中华肿瘤杂志
中華腫瘤雜誌
중화종류잡지
CHINESE JOURNAL OF ONCOLOGY
2012年
10期
770-774
,共5页
马文玥%张频%张柏林%王翔%徐晓洲%郑闪%王佳玉%蔡锐刚%袁芃%马飞%樊英%徐兵河
馬文玥%張頻%張柏林%王翔%徐曉洲%鄭閃%王佳玉%蔡銳剛%袁芃%馬飛%樊英%徐兵河
마문모%장빈%장백림%왕상%서효주%정섬%왕가옥%채예강%원봉%마비%번영%서병하
乳腺肿瘤%受体,雌激素%受体,孕激素%受体,表皮生长因子%化学疗法,新辅助%临床方案
乳腺腫瘤%受體,雌激素%受體,孕激素%受體,錶皮生長因子%化學療法,新輔助%臨床方案
유선종류%수체,자격소%수체,잉격소%수체,표피생장인자%화학요법,신보조%림상방안
Breast neoplasms%Receptors,estrogen%Receptors,progesterone%Receptor,epidermal growth factor%Chemotherapy,neoadjuvant%Clinical protocols
目的 评价卡铂联合紫杉醇方案治疗局部晚期三阴性乳腺癌的疗效、安全性和远期生存,探索三阴性乳腺癌的优选化疗方案.方法 收集31例经粗针穿刺病理确诊的ⅡA～ⅢC期浸润性乳腺癌患者的临床资料,分析其新辅助化疗效果、生存状况、手术效果及其与免疫组化检测指标的关系.结果 31例乳腺癌患者中,30例患者按计划完成新辅助化疗,1例因首次应用紫杉醇过敏而改用其他方案.28例可评价临床疗效,1例未评价疗效,1例化疗1周期无法评价疗效.客观有效率为85.7％,其中完全缓解(CR)4例(14.3％),部分缓解20例(71.4％),疾病稳定3例(10.7％),疾病进展1例(3.6％).临床降期率为85.7％.31例患者均可评价不良反应.主要不良反应为粒细胞减少,发生率为93.5％,其中3～4级发生率为74.2％,无粒细胞减少性发热.行保乳手术患者4例,改良根治术23例.术后获病理完全缓解(pCR)者11例,pCR率为40.7％,其中乳腺pCR率为44.4％(12/27),腋下淋巴结pCR率为77.8％ (21/27).新辅助化疗临床评价为CR的4例患者均获pCR.出现复发转移者8例,其中局部区域复发者1例,远处转移者7例;出现在确诊后2年内者6例.11例pCR患者中,无病生存者10例,确诊后45个月出现肺转移者1例,现带瘤生存.死亡6例.本组患者中位无病生存时间、总生存时间未达到,3年无病生存率、总生存率分别为62.0％和74.7％.结论 卡铂联合紫杉醇方案治疗局部晚期三阴性乳腺癌客观有效率高,pCR率优于蒽环类联合紫杉类方案,耐受性良好,是治疗局部晚期三阴性乳腺癌的优选化疗方案.
目的 評價卡鉑聯閤紫杉醇方案治療跼部晚期三陰性乳腺癌的療效、安全性和遠期生存,探索三陰性乳腺癌的優選化療方案.方法 收集31例經粗針穿刺病理確診的ⅡA～ⅢC期浸潤性乳腺癌患者的臨床資料,分析其新輔助化療效果、生存狀況、手術效果及其與免疫組化檢測指標的關繫.結果 31例乳腺癌患者中,30例患者按計劃完成新輔助化療,1例因首次應用紫杉醇過敏而改用其他方案.28例可評價臨床療效,1例未評價療效,1例化療1週期無法評價療效.客觀有效率為85.7％,其中完全緩解(CR)4例(14.3％),部分緩解20例(71.4％),疾病穩定3例(10.7％),疾病進展1例(3.6％).臨床降期率為85.7％.31例患者均可評價不良反應.主要不良反應為粒細胞減少,髮生率為93.5％,其中3～4級髮生率為74.2％,無粒細胞減少性髮熱.行保乳手術患者4例,改良根治術23例.術後穫病理完全緩解(pCR)者11例,pCR率為40.7％,其中乳腺pCR率為44.4％(12/27),腋下淋巴結pCR率為77.8％ (21/27).新輔助化療臨床評價為CR的4例患者均穫pCR.齣現複髮轉移者8例,其中跼部區域複髮者1例,遠處轉移者7例;齣現在確診後2年內者6例.11例pCR患者中,無病生存者10例,確診後45箇月齣現肺轉移者1例,現帶瘤生存.死亡6例.本組患者中位無病生存時間、總生存時間未達到,3年無病生存率、總生存率分彆為62.0％和74.7％.結論 卡鉑聯閤紫杉醇方案治療跼部晚期三陰性乳腺癌客觀有效率高,pCR率優于蒽環類聯閤紫杉類方案,耐受性良好,是治療跼部晚期三陰性乳腺癌的優選化療方案.
목적 평개잡박연합자삼순방안치료국부만기삼음성유선암적료효、안전성화원기생존,탐색삼음성유선암적우선화료방안.방법 수집31례경조침천자병리학진적ⅡA～ⅢC기침윤성유선암환자적림상자료,분석기신보조화료효과、생존상황、수술효과급기여면역조화검측지표적관계.결과 31례유선암환자중,30례환자안계화완성신보조화료,1례인수차응용자삼순과민이개용기타방안.28례가평개림상료효,1례미평개료효,1례화료1주기무법평개료효.객관유효솔위85.7％,기중완전완해(CR)4례(14.3％),부분완해20례(71.4％),질병은정3례(10.7％),질병진전1례(3.6％).림상강기솔위85.7％.31례환자균가평개불량반응.주요불량반응위립세포감소,발생솔위93.5％,기중3～4급발생솔위74.2％,무립세포감소성발열.행보유수술환자4례,개량근치술23례.술후획병리완전완해(pCR)자11례,pCR솔위40.7％,기중유선pCR솔위44.4％(12/27),액하림파결pCR솔위77.8％ (21/27).신보조화료림상평개위CR적4례환자균획pCR.출현복발전이자8례,기중국부구역복발자1례,원처전이자7례;출현재학진후2년내자6례.11례pCR환자중,무병생존자10례,학진후45개월출현폐전이자1례,현대류생존.사망6례.본조환자중위무병생존시간、총생존시간미체도,3년무병생존솔、총생존솔분별위62.0％화74.7％.결론 잡박연합자삼순방안치료국부만기삼음성유선암객관유효솔고,pCR솔우우은배류연합자삼류방안,내수성량호,시치료국부만기삼음성유선암적우선화료방안.
Objective To evaluate the efficacy,safety and survival of combination of carboplatin plus paclitaxel as neoadjuvant chemotherapy (NACT) for patients with locally advanced triple-negative breast cancer (TNBC),and explore an optimal regimen for TNBC.Methods Patients with core needle biopsy confirmed pathological diagnosis of Ⅱ A ～ ⅢC invasive breast cancer,negative for estrogen and progesterone receptors and HER2 by immunohistochemistry,and with indication for NACT were eligible in this study.The biopsy tumor tissues were tested for CK5/6,CK14,EGFR and Ki67.The patients received paclitaxel 175 mg/m2 on day 1,carboplatin at an area under the curve 5 mg· min/ml on day 2 of every 21 days.The clinical response was evaluated every 2 cycles according to Standard RECIST 1.0 criteria and surgery was done after four to six cycles.Pathological complete remission (pCR) was defined if absence of invasive tumor in the breast and axillary lymph nodes samples or residual carcinoma in situ only.Results Overall,thirtyone patients were enrolled from January 2008 to November 2010.The median age was 51 years and 83.9％ of the patients were diagnosed as stage Ⅱ B to Ⅲ C diseases.30 Patients completed chemotherapy as planed while one patient changed regimen due to paclitaxel allergy.Twenty-eight patients could be evaluated for clinical efficacy,of which CR,PR,SD,PD were achieved in 4,20,3 and 1 women,respectively.The objective response rate was 85.7％.The expression rate of CK5/6,CK14 and EGFR were 88.9％ (24/27),59.3％ (16/27) and 63％ (17/27),respectively.Among 27 patients who received modified radical mastectomy or breast-conserving surgery,11 patients obtained pCR,with a pCR rate of 40.7％ (95％ CI 22.2％-59.3％).Five of six CK5/6-and CK14-positive patients achieved pCR.All the 31 patients could be evaluated for toxicity according to the NCI-CTC v3.0 criteria.The major toxicities were neutropenia (93.5％),vomiting (45.2％) and ALT/AST increase (32.3％),and grade 3-4 toxicities accounted for 74.2％,3.2％,0,respectively.Until December 2011,at a median follow-up of 28.9 months (range 5-47.9),eight patients developed recurrence including 5 patients died.Among 11 patients with pCR,one suffered from lung metastasis at 45 months after diagnosis and survived with tumor until now.The other ten were alive and disease free.The 3-year DFS and OS were 62％ and 74.7％,respectively.Conclusions As a neoadjuvant treatment for triple-negative breast cancer,carboplatin plus paclitaxel regimen achieves notable higher objective response rate and pCR rate compared with the anthracycline plus paclitaxel regimen reported in the literature,and is well tolerable.It is an optimized regimen for TNBC.
