CAJ | 학술논문

目的观察新辅助化疗2周期后病灶径线变化与4周期后病理评效结果间的相关性,探讨应用超声评效方法预测乳腺癌新辅助化疗疗效的可行性.方法回顾性观察了138例完成4周期CTFci4w[环磷酰胺(CTX)500 mg/m~2,D1、D8 Q28D;吡(柔)比星(THP)35 mg/m~2,D1、D8 Q28D;5氟尿嘧啶(5-Fu)200 mg·m~(-2)·d~(-1)持续静脉泵注(ci)D1-D28]方案新辅助化疗和84例完成4周期Tq1w(PTX60-80mg/m~2,D1、D8、D15 Q21D)方案新辅助化疗的原发性乳腺癌患者资料,应用受试者工作特征曲线(ROE曲线)分析,对以新辅助化疗2周期后超声影像测量的肿瘤最大垂直双径乘积变化预测4周期后病理Miller & Payne分级进行评价.结果对以超声评效预测新辅助化疗无效、化疗显效和病理学完全缓解3种情况进行ROC曲线分析,其曲线下面积依次为0.689、0.655和0.647(P均<0.05).以传统超声评效<50%为标准预测新辅助化疗无效,或以超声评效≥50%为标准预测化疗显效,kappa值<0.40.结论原发性乳腺癌CTFci4w或Tq1w方案新辅助化疗2周期后,单独以原发灶超声大小变化不能可靠预测化疗4周期后的病理评效结果.
목적 관찰신보조화료2주기후병조경선변화여4주기후병리평효결과간적상관성,탐토응용초성평효방법예측유선암신보조화료료효적가행성.방법 회고성관찰료138례완성4주기CTFci4w[배린선알(CTX)500 mg/m~2,D1、D8 Q28D;필(유)비성(THP)35 mg/m~2,D1、D8 Q28D;5불뇨밀정(5-Fu)200 mg·m~(-2)·d~(-1)지속정맥빙주(ci)D1-D28]방안신보조화료화84례완성4주기Tq1w(PTX60-80mg/m~2,D1、D8、D15 Q21D)방안신보조화료적원발성유선암환자자료,응용수시자공작특정곡선(ROE곡선)분석,대이신보조화료2주기후초성영상측량적종류최대수직쌍경승적변화예측4주기후병리Miller & Payne분급진행평개.결과 대이초성평효예측신보조화료무효、화료현효화병이학완전완해3충정황진행ROC곡선분석,기곡선하면적의차위0.689、0.655화0.647(P균<0.05).이전통초성평효<50%위표준예측신보조화료무효,혹이초성평효≥50%위표준예측화료현효,kappa치<0.40.결론 원발성유선암CTFci4w혹Tq1w방안신보조화료2주기후,단독이원발조초성대소변화불능가고예측화료4주기후적병리평효결과.
Objective To investigate the correlation between change of tumor size after 2 cycles of neoadjuvant chemotherapy and pathological evaluation after 4 cycles of neoadjuvant chemotherapy. And to evaluate the feasibility of predicting pathological evaluation by ultrasonic evaluation in the initial stage of neoadjuvant chemotherapy for primary breast cancer. MethodsRetrospective analysis was performed in women with primary breast cancer,including 138 patients receiving 4 cycles of anthracycline-based neuadjuvant chemotherapy (CTX500 mg/m~2, D1, D8 Q28D; THP35 mg/m~2, D1, D8 Q28D; 5-Fu200 mg/m~2/day, ci D1-D28), and 84 patients receiving 4 cycles of taxane-based neoadjuvant chemotherapy (PTX60-80mg/m~2, D1, D8, D15 Q21D). The ROC (receiver operating characteristic) curve was employed to evaluate whether the product change of 2 largest perpendicular diameters of tumor as observed by ultrasonography after 2 cycles of neoadjuvant chemotherapy could exactly predict the pathologic evaluation by the Miller & Payne grading system criteria after 4 cycles of neoadjuvant chemotherapy. Results When no response, excellent response or pathologic complete remission to neoadjuvant chemotherapy were predicted by ultrasonic evaluation. And the areas under the curve ROC were 0. 689, 0. 655 and 0. 647 respectively (all P values <0. 05). It was predicted as no response by using the traditional standard of ultrasonic evaluation of <50% or excellent response at ≥ 50% ( kappa<0. 40 ). ConclusionPathological evaluation after 4 cycles of anthracycline- or taxane-basecl primary chemotherapy in breast cancer can't be predicted reliably only by the product change of 2 largest perpendicular diameters of tumor as observed by ultrasound after 2 cycles of neoadjuvant chemotherapy.