Sirohi B, Arnedos M, Popat S, Ashley S, Nerurkar A, Walsh G, Johnston S, Smith I E
Breast Unit, Royal Marsden NHS Foundation Trust, London, UK.
Ann Oncol. 2008 Nov;19(11):1847-52. doi: 10.1093/annonc/mdn395. Epub 2008 Jun 20.
Experimental data suggest that triple-negative (TN) breast cancer may have increased sensitivity to platinum-based chemotherapy but clinical data are limited. We present our long-term results with platinum-based chemotherapy for TN breast cancer.
In all, 94 (17 TN), 79 (11 TN) and 155 (34 TN) patients receiving platinum-based chemotherapy in neo-adjuvant/adjuvant and advanced setting were included. Response rates and outcome were compared for TN tumours versus others.
Neo-adjuvant complete response rates were significantly higher for TN tumours (88%) than others (51%; P = 0.005). The 5-year overall survival (OS) for TN tumours following adjuvant/neo-adjuvant chemotherapy was 64% [95% confidence interval (CI) 44% to 79%] compared with 85% (95% CI 79% to 90%) for others. Five-year disease-free survival for TN tumours was 57% (95% CI 37% to 73%) compared with 72% (95% CI 64% to 78%) for others. For patients with advanced breast cancer, overall response rates were 41% for TN tumours and 31% for others (P = 0.3). Patients with TN tumours had a significantly prolonged progression-free survival of 6 months compared with 4 months for others (P = 0.05), though the OS was not significantly different between the two groups (11 versus 7 months).
Platinum-based chemotherapy achieves increased response rates for TN tumours, with a trend towards worse survival in early breast cancer through an improved survival in advanced disease. Prospective randomised trials are warranted.
实验数据表明三阴性（TN）乳腺癌可能对铂类化疗的敏感性增加，但临床数据有限。我们展示了铂类化疗治疗TN乳腺癌的长期结果。
总共纳入了94例（其中17例为TN）、79例（其中11例为TN）和155例（其中34例为TN）在新辅助/辅助及晚期情况下接受铂类化疗的患者。比较了TN肿瘤与其他肿瘤的缓解率和结局。
TN肿瘤的新辅助完全缓解率（88%）显著高于其他肿瘤（51%；P = 0.005）。辅助/新辅助化疗后TN肿瘤的5年总生存率（OS）为64%[95%置信区间（CI）44%至79%]，而其他肿瘤为85%（95% CI 79%至90%）。TN肿瘤的5年无病生存率为57%（95% CI 37%至73%），其他肿瘤为72%（95% CI 64%至78%）。对于晚期乳腺癌患者，TN肿瘤的总体缓解率为41%，其他肿瘤为31%（P = 0.3）。TN肿瘤患者的无进展生存期显著延长至6个月，而其他患者为4个月（P = 0.05），尽管两组的总生存期无显著差异（分别为11个月和7个月）。
铂类化疗使TN肿瘤的缓解率提高，早期乳腺癌患者生存有变差趋势，但晚期疾病患者生存得到改善。有必要进行前瞻性随机试验。
