表柔比星联合紫杉醇新辅助化疗治疗乳腺癌保乳术患者的疗效及安全性

目的：探讨表柔比星联合紫杉醇（E+T）新辅助化疗对乳腺癌保乳术患者的效果及安全性。 方法：选取2014年1月—2018年1月收治的107例IIa~IIIa期女性原发性乳腺癌患者，患者均于保乳术前行3周E+T方案新辅助化疗，且患者化疗前均检测空芯针穿刺标本雌激素受体（ER）、孕激素受体（PR）、人表皮生长因子受体2（HER-2）、Ki-67、p53及Bcl-2表达情况。评价临床及病理疗效并评估毒副反应情况。 结果：所有患者均完成了4个或6个疗程的术前3周E+T新辅助化疗，5例IIIa期患者化疗后降期为IIb；患者均于化疗后12~16 d行乳腺癌保乳术治疗。临床有效率为89.72%，病理性完全缓解（pCR）率为17.76%，腋窝淋巴结转阴率为54.76%。不同ER、PR、Ki-67、p53表达状态患者间pCR率有统计学差异（均P<0.05），而不同HER-2、Bcl-2表达状态患者间pCR率无统计学差异（均P>0.05）。除出现IV度白细胞减少5例、IV度中性粒细胞减少5例外，其余毒性反应均可耐受。86例术后随访12~60个月，复发转移19例，死亡6例，2例出现对侧乳腺癌，其余患者均恢复良好。 结论：E+T新辅助化疗方案治疗乳腺癌保乳术患者可获得较高的pCR率，毒副反应可耐受。ER、PR、Ki-67、p53可作为E+T新辅助化疗方案疗效的预测因子。

Efficacy and safety of neoadjuvant chemotherapy with epirubicin plus paclitaxel in treatment of patients undergoing breast-preserving surgery for breast cancer

Objective: To investigate the efficacy and safety of neoadjuvant chemotherapy with epirubicin plus paclitaxel (E+T) in patients undergoing breast conserving surgery for breast cancer.  Methods: One-hundred and seven female patients with 107 patients with stage IIa-IIIa primary breast cancer admitted from January 2014 to January 2018 were enrolled. All patients received 3-week E+T neoadjuvant chemotherapy before breast-conserving surgery, and all patients underwent detection of the expressions of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2), Ki-67, p53 and Bcl-2 in the hollow needle aspiration specimens before neoadjuvant chemotherapy. The clinical and pathological outcomes were assessed, and the toxic and adverse effects were evaluated. Results: All patients completed 4 or 6 courses of 3-week E+T neoadjuvant chemotherapy before operation, and the tumor stage was downgraded to stage IIb in 5 stage IIIa patients after chemotherapy. All patients underwent breast-conserving surgery 12-16 d after neoadjuvant chemotherapy. The clinical effective rate was 89.72%, the pathological complete response (pCR) rate was 17.76%, and the negative conversion rate of the axillary lymph nodes (ALN) was 54.76%. There were significant differences in pCR rates between patients with positive and negative expressions of ER, PR, Ki-67 and p53 (all P<0.05), but no significant differences in pCR rates between patients with positive and negative expressions of HER-2 and Bcl-2 (both P>0.05). All toxic effects were tolerable, except for degree IV leukopenia in 5 cases and degree IV neutropenia in 5 cases. Eighty-six patients were followed up for 12-60 months, recurrence and metastasis occurred in 19 cases, death occurred in 6 cases, and contralateral breast cancer occurred in 2 cases, while the remaining patients recovered well. Conclusion: In breast cancer patients undergoing breast-conserving surgery, higher pCR rate can achieved by neoadjuvant chemotherapy of E+T regimen with tolerable toxic and adverse reactions. ER, PR, Ki-67, p53 can be used as efficacy predictors for E+T neoadjuvant chemotherapy.