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目的:了解淋巴结阳性绝经前乳腺癌患者新辅助化疗的疗效,探索乳腺癌新辅助化疗的敏感性预测指标对预后影响。方法:收集我院2006-06-01-2009-06-01治疗并符合条件的186例乳腺癌患者,96例淋巴结阳性绝经前乳腺癌患者接受TEC方案(新辅助化疗组)。分析患者反应率,进一步根据术后免疫组化及常规病理结果分层分析可以预测敏感性的临床指标。同期入组90例直接接受手术治疗的乳腺癌患者作为对照组。结果:新辅助化疗后40例(41.7%)临床完全缓解(cCR),42例(43.8%)临床部分缓解(cPR),总反应率(ORR)为85.5%。21例(21.9%)病理完全缓解(pCR)。雌激素受体(ER)阴性患者ORR高于ER阳性患者(94.1%vs80.7%,P=0.035);浸润性导管癌患者ORR高于浸润性小叶癌患者(87.8%vs55.5%,P=0.029)。新辅助化疗与直接手术组比较,3年无瘤生存率有提高(83.5%vs68.5%,P=0.039),3年总生存率差异无统计学意义(89.9%vs88.6%,P=0.473)。结论:淋巴结阳性绝经前乳腺癌采用TEC新辅助化疗可以取得较高的反应率,ER阴性和浸润性小叶癌是新辅助化疗敏感性预测指标。TEC方案有助于提高3年无瘤生存率,但对总生存率的延长尚不明确。
Objective: To understand the effect of neoadjuvant chemotherapy in patients with lymph node-positive premenopausal breast cancer and to explore the prognostic significance of the sensitivity of neoadjuvant chemotherapy in breast cancer. METHODS: Totally 186 patients with breast cancer were treated and matched in our hospital from 2006-06-01-2009-06-01. Ninety-six patients with lymph node-positive premenopausal breast cancer received TEC regimen (neoadjuvant chemotherapy). Analysis of the patient response rate, further based on postoperative immunohistochemistry and stratification analysis of conventional pathological results can predict the clinical indicators of sensitivity. In the same period, 90 patients with breast cancer directly undergoing surgery were selected as the control group. Results: After complete neoadjuvant chemotherapy, 40 patients (41.7%) achieved complete remission (cCR) and 42 patients (43.8%) achieved partial remission (cPR) with a total response rate of 85.5%. Twenty-one patients (21.9%) had complete remission (pCR). The ORR of patients with negative estrogen receptor (ER) was higher than that of patients with positive ER (94.1% vs80.7%, P = 0.035). The ORR of invasive ductal carcinoma was higher than that of invasive lobular carcinoma (87.8% vs55.5%, P = 0.029). Compared with the direct operation group, neoadjuvant chemotherapy improved the 3-year disease-free survival rate (83.5% vs68.5%, P = 0.039), and there was no significant difference in the 3-year overall survival rate (89.9% vs88.6%, P = 0.473). Conclusion: Neoadjuvant chemoradiation with lymph node-positive premenopausal women with breast cancer can achieve a higher response rate. ER-negative and invasive lobular carcinoma are the predictors of neoadjuvant chemotherapy sensitivity. TEC regimen will help to improve the 3-year disease-free survival rate, but the extension of the overall survival rate is not yet clear.