TEC與TE方案在乳腺癌新輔助化療中的臨床療效觀察分析
發(fā)布時(shí)間：2018-08-09 12:42
【摘要】：[目的]回顧性研究分析多西他賽+表柔比星+環(huán)磷酰胺(TEC)方案與多西他賽+表柔比星(TE)方案在乳腺癌新輔助化療中的臨床療效、相關(guān)影響因素以及毒副反應(yīng)差異,并間接探討乳腺癌分子分型與新輔助化療療效的關(guān)系,以期為乳腺癌新輔助化療方案選擇及個(gè)體化治療方案的制定提供參考。[方法]連續(xù)性收集2008年1月至2011年12月云南省腫瘤醫(yī)院收治的TNM分期為Ⅱa-Ⅲc期乳腺癌患者106例,均為女性,經(jīng)空心針穿刺病理活檢證實(shí)為浸潤(rùn)性乳腺癌,并行免疫組化檢查,確定雌激素受體(estrogenreceptor,ER)、孕激素受體(progesterone receptor,PR)和人表皮生長(zhǎng)因子受體2 (human epidermal growth factor receptor 2,HER-2)、Ki-67 水平。將患者分為 2 組:TEC 方案組與TE方案組,其中行TEC方案化療患者61例;行TE方案化療患者45例。收集患者病理及臨床相關(guān)信息,通過(guò)電話隨訪及門診隨訪了解患者的治療、復(fù)發(fā)、轉(zhuǎn)移及生存情況。所選病例患者術(shù)前均行3-6周期TEC方案或TE方案新輔助化療,化療結(jié)束均接受手術(shù),術(shù)后根據(jù)病理檢查結(jié)果規(guī)范完成相關(guān)治療。臨床療效評(píng)價(jià)參照RECIST1.1實(shí)體瘤療效評(píng)價(jià)標(biāo)準(zhǔn),病理療效評(píng)價(jià)依據(jù)Miller Payne (MP)系統(tǒng)。應(yīng)用spss21.0統(tǒng)計(jì)學(xué)軟件對(duì)數(shù)據(jù)進(jìn)行卡方檢驗(yàn)和fisher的精確檢驗(yàn),P0. 05視為差異有統(tǒng)計(jì)學(xué)意義,分別比較2種化療方案組臨床有效率、病理完全緩解(pCR)率、化療毒副反應(yīng)等是否具有統(tǒng)計(jì)學(xué)差異,不同年齡分組、月經(jīng)情況、初潮年齡、哺乳情況、化療周期數(shù)、病理類型、初診腫瘤大小、初診臨床分期、初診淋巴結(jié)狀態(tài)等在兩種化療方案的臨床療效情況,以及探討乳腺癌分子分型與新輔助化療療效的關(guān)系等,采用COX風(fēng)險(xiǎn)回歸模型分析不同化療方案與患者總生存及無(wú)病生存的關(guān)系。[結(jié)果]TE組45例患者的pCR率、臨床有效率分別為17.8%和68.9%,均高于TEC組61例患者的14.8%和65.6%,但差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.675,0.720);TE組及TEC組的保乳率分別為6.7%、3.3%,無(wú)顯著性差異(P=0.416);兩組的常見(jiàn)不良反應(yīng)為粒細(xì)胞減少癥及肝功能損傷,均沒(méi)有顯著性差異(P=0.272,0.123)。但是TE組26人(57.80%)出現(xiàn)Ⅳ°骨髓抑制,TEC組23人(37.7%)出現(xiàn)Ⅳ °骨髓抑制,兩組之間Ⅳ °骨髓抑制發(fā)生率比較,P=0.040,具有統(tǒng)計(jì)學(xué)差異。TE組5年總生存率為86.7%; TEC組5年總生存率為83.6%。生存函數(shù)采用COX回歸分析,P=0.352,無(wú)統(tǒng)計(jì)學(xué)差異�；颊吣挲g、絕經(jīng)情況、初潮年齡、哺乳情況、初診臨床分期、不同化療周期數(shù)等在兩組化療方案間比較均沒(méi)有統(tǒng)計(jì)學(xué)差異。臨床有效率與pCR率在Luminal A型中分別為47.4%和0%,在Luminal B型中分別為64%和10%,在HER2過(guò)表達(dá)型中分別為50%和25%,在TNBC中分別為87.9%和33.3%,有統(tǒng)計(jì)學(xué)差異(P=0.014,0.004),進(jìn)一步研究三陰性乳腺癌(TNBC)的病理緩解率、臨床有效率分別為33.3%和87.9%,均高于非TNBC組的8.2%和58.9%,差異具體統(tǒng)計(jì)學(xué)意義(P=0.020,0.030)。[結(jié)論]1.TE方案與TEC方案兩組之間臨床有效率、病理完全緩解率、保乳率、總生存、無(wú)病生存均無(wú)統(tǒng)計(jì)學(xué)差異。2. TE方案與TEC方案兩組之間骨髓抑制與肝功能損傷發(fā)生率無(wú)統(tǒng)計(jì)學(xué)差異,但是,TEC組Ⅳ°骨髓抑制較TE組發(fā)生率更低。3.分子分型亞組中TNBC型、HER-2過(guò)表達(dá)型、LuminalA型、LuminalB型4組之間臨床有效率、pCR率均有統(tǒng)計(jì)學(xué)差異。TNBC與非TNBC臨床有效率、pCR率均有統(tǒng)計(jì)學(xué)差異。TNBC較非TNBC有更好的臨床有效率及pCR率。因此,結(jié)合臨床療效及化療不良反應(yīng),在新輔助化療中TEC方案更值得推薦;不同分子分型的新輔助化療中,TNBC更易從中獲益。
[Abstract]:[Objective] to review and analyze the clinical efficacy of docetaxel + epirubicin + cyclophosphamide (TEC) and docetaxel + epirubicin (TE) in the new adjuvant chemotherapy of breast cancer, related factors and differences in toxic and side effects, and indirectly discuss the relationship between the molecular classification of breast cancer and the therapeutic effect of neoadjuvant chemotherapy in order to be a new adjuvant for breast cancer. The selection of chemotherapeutic regimen and the formulation of the individualized treatment scheme provided reference. [Methods] the TNM stage of the TNM stage of stage II a- III C of breast cancer patients was collected from January 2008 to December 2011 in 106 cases of breast cancer patients, all of which were female. Through biopsy of hollow needle biopsy proved to be invasive breast cancer, parallel immunohistochemical examination and determination of female. The hormone receptor (estrogenreceptor, ER), progesterone receptor (progesterone receptor, PR) and human epidermal growth factor receptor 2 (human epidermal growth factor receptor 2, HER-2) and Ki-67 levels were divided into 2 groups: 61 patients with chemotherapy regimens and 45 chemotherapy patients. The treatment, recurrence, metastasis and survival of the patients were understood by telephone follow-up and outpatient follow-up. 3-6 cycles of TEC or TE regimen were performed before the operation. All the patients received surgery at the end of the chemotherapy, and the related treatment was completed according to the pathological examination results. The clinical efficacy evaluation referred to RECIST1.. 1 the evaluation criteria for the curative effect of solid tumor, the evaluation of the pathological effect was based on the Miller Payne (MP) system. Spss21.0 statistics software was used to carry out the chi square test and the accurate test of Fisher, and the difference between the P0. 05 was statistically significant. The clinical efficiency of the 2 chemotherapy regimens, the complete pathological remission (pCR) rate, the side reaction of chemotherapy, and so on were compared. There were statistically different age groups, menstruation, age of menarche, age of menarche, breast feeding, number of chemotherapy, pathological type, primary diagnosis of tumor size, primary clinic stage, first diagnosis of lymph node status, and the relationship between the two types of chemotherapy and the relationship between the subclassification of breast cancer and the effect of neoadjuvant chemotherapy. The relationship between different chemotherapy regimens and patients' total survival and disease-free survival was analyzed. [results]TE group, group]TE, pCR rate, clinical effective rate was 17.8% and 68.9%, respectively higher than 14.8% and 65.6% in group TEC 61 patients, but the difference was not statistically significant (P=0.675,0.720); TE and TEC group were 6.7%, 3.3%, respectively (P =0.416): the common adverse reactions in the two groups were granulocytopenia and liver dysfunction (P=0.272,0.123). But in group TE, 26 (57.80%) had IV degree myelosuppression, 23 (37.7%) in group TEC had 4 degree myelosuppression, and the incidence rate of IV degree marrow suppression among the two groups was compared, P=0.040, with statistical difference of 5 year total birth in group.TE. The total survival rate was 86.7%, and the 5 year total survival rate of group TEC was 83.6%. survival function using COX regression analysis and P=0.352, there was no statistical difference. There was no statistical difference between the two groups of chemotherapy schemes, such as age, menopause, age of menarche, breast feeding, primary clinical stage and different chemotherapy cycle number. The clinical efficiency and pCR rate were Luminal A type. 47.4% and 0% in Luminal B respectively, 50% and 25% in HER2 overexpression, 87.9% and 33.3% in TNBC, respectively, with statistical difference (P=0.014,0.004). The pathological remission rate of three negative breast cancer (TNBC) was further studied, the clinical efficiency was 33.3% and 87.9% respectively, which were higher than those of non TNBC group 8.2% and 58.9%, The difference was statistically significant (P=0.020,0.030). [Conclusion The clinical efficiency, total remission rate, breast conserving rate, total survival, and disease free survival between the two groups of]1.TE and TEC regimen were not statistically different between the.2. TE scheme and the TEC scheme two groups, but there was no significant difference in the incidence of bone marrow suppression and liver function injury between the two groups, but the TEC Group IV degree of bone marrow suppression. Compared with the TE group, the incidence of TNBC, HER-2 overexpression, LuminalA and LuminalB in the subgroup of.3. was lower than that of the 4 groups. The pCR rate had a statistically difference between.TNBC and non TNBC, and the pCR rate had a statistically significant difference between non TNBC and non TNBC. In response to neoadjuvant chemotherapy, the TEC protocol is more recommended. TNBC is more likely to benefit from neoadjuvant chemotherapy with different molecular typing.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.9
本文編號(hào)：2174109
[Abstract]:[Objective] to review and analyze the clinical efficacy of docetaxel + epirubicin + cyclophosphamide (TEC) and docetaxel + epirubicin (TE) in the new adjuvant chemotherapy of breast cancer, related factors and differences in toxic and side effects, and indirectly discuss the relationship between the molecular classification of breast cancer and the therapeutic effect of neoadjuvant chemotherapy in order to be a new adjuvant for breast cancer. The selection of chemotherapeutic regimen and the formulation of the individualized treatment scheme provided reference. [Methods] the TNM stage of the TNM stage of stage II a- III C of breast cancer patients was collected from January 2008 to December 2011 in 106 cases of breast cancer patients, all of which were female. Through biopsy of hollow needle biopsy proved to be invasive breast cancer, parallel immunohistochemical examination and determination of female. The hormone receptor (estrogenreceptor, ER), progesterone receptor (progesterone receptor, PR) and human epidermal growth factor receptor 2 (human epidermal growth factor receptor 2, HER-2) and Ki-67 levels were divided into 2 groups: 61 patients with chemotherapy regimens and 45 chemotherapy patients. The treatment, recurrence, metastasis and survival of the patients were understood by telephone follow-up and outpatient follow-up. 3-6 cycles of TEC or TE regimen were performed before the operation. All the patients received surgery at the end of the chemotherapy, and the related treatment was completed according to the pathological examination results. The clinical efficacy evaluation referred to RECIST1.. 1 the evaluation criteria for the curative effect of solid tumor, the evaluation of the pathological effect was based on the Miller Payne (MP) system. Spss21.0 statistics software was used to carry out the chi square test and the accurate test of Fisher, and the difference between the P0. 05 was statistically significant. The clinical efficiency of the 2 chemotherapy regimens, the complete pathological remission (pCR) rate, the side reaction of chemotherapy, and so on were compared. There were statistically different age groups, menstruation, age of menarche, age of menarche, breast feeding, number of chemotherapy, pathological type, primary diagnosis of tumor size, primary clinic stage, first diagnosis of lymph node status, and the relationship between the two types of chemotherapy and the relationship between the subclassification of breast cancer and the effect of neoadjuvant chemotherapy. The relationship between different chemotherapy regimens and patients' total survival and disease-free survival was analyzed. [results]TE group, group]TE, pCR rate, clinical effective rate was 17.8% and 68.9%, respectively higher than 14.8% and 65.6% in group TEC 61 patients, but the difference was not statistically significant (P=0.675,0.720); TE and TEC group were 6.7%, 3.3%, respectively (P =0.416): the common adverse reactions in the two groups were granulocytopenia and liver dysfunction (P=0.272,0.123). But in group TE, 26 (57.80%) had IV degree myelosuppression, 23 (37.7%) in group TEC had 4 degree myelosuppression, and the incidence rate of IV degree marrow suppression among the two groups was compared, P=0.040, with statistical difference of 5 year total birth in group.TE. The total survival rate was 86.7%, and the 5 year total survival rate of group TEC was 83.6%. survival function using COX regression analysis and P=0.352, there was no statistical difference. There was no statistical difference between the two groups of chemotherapy schemes, such as age, menopause, age of menarche, breast feeding, primary clinical stage and different chemotherapy cycle number. The clinical efficiency and pCR rate were Luminal A type. 47.4% and 0% in Luminal B respectively, 50% and 25% in HER2 overexpression, 87.9% and 33.3% in TNBC, respectively, with statistical difference (P=0.014,0.004). The pathological remission rate of three negative breast cancer (TNBC) was further studied, the clinical efficiency was 33.3% and 87.9% respectively, which were higher than those of non TNBC group 8.2% and 58.9%, The difference was statistically significant (P=0.020,0.030). [Conclusion The clinical efficiency, total remission rate, breast conserving rate, total survival, and disease free survival between the two groups of]1.TE and TEC regimen were not statistically different between the.2. TE scheme and the TEC scheme two groups, but there was no significant difference in the incidence of bone marrow suppression and liver function injury between the two groups, but the TEC Group IV degree of bone marrow suppression. Compared with the TE group, the incidence of TNBC, HER-2 overexpression, LuminalA and LuminalB in the subgroup of.3. was lower than that of the 4 groups. The pCR rate had a statistically difference between.TNBC and non TNBC, and the pCR rate had a statistically significant difference between non TNBC and non TNBC. In response to neoadjuvant chemotherapy, the TEC protocol is more recommended. TNBC is more likely to benefit from neoadjuvant chemotherapy with different molecular typing.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.9
【參考文獻(xiàn)】
相關(guān)期刊論文 前9條
1 陳峰;沈霞平;邊林莉;張祖蘭;;TE方案與TEC方案在乳腺癌新輔助化療中的療效比較[J];中國(guó)腫瘤;2013年11期
2 賈海霞;吳建南;李順榮;顧然;蘇逢錫;;表阿霉素聯(lián)合多西紫杉醇新輔助化療治療三陰乳腺癌的療效及預(yù)后評(píng)價(jià)[J];嶺南現(xiàn)代臨床外科;2012年05期
3 尹波;劉莉;鄒麗萍;耿道穎;;乳腺癌新輔助化療前后動(dòng)態(tài)增強(qiáng)MRI半定量[J];中國(guó)醫(yī)學(xué)計(jì)算機(jī)成像雜志;2011年03期
4 桑果;王本忠;;TE方案與TEC方案在乳腺癌新輔助化療中的療效及毒性對(duì)比分析[J];安徽醫(yī)學(xué);2011年04期
5 王姝姝;張毅;齊曉偉;陳慶秋;姜軍;;乳腺癌新輔助化療后殘留灶分型與ER、PR、HER-2的關(guān)系[J];第三軍醫(yī)大學(xué)學(xué)報(bào);2010年21期
6 陳衛(wèi)軍;梁兆煜;陳岸;;TEC方案在乳腺癌新輔助化療中的臨床應(yīng)用:附49例報(bào)告[J];南方醫(yī)科大學(xué)學(xué)報(bào);2010年06期
7 劉慶儀;任洪文;黃小云;李少英;王尊;孫愛(ài)靜;;乳腺癌保乳治療176例回顧性分析[J];中國(guó)癌癥防治雜志;2010年01期
8 楊學(xué)寧,吳一龍;實(shí)體瘤治療療效評(píng)價(jià)標(biāo)準(zhǔn)——RECIST[J];循證醫(yī)學(xué);2004年02期
9 張斌,蔡玉娥,張齊,英子偉,蔣書玲,徐宏,鄭勇學(xué),姜大慶;可手術(shù)的乳腺癌術(shù)前化療的遠(yuǎn)期效果[J];中華腫瘤雜志;1997年04期
，本文編號(hào)：2174109
本文鏈接：http://sikaile.net/yixuelunwen/zlx/2174109.html
最近更新
教材專著
