局部晚期和 III 期乳腺癌患者的新辅助化疗。

Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.

Chin Med J (Engl). 2009 Dec 20;122(24):2993-7.

BACKGROUND

Neoadjuvant chemotherapy has been used as a primary treatment for locally advanced or inflammatory breast cancer, and recently extended to operable breast cancer. However, only a few studies have published data concerning the outcomes of patients with stages II and III breast cancer after neoadjuvant chemotherapy.

METHODS

This study retrospectively investigated the clinical value of neoadjuvant chemotherapy for patients with stages II and III breast cancer. The patients in Group 1 (n = 54) were treated with neoadjuvant chemotherapy, followed by definitive surgery and adjuvant therapy. The patients in Group 2 (n = 43) initially received definitive surgery, followed by adjuvant chemotherapy and other therapies. The operability rates for breast conservation and dermatoplasty were observed in Group 1 after neoadjuvant chemotherapy. After follow-up, the recurrence and overall and disease-free survival rates of the two groups were analyzed.

RESULTS

Neoadjuvant chemotherapy increased the operability rates for breast conservation from 17.1% to 40.0% in stage II (P = 0.034) and 0% to 12.6% in stage III (P = 0.016), and decreased the dermatoplasty rates from 17.1% to 2.8% in stage II (P = 0.046) and 28.1% to 8.1% in stage III (P = 0.026). After a median follow-up of 46.8 months, there were 11 deaths and 13 recurrences in Group 1, and 15 deaths and 19 recurrences in Group 2. The overall and disease-free survival rates of stage III disease were significantly higher in Group 1 than in Group 2 (68.4% vs 31.2%, P = 0.028, and 63.2% vs 25.0%, P = 0.024, respectively). There were no significant differences in the overall and disease-free survival rates of stage II disease for Group 1 compared with Group 2 (85.7% vs 85.2%, P = 0.953, and 80.6% vs 74.1%, P = 0.400, respectively).

CONCLUSIONS

Neoadjuvant chemotherapy resulted in increased operability for breast conservation and decreased dermatoplasty. Neoadjuvant chemotherapy exhibited better recurrence control, and overall and disease-free survival rates in stage III disease. However, neoadjuvant chemotherapy did not confer greater survival on stage II disease.

背景

新辅助化疗已被用于局部晚期或炎性乳腺癌的主要治疗方法，最近也扩展到可手术的乳腺癌。然而，只有少数研究发表了新辅助化疗后 II 期和 III 期乳腺癌患者结局的数据。

方法

本研究回顾性分析了新辅助化疗治疗 II 期和 III 期乳腺癌患者的临床价值。第 1 组（n=54）患者接受新辅助化疗，然后进行确定性手术和辅助治疗。第 2 组（n=43）患者初始接受确定性手术，然后接受辅助化疗和其他治疗。观察第 1 组新辅助化疗后保乳和皮瓣成形术的可操作性。随访后，分析两组患者的复发率和总生存率及无病生存率。

结果

新辅助化疗使 II 期乳腺癌的保乳可操作性从 17.1%增加到 40.0%（P=0.034），使 III 期乳腺癌的保乳可操作性从 0%增加到 12.6%（P=0.016），使 II 期乳腺癌的皮瓣成形术率从 17.1%降低到 2.8%（P=0.046），使 III 期乳腺癌的皮瓣成形术率从 28.1%降低到 8.1%（P=0.026）。中位随访 46.8 个月后，第 1 组有 11 例死亡和 13 例复发，第 2 组有 15 例死亡和 19 例复发。III 期疾病的总生存率和无病生存率在第 1 组明显高于第 2 组（68.4% vs. 31.2%，P=0.028，63.2% vs. 25.0%，P=0.024）。第 1 组与第 2 组 II 期疾病的总生存率和无病生存率无显著差异（85.7% vs. 85.2%，P=0.953，80.6% vs. 74.1%，P=0.400）。