Eltahir A, Heys S D, Hutcheon A W, Sarkar T K, Smith I, Walker L G, Ah-See A K, Eremin O
Department of Surgery, University of Aberdeen, Scotland, United Kingdom.
Am J Surg. 1998 Feb;175(2):127-32. doi: 10.1016/s0002-9610(97)00279-1.
Neoadjuvant (primary) chemotherapy is being used increasingly in the treatment of patients with large and locally advanced breast cancer with the aim of reducing the size of the primary tumor and eliminating micrometastatic disease. Response rates to, compliance with, and survival of patients following neoadjuvant chemotherapy have been variable. We report the results of a consecutive series of 77 patients with breast cancer who received neoadjuvant chemotherapy.
Seventy-seven patients with locally advanced breast cancers were treated with multimodality therapy comprising up to six cycles of chemotherapy (cyclophosphamide, vincristine, doxorubicin, and prednisolone), radiotherapy, and then surgery. The median follow-up was 54 months. Clinical response rates to therapy and overall survival have been documented. In addition, prognostic factors for survival were identified using the Cox proportional hazards model.
The overall objective response rate of the primary tumor to chemotherapy alone was 87% (25% complete and 62% partial responses, UICC criteria). Following radiotherapy the response rate was 90% (52% complete and 38% partial responses). The overall 5-year survival for all patients was 0.48. However, the probability of survival at 5 years was 0.74 in those with a complete response, and 0.36 if there was a partial clinical response, but no patients who had either stasis of disease or progression survived for 5 years. Independent predictors of better survival that were identified were a complete histopathological response after chemotherapy and radiotherapy, a complete clinical response to chemotherapy, and five or six cycles of chemotherapy versus four or less.
Neoadjuvant chemotherapy in patients with large and locally advanced breast cancers can result in satisfactory local control and overall survival rates, especially in patients with a complete clinical or histopathological response after treatment.
新辅助（原发性）化疗在治疗大型局部晚期乳腺癌患者中的应用越来越广泛，目的是缩小原发性肿瘤的大小并消除微转移疾病。新辅助化疗后的缓解率、患者的依从性和生存率各不相同。我们报告了连续77例接受新辅助化疗的乳腺癌患者的结果。
77例局部晚期乳腺癌患者接受了多模式治疗，包括多达六个周期的化疗（环磷酰胺、长春新碱、阿霉素和泼尼松龙）、放疗，然后进行手术。中位随访时间为54个月。记录了治疗的临床缓解率和总生存率。此外，使用Cox比例风险模型确定了生存的预后因素。
仅化疗时原发性肿瘤的总体客观缓解率为87%（完全缓解25%，部分缓解62%，UICC标准）。放疗后的缓解率为90%（完全缓解52%，部分缓解38%）。所有患者的总体5年生存率为0.48。然而，完全缓解患者的5年生存概率为0.74，部分临床缓解患者为0.36，但疾病停滞或进展的患者均无5年生存者。确定的更好生存的独立预测因素是化疗和放疗后完全的组织病理学缓解、化疗的完全临床缓解以及五个或六个周期化疗对比四个或更少周期。
大型局部晚期乳腺癌患者的新辅助化疗可带来令人满意的局部控制率和总生存率，尤其是治疗后有完全临床或组织病理学缓解的患者。
