoadjuvant chemotherapy. Methods Eligible women received neoadjuvant therapy for LABC and were scheduled to undergo a definitive surgical procedure. Vital blue dye SL was attempted followed by level I and II axillary dissection. Results SL was successful in 29 of 34 patients (detection rate, 85%). Thirteen patients (45%) had positive nodes, and eight (28%) had negative nodes on both SL and ALND. In five patients (17%), the sentinel node was the only positive node identified. Overall, there was a 90% concordance between SL and ALND. The false-negative rate and negative predictive value were 14% and 73%, respectively. Among the subgroup without inflammatory cancer, the detection and concordance rates were 89% and 96%, respectively. The false-negative rate was 6%, and the negative predictive value was 88%. Conclusions SL after neoadjuvant chemotherapy may reliably predict axillary staging except in inflammatory breast cancer. Further studies are required to assess the utility of SL as the only mode of axillary evaluation in these women.     

循环肿瘤细胞在乳腺癌新辅助化疗中的应用进展

·综 述·     

Selection of local therapy after neoadjuvant chemotherapy in patients with stage IIIA,B breast cancer

Background: Stage IIIA,B breast cancer is commonly treated with neoadjuvant chemotherapy because of high objective response rates and improved operability. Criteria for subsequent selection of local therapy—mastectomy, radiotherapy, or both—are not well defined. We adopted a policy of selective local therapy based on rebiopsy of the breast and clinical axillary lymph node status at the time of best response to chemotherapy. Methods: Between 1980 and 1993, 126 patients with stage IIIA,B breast cancer were treated with neoadjuvant chemotherapy and definitive local therapy. The long-term incidence of locoregional failure (in-breast, chest wall, axilla, supraclavicular, neck), relapse-free survival, and overall survival was determined. Results: The overall clinical objective response rate to chemotherapy was 95.2%. Eighty-three patients underwent mastectomy, with negative margins achieved in 91.6%. Forty-two patients had breast preservation; the overall in-breast recurrence rate was 19.0% (8 of 42 patients). The overall locoregional recurrence rate by site was: chest wall—8.7% (11 of 126 patients), axilla—8.7% (11 of 126 patients), supraclavicular—5.6% (7 of 126 patients), and neck—4.0% (5 of 126 patients). The axillary recurrence rate was 6.6% (5 of 76 patients) for clinically negative axilla treated with radiotherapy only, and 12.0% (6 of 50 patients) for clinically positive axilla treated with surgery only. The overall long-term survival probabilities (6 years) according to stage were: stage IIIA—58.0%, stage IIIB_noninflam—58.0%, stage IIIB_inflam—36.0%. Conclusions: These findings support a selective approach to local therapy in patients with stage IIIA,B breast cancer. This approach provides local control in most patients, and allows for breast preservation and elimination of axillary dissection in selected patients. Presented at the 49th Annual Cancer Symposium of the Society of Surgical Oncology, Atlanta, Georgia, March 21–24, 1996.     

5-FU植入剂联合静脉化疗在乳腺癌新辅助化疗的临床观察

目的 对比CAF方案与植入型5-氟尿嘧啶（5-FU）替代CAF方案治疗II-III晚期乳腺癌的近期疗效与毒性反应。方法 将63名II-III期乳腺癌患者随机分组,植入型5-FU替代CAF方案为试验组,CAF（静脉给药）方案为对照组。结果 1）标准组有效率为56.3％,试验组为83.9％,差异有统计学意义;3）试验组消化道反应及III-IV度白细胞下降发生率较对照组低。结论 植入型5-FU可以提高II-III期乳腺癌新辅助化疗有效率,且毒性反应较低。肿瘤药物局部植入是一种有效安全的给药途径。     

Dose-dense chemotherapy for breast cancer

The concept of dose-dense chemotherapy has emerged and is based on the hypothesis that maximal chemotherapy effectiveness can be achieved by scheduling the interval of chemotherapy to correspond to the period of most rapid tumor growth, as predicted by preclinical models. The granulocyte-colony stimulating factor support has permitted the safe delivery of chemotherapy at shorter ("dose-dense") inter-treatment intervals. Several randomized trials have been conducted to test the feasibility and effectiveness of anthracycline and/or taxanes-based dose-dense strategies. They have been associated with a modest impact on disease recurrence and overall survival of patients with early-stage breast cancer. Subset analyses have suggested increased benefits for specific tumor subtypes such as hormone receptor-negative, highly proliferative or HER2 overexpressing tumors. This review article aims to outline the theoretical framework for dose-dense chemotherapy and summarizes the results of several recent clinical trials addressing this concept within neoadjuvant and adjuvant breast cancer treatment and discuss their implications for clinical practice. Further studies are needed to define the optimal regimen and the patient population that will receive the greatest benefit from dose-dense strategy.     

淋巴细胞亚群对乳腺癌新辅助化疗疗效的预测价值

目的 本研究旨在探讨治疗前淋巴细胞亚群对乳腺癌新辅助化疗(NAC)疗效的预测价值.方法 本研究选取2016年4月至2020年6月在中山大学孙逸仙纪念医院接受NAC的乳腺癌患者109例.采用卡方检验及logistics回归分析不同淋巴细胞亚群比例与病理完全缓解(pCR)的相关性,并通过Kaplan-Meier曲线评估其与...     

“三阴”乳腺癌新辅助化疗前后BCSG1基因状况研究

目的 探讨乳腺癌特异基因（BCSG1）在“三阴”性乳腺癌新辅助化疗疗效评估中的价值。方法采用免疫组化S．P法和荧光定量PCR方法检测32例“三阴”性乳腺癌患者新辅助化疗（CEF方案）前后乳腺癌组织BCSG1的表达,比较化疗前后肿瘤体积的变化情况,分析新辅助化疗前后BCSG1蛋白表达与肿瘤形态学变化的关系。结果23例乳腺癌患者新辅助化疗后肿瘤体积均有明显缩小,病灶缓解率（CR＋PR）为84．4％;新辅助化疗后BCSG1mRNA表达水平亦明显低于化疗前（P〈O．05）,BCSG1蛋白高表达率低于新辅助化疗前（P〈0．01）。结论BCSG1分子和蛋白水平在“三阴”性乳腺癌新辅助化疗后均明显降低,与新辅助化疗后疗效呈负相关（r=-0．584,P〈0．01）,提示BCSG1可作为“三阴”乳腺癌新辅助化疗疗效的预测因子。     

背阔肌肌皮瓣修复新辅助化疗后局部晚期乳腺癌组织缺损的疗效观察

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。     

Diagnosis of complete response to neoadjuvant chemotherapy using diagnostic imaging in primary breast cancer patients

Advances in the therapeutic agents used for neoadjuvant chemotherapy (NAC) have recently achieved higher response rates and induced a greater number of pathologic complete responses (pCR) than ever before. The aim of this study is the diagnosis of pCR after NAC by diagnostic imaging of clinical complete response (cCR) patients. This study included 35 breast cancer patients who demonstrated cCR after receiving NAC with a combination of anthracycline and taxane from May 1998 to August 2003. Surgical treatment included breast-conserving therapy followed by radiotherapy or mastectomy. The identity of post-NAC lesions as either a complete response (CR) or partial response (PR) were made by mammography, ultrasonography, and contrast-enhanced computed tomography (CT). Among the 35 patients, 11 achieved pCR, including the disappearance of both invasive and intraductal components. Of the patients achieving pCR, eight were defined as CR and three were determined to be PR by CT. There was a significant relationship between the pCR and the determination of CR by CT. The determination of CR by ultrasonography was indicative of the disappearance of pathologic invasive components. While mammography appeared to reflect the observed histologic results, we did not observe any statistical differences. A subset of cases exhibited discrepancies between the imaging and pathologic results, likely due to the replacement of destroyed tumor cells by fibrosis and granulomatous tissue. The evaluation of CR by CT was significantly indicative of pCR. The positive predictive value, however, was not large enough to avoid surgical treatment. Further studies will be needed to establish a diagnosis of pCR.     

Preoperative evaluation of residual tumor extent by three-dimensional magnetic resonance imaging in breast cancer patients treated with neoadjuvant chemotherapy

The purpose of this study was to evaluate the usefulness of three-dimensional magnetic resonance imaging (3D MRI) for the preoperative assessment of residual tumor extent in breast cancer patients treated with neoadjuvant chemotherapy (NAC). Thirty-eight breast cancer patients treated with NAC containing taxane and/or anthracycline for 3-6 months were enrolled in this study. Tumor size was measured by means of calipers, ultrasonography, and dynamic MRI before and after NAC. Three-dimensional maximum intensity projection MRIs to measure the tumor size were created for every case. The tumor size determined by calipers, ultrasonography, and 3D MRI after NAC was compared with that determined by pathologic examination. The tumor size determined by 3D MRI showed a strong correlation with that determined by pathologic examination (r = 0.896). Moderate, but significant correlations were found between measurements obtained with calipers and pathology (r = 0.554), and between ultrasonography and pathology (r = 0.484). The response rates to NAC were estimated at 84.2% with calipers, 58.0% with ultrasonography, and 44.7% with 3D MRI. Calipers and ultrasonography thus tended to overestimate the response to NAC compared to 3D MRI (p < 0.001 and 0.240, respectively). Three-dimensional MRI can visualize residual tumor extent after NAC more accurately than calipers and ultrasonography, and seems to be more reliable than other modalities for estimating response to NAC. It should also help surgeons with decision making for breast-conserving surgery after NAC.     

乳腺癌新辅助化疗后前哨淋巴结活检术的研究

目的 探讨乳腺癌病人新辅助化疗后前哨淋巴结活检的可行性。方法对2003年11月至2004年10月住院治疗中的57例Ⅱ、Ⅲ期乳腺癌病人行新辅助化疗后，临床检查腋窝淋巴结阴性行前哨淋巴结活检术（SLNB）。结果57例中检出前哨淋巴结（SLN）53例，检出率93．0％。SLN对腋窝淋巴结状况预测的敏感性为89．7％，特异性为100．0％，准确性为94．3％，阳性预测值为100．0％，阴性预测值为88．9％，假阴性率为5．7％。肿瘤对化疗反应为CR（完全缓解）、PR（部分缓解）和SD（稳定）的SLN检出率分别为100．0％、96．7％和70．0％（P〈0．01）。SLN假阴性3例均为腋窝淋巴结转移数〉4个者。结论Ⅱ、Ⅲ期乳腺癌实施新辅助化疗后。行SLNB可获得与早期乳腺癌SLNB相似的效果。     

Rates of major complications during neoadjuvant and adjuvant chemotherapy for early breast cancer: An off study population

ObjectivesTo determine the incidence and risk factors for thromboembolic events (TE) and febrile neutropenia (FN) in patients receiving systemic chemotherapy for early breast cancer (EBC).Methods325 patients received FEC₇₅, FEC₁₀₀-T or ECaP for EBC in 2013.ResultsTE occurred in 7.4% and FN in 19.1% of patients. Risk factors for TE were: central venous catheter (p = 0.011). Risk factors for FN were: FEC₁₀₀-T treatment versus FEC₇₅ and ECaP (p ≤ 0.001); lower pre-treatment neutrophil count (p = 0.009) and poorer performance status (p = 0.012). Two patients died from treatment-related toxicities.ConclusionIn real-world experience, the majority of patients completed adequate treatment, despite significant complications.