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目的探讨乳腺癌新辅助化疗疗效及ER/PR,HER2,Ki67,CyclinA2的疗效预测价值。方法 2004年10月~2009年12月50例Ⅰ~Ⅲ期原发性乳腺癌,采用含紫杉类(TP/TC或TE/PE/TEC方案)或蒽环类(EC/FEC方案)联合方案,术前化疗2~6周期,45例接受手术,术后完成规定化疗,应用B超结合触诊判断临床疗效。结果化疗前后肿瘤中位最大径分别为3.6 cm和2.2 cm,有统计学差异(Z=-5.723,P=0.000)。临床疗效:CR 3例(6%),PR 35例(70%),SD 11例(22%),PD 1例(2%),临床RR 76.0%(38/50)。45例接受手术,术后3例pCR(3/45,6.7%),3例tpCR(3/45,6.7%)。4年无病生存期(DFS)为86.2%,4年总生存率为93.1%,中位DFS 62.4月[SE:2.535,95%CI(57.450~67.388)]。不同情况下肿瘤缩小比例并无统计学差异,包括月经状态(绝经前vs.绝经后,46.4%vs.40.6%,P=0.536)、激素受体状况(阳性vs.阴性,43.0%vs.42.2%,P=0.929)、HER2(阳性vs.阴性,41.3%vs.43.9%,P=0.774)、Ki67(阳性vs.阴性,47.2%vs.43.1%,P=0.363)、CyclinA2(阳性vs.阴性,34.3%vs.50.0%,P=0.375)、分化程度(高分化vs.中分化vs.低分化,44.1%vs.42.9%vs.41.3%,P=0.983)以及不同化疗方案(TP/TC vs.TE/PE/TEC vs.EC/FEC,52.7%vs.39.8%vs.38.9%,P=0.440)。结论紫杉类及蒽环类药物联合方案用于浸润性乳腺癌的术前化疗,可有效控制肿瘤。ER/PR,HER2,Ki67,CyclinA2的状态与肿瘤缩小比例之间并无统计学意义的关联性。
Objective To investigate the efficacy of neoadjuvant chemotherapy and the predictive value of ER / PR, HER2, Ki67 and CyclinA2 in breast cancer. Methods Fifty patients with stage Ⅰ ~ Ⅲ primary breast cancer from October 2004 to December 2009 were treated with TP / TC or TE / PE / TEC regimen or anthracycline (EC / FEC) regimen Program, preoperative chemotherapy 2 to 6 cycles, 45 patients underwent surgery, after the completion of the prescribed chemotherapy, the application of B-ultrasonography palpation to determine the clinical efficacy. Results The median maximum diameter of tumor before and after chemotherapy were 3.6 cm and 2.2 cm, respectively, with statistical difference (Z = -5.723, P = 0.000). Clinical efficacy: CR 3 cases (6%), PR 35 cases (70%), SD 11 cases (22%), PD 1 case (2%), clinical RR 76.0% (38/50). Among the 45 cases who received surgery, 3 cases had pCR (3 / 45,6.7%) and 3 cases had tpCR (3 / 45,6.7%). The 4-year disease-free survival (DFS) was 86.2%, and the 4-year overall survival was 93.1%. The median DFS was 62.4 months [SE: 2.535,95% CI 57.450-67.388]. There was no statistically significant difference in tumor reduction in different situations, including menstrual status (pre-menopausal vs. postmenopausal 46.4% vs. 40.6%, P = 0.536), hormone receptor status (positive vs. negative, 43.0% vs.42.2 (P <0.05), P = 0.929), HER2 (positive vs. negative, 41.3% vs.43.9%, P = 0.774), Ki67 (positive vs. negative, 47.2% vs.43.1%, P = 0.363) (34.3% vs 50.0%, P = 0.375), the degree of differentiation (high differentiated vs. moderately differentiated vs. poorly differentiated, 44.1% vs 42.9% vs 41.3%, P = 0.983) TC vs. TE / PE / TEC vs. EC / FEC, 52.7% vs. 39.8% vs. 38.9%, P = 0.440). Conclusion The combination of taxane and anthracycline for preoperative chemotherapy for invasive breast cancer can effectively control the tumor. There was no statistically significant association between the status of ER / PR, HER2, Ki67, CyclinA2 and tumor reduction.