乳腺癌新辅助化疗疗效的评价及影响因素分析

目的分析不同评价方法评估乳腺癌新辅助化疗疗效的价值,探讨化疗疗效的影响因素。方法对171例Ⅱ、Ⅲ期可手术乳腺癌患者分别行CEF、NE和TEC方案新辅助化疗。完成2个周期化疗者11例,3个周期者111例,≥4个周期者49例。采用触诊、超声和病理学方法评价疗效。化疗效果影响因素的判定采用单因素分析和多因素Logistic回归分析方法。结果触诊评价完全缓解（CR）32例（18．7％）,总有效率为88．3％。超声评价CR7例（4．1％）,总有效率为74．9％。病理组织学评价CR26例（15．2％）。触诊和超声评价与病理组织学评价的CR符合率分别为43．8％和42．9％。多因素分析结果表明,肿瘤大小是影响乳腺癌新辅助化疗病理CR的独立因素。结论化疗疗效的临床评价与病理组织学评价缺乏很好的一致性,触诊和超声评价CR易高估和低估。肿瘤大小是影响乳腺癌新辅助化疗病理CR的独立因素,肿块不易达到病理CR。

Assessment of neoadjuvant chemotherapy in breast cancer patients

OBJECTIVE: To assess the response of neoadjuvant chemotherapy and its influencing factors in the breast cancer patients. METHODS: 171 patients with stage II or operable stage III breast cancers were treated with neoadjuvant chemotherapy before surgery between January 2004 and May 2005. Of these, 160 received and completed > or =3 cycles of neoadjuvant chemotherapy, 11 received only 2 cycles. The regimens of neoadjuvant chemotherapy were: CEF (CTX, Epirubicin, 5-Fu); NE (Navelbine, Epirubicin); TEC (Taxotere, Epirubicin, CTX). Response of neoadjuvant chemotherapy was evaluated in all patients by palpation, ultrasonography and pathological methods. RESULTS: Complete response rate and clinical objective response rate determined by clinical palpation (cCR, cOR), ultrasonography (sCR, sOR) and pathology (pCR) was 18.7% and 88.3%; 4.1% and 74.9%; 15.2%, respectively. The correspondence rate of the pCR with cCR and sCR was 43.8% and 42.9%, respectively. It was showed by univariate analysis that patient whose tumor was < or =3 cm in diameter, or ER negative or grade 3 were more likely to achieve a pCR than those whose tumor was >3 cm, or ER positive or grade 1. Logistic regression analysis showed that only tumor size was the significant predictive factor for response to neoadjuvant chemotherapy in patients with primary breast cancer. CONCLUSION: Patient with small, or ER negative or grade 3 tumor may have better pathological response to neoadjuvant chemotherapy, particularly, the tumor size is more predictive of pCR. Palpation or ultrasonography may have a tendency either to under- or to overestimate pCR. Breast neoplasms/drug therapy;