Ki-67阳性或阴性表达乳腺癌不同辅助治疗方案的远期疗效比较

目的 探讨不同Ki-67表达情况下，乳腺癌术后不同辅助化疗方案及辅助化疗后接受不同内分泌药物治疗的远期疗效。方法 收集2008年1月至2009年12月694例乳腺癌患者，术后均接受蒽环类或蒽环类序贯紫杉类方案化疗；再选取其中ER阳性且绝经的261例患者，均接受选择性雌激素受体调节剂（SERM）或芳香化酶抑制剂（AI）内分泌治疗。对Ki-67不同表达情况下，不同辅助化疗方案及辅助化疗后不同内分泌药物治疗与无病生存期（DFS）和总生存期（OS）的关系进行分析。结果（1） 527例Ki-67阳性乳腺癌患者的中位DFS和OS分别为37.0个月和38.0个月，其中蒽环类方案组和序贯紫杉类方案组的中位DFS分别为36.5个月和38.0个月（P=0.046），OS分别为38.0个月和39.0个月（P=0.045）；167例Ki-67阴性患者的中位DFS和OS分别为49.4个月和51.5个月，蒽环类方案组和序贯紫杉类方案组的中位DFS和OS差异均无统计学意义。在Ki 67和ER表达的4种组合中，仅Ki-67+ER-表达组蒽环类方案与序贯紫杉类方案的中位DFS（30.5个月vs.35.9个月，P=0.030）和中位OS（39.2个月vs.42.1个月，P=0.160）的差异有统计学意义。（2）261例ER阳性且绝经的患者中，200例Ki-67阳性者的中位DFS和OS分别为38.0个月和39.0个月，另外61例Ki-67阴性患者的中位DFS和OS分别为52.0个月和53.3个月；无论Ki-67阳性或阴性表达，接受SERM或AI治疗患者的DFS和OS均无显著差异。结论 在Ki-67阳性乳腺癌术后辅助化疗中，蒽环类序贯紫杉类方案疗效优于蒽环类方案。在ER阳性接受内分泌治疗的绝经患者中，SERM和AI在不同Ki-67表达者中的疗效相当。

Long-term response of different adjuvant therapies in breast cancer with different Ki-67 expressions

Objective To analyze the long-term response of different adjuvant chemotherapies and endocrine-therapies after adjuvant chemotherapy in patients of breast cancer after operation with different Ki-67 expressions. Methods A total of 694 patients with breast cancer were collected from January 2008 to December 2009. All the patients accepted anthracycline-based or sequential tax- ane chemotherapy and 261 menopausal patients in them with ER positive expression accepted selective estrogen receptor modulator （SERM） or aromatase inhibitor （AI） after adjuvant chemotherapy. On the occasion of different Ki-67 expressions, the correlation of disease-free survival （ DFS）, overall survival （OS） with different adjuvant chemotherapies and endocrine-therapies after adjuvant chemotherapy were analyzed by statistics. Results （ 1 ） In 527 cases of Ki-67 positive expression, the median DFS and OS were 37. 0 and 38.0 months. For those accepted anthracycline-based and sequential taxane regimen, the median DFS were 36. 5 months and 38.0 months （P = 0. 046）, and the median OS were 38.0 months and 39.0 months （P = O. 045 ）. In 167 cases of Ki-67 negative expres- sion, the median DFS and OS were 49.4 and 51.5 months, and the median DFS and OS between anthracycline-based and sequential taxane regimen had no statistic significance. In 4 types of Ki-67 and ER status, only in patients of Ki-67 ＋ ER-, the median DFS （30. 5 months vs. 35.9 months, P =0. 030） and median OS （39. 2 months vs. 42. 1 months, P =0. 160） for anthracycline-based and sequential taxane regime had statistic significance. （2） In 261 menopausal patients with ER positive expression, 200 cases of Ki-67 were positive expressed with the median DFS and OS of 38.0 and 39.0 months. While in 61 cases of Ki-67 negative expression, the median DFS and OS were 52.0 and 53.3 months. The median OS and PFS had no significance in patients accepted SERM or AI with different Ki-67 expression. Conclusion In the adjuvant chemotherapy of breast cancer after operation, the efficacy of sequential tax- anes regimen is superior to anthracycline-based regimen in Ki-67 positive expressed patients. In menopausal patients with ER positive expression, the efficacy of SERM is similar to that of AI with different Ki-67 expression.