三阴性乳腺癌的新辅助化疗：附31 例报告

Neoadjuvant chemotherapy for triple negative breast cancer: a report of 31 cases

摘要:

目的：探讨三阴性乳腺癌（TNBC）新辅助化疗的疗效。 方法：回顾性分析2009年1月―2013年1月收治的63例I~III期TNBC患者临床资料，其中31例术前行新辅助化疗（新辅助化疗组），32例行直接手术后辅助化疗（术后辅助化疗组），新辅助化疗与术后的辅助化疗均采用蒽环类为主序贯紫杉类方案。分析新辅助化疗组患者术前获益情况，并比较两组患者术后复发转移与生存率情况。 结果：新辅助化疗组31例患者术前总获益率为100%，其中完全缓解达61.29%（19/31）；3年内发生局部复发和远处转移者新辅助化疗组13例（41.94%），术后辅助化疗组22例（68.75%），两组差异有统计学意义（χ2=4.585，P<0.05）。新辅助化疗组和术后辅助化疗组的3年无病生存率分别为48.38%、25.00%；5年总生存率分别为38.71%、9.78%，新辅助化疗组两者均明显优于术后辅助化疗组（χ2=4.870，P=0.027；χ2=7.469，P=0.006）。 结论：蒽环类为主序贯紫杉类方案的新辅助化疗能使TNBC患者明显获益，且远期疗效优于术后辅助化疗。

Abstract:

Objective: To investigate the efficacy of neoadjuvant chemotherapy in treatment of triple negative breast cancer (TNBC). Methods: The clinical data of 63 patients with stage I to III TNBC treated from January 2009 to January 2013 were analyzed retrospectively. Of the patients, 31 cases received preoperative neoadjuvant chemotherapy (neoadjuvant chemotherapy group) and 32 cases directly underwent surgery and postoperative adjuvant therapy (postoperative adjuvant therapy group). Sequential taxanes after anthracycline-based regimen was adopted in either neoadjuvant chemotherapy or postoperative adjuvant therapy. The preoperative benefit in neoadjuvant chemotherapy group of patients was analyzed, and the postoperative recurrence, metastasis and survival of the two groups of patients were compared. Results: The overall preoperative benefit rate among the 31 patients in neoadjuvant chemotherapy group was 100%, in which the complete response rate reached 61.29% (19/31). Local recurrence or distant metastasis within postoperative 3 years occurred in 13 cases (41.94%) in neoadjuvant chemotherapy group and 22 cases (68.75%) in postoperative adjuvant therapy group respectively, and the difference between the two groups had statistical significance (χ2=4.585, P<0.05). In neoadjuvant chemotherapy group and postoperative adjuvant therapy group, the 3-year disease-free survival rate was 48.38% and 25.00%, and 5-year overall survival rate was 38.71% and 9.78% respectively, and these two parameters in neoadjuvant chemotherapy group were significantly better than those in postoperative adjuvant therapy group (χ2=4.870, P=0.027; χ2=7.469, P=0.006). Conclusion: Neoadjuvant chemotherapy with an anthracycline-based regimen plus taxanes can effectively benefit the TNBC patients, and its long-term efficacy is also better than that of postoperative adjuvant chemotherapy.