TP与EC-T化疗方案在三阴性乳腺癌新辅助化疗中疗效与BRCA1突变关系

目的:探讨TP与EC-T化疗方案在三阴性乳腺癌新辅助化疗中的疗效，并探索铂类与BRCA1突变关系。方法:选取2016年5月-2020年5月在我院诊断三阴性乳腺癌需新辅助化疗的122例患者，均行BRCA检测，将BRCA1胚系突变患者及未突变患者随机分为两组，一组给予TP（62例）方案新辅助化疗，一组给予EC-T（60例）方案新辅助化疗；按照不同因素分析两组pCR差异。结果:TP组pCR率为56.5%，EC-T组pCR率36.7%，差异有统计学意义（P=0.029）；对于ypT0/is或ypN0 TP组对比EC-T组仍然具有明显优势（分别为64.5% vs 43.3%,P=0.019；69.4% vs 41.7%,P=0.002）；对于BRCA1突变患者，TP组与EC-T组pCR率无统计学差异（50.0% vs 44.4%,P=0.343），对TP组内BRCA1突变与未突变人群pCR率无统计学差异（50.0% vs 57.7%,P=0.224）,对EC-T组内BRCA1突变与未突变人群pCR率无统计学差异（44.4% vs 35.3%,P=0.248）。122例患者的不良反应以 1-2级较常见。EC-T组和TP组患者1-2级恶心/呕吐的发生率分别为71.7％和38.7％(P=0.000 3)，3-4级恶心/呕吐的发生率分别为21.7％和3.2％(P=0.002);TP组和EC-T组患者1-2级血小板减少症的发生率分别为32.3％和8.3％(P=0.001)，3-4级血小板减少症的发生率分别为9.7％和0％(P=0.008)。其他3-4级不良反应少见。结论:TP方案对比EC-T方案明显提高三阴性乳腺癌pCR率，BRCA1是否突变未发现影响铂类方案疗效，整体两组不良反应可以耐受，其中TP组血小板减少发生率较高。

TP and EC-T chemotherapy regimens in neoadjuvant chemotherapy for triple negative breast cancer and the relationship between platinum and BRCA1 mutation

Objective:To investigate the effect analysis of TP and EC-T chemotherapy regimens in neoadjuvant chemotherapy for triple negative breast cancer,and to explore the relationship between platinum and BRCA1 mutation.Methods:A total of 122 patients were randomly divided into two groups,the BRCA1 mutant group and the BRCA1 non-mutant group,the BRCA1 mutant group received TP(62 cases)regimen of neoadjuvant chemotherapy,and the BRCA1 non-mutant group received EC-T(60 cases)regimen of neoadjuvant chemotherapy.The pCR rate between the two groups were analyzed according to different factors.Results:The pCR rate was 56.5% in the TP group and 36.7% in the EC-T group,the difference was statistically significant(P=0.029).Compared with EC-T group,ypT0/is or ypN0,TP group still had significant advantages(64.5% vs 43.3%,P=0.019;69.4% vs 41.7%,P=0.002).For patients with BRCA1 mutations,there was no statistically significant difference in pCR rate between the TP group and the EC-T group(50.0% vs 44.4%,P=0.343).There was also no statistically significant difference in pCR rate between the TP group and the non-mutant group(50.0% vs 57.7%,P=0.224).There was no statistically significant difference in pCR rate between the BRCA1 mutations and the non-mutant group(44.4% vs 35.3%,P=0.248).The adverse reactions of 122 patients were of grade 1-2.The incidence of grade 1-2 nausea/vomiting was 71.7% in the EC-T group and 38.7% in the TP group(P=0.000 3),and the incidence of grade 3-4 nausea/vomiting was 21.7% and 3.2%(P=0.002),respectively.The incidence of grade 1-2 thrombocytopenia was 32.3% in the TP group and 8.3% in the EC-T group(P=0.001),while that of grade 3-4 thrombocytopenia was 9.7% and 0%(P=0.008).Other grade 3-4 adverse reactions were rare.Conclusion:Compared with EC-T,TP significantly increased the pCR rate of triple negative breast.BRCA1/2 mutation is not found to affect the efficacy of the platinum,and the adverse reactions of the two groups are tolerable,but the TP group had a higher incidence of thrombocytopenia.