天津医药

天津医药 ›› 2019, Vol. 47 ›› Issue (4): 409-413.doi: 10.11958/20182100

• 临床研究 • 上一篇    下一篇

术后补充化疗对完整周期新辅助化疗后未获pCR的ⅡA~ⅢB期乳腺癌患者预后的影响

刘梅，张敏，只向成   

  1. 天津医科大学肿瘤医院乳腺三科，国家肿瘤临床医学研究中心，乳腺癌防治教育部重点实验室，天津市“肿瘤防治”重点实验 室，天津市恶性肿瘤临床医学研究中心（邮编 300060）
  • 收稿日期:2018-12-20 修回日期:2019-02-24 出版日期:2019-04-15 发布日期:2019-05-27
  • 通讯作者: 刘梅 E-mail:liumei77916@163.com
  • 作者简介:刘梅（1993），女，硕士在读，主要从事乳腺癌方面研究
  • 基金资助:
    国家自然科学基金

The effect of postoperative chemotherapy on the prognosis of patients with stage ⅡA - ⅢB breast cancer without pCR after the complete cycle of neoadjuvant chemotherapy

LIU Mei, ZHANG Min, ZHI Xiang-cheng   

  1. The Third Department Breast Cancer, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Treatment (Ministry of Education); Key Laboratory of Cancer Prevention and Treatment, Tianjin; Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
  • Received:2018-12-20 Revised:2019-02-24 Published:2019-04-15 Online:2019-05-27
  • Contact: mei liu E-mail:liumei77916@163.com

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摘要： 目的 探讨术后补充化疗对完整周期新辅助化疗后未获病理完全缓解（pCR）的ⅡA~ⅢB期乳腺癌患者预 后的影响。方法 回顾性分析行完整周期新辅助化疗后未获 pCR的 208例ⅡA~ⅢB期的乳腺癌患者，其中 81例患 者术后行补充化疗（补充化疗组），127例未行补充化疗（未补充化疗组）。分析 2组患者 3年总生存率、3年无病生存 率及影响复发转移的因素。结果 中位随访时间 40 个月，全组无病生存率为 76.9%（160/208），3 年总生存率为 88.9%（185/208）。补充化疗组较未补充化疗组无病生存率提高（87.7% vs. 72.4%，P＜0.05）。补充化疗组和未补充化 疗组 3年总生存率分别为 94.2%和 92.1%，差异无统计学意义（P＞0.05）。单因素分析表明雌激素受体（ER）状态、孕 激素受体（PR）状态、HER-2状态及术后补充化疗情况是无病生存的影响因素（P＜0.05），多因素分析显示术后未补 充化疗（HR=2.044，P=0.033）和 HER-2阳性（HR=3.418，P＜0.001）是影响患者无病生存不良预后的独立危险因素。 结论 术后补充化疗可提高完整周期新辅助化疗后未获 pCR的ⅡA~ⅢB期乳腺癌患者的无病生存率，HER-2阳性 患者的预后更差。

关键词: 乳腺肿瘤, 化学疗法, 辅助, 预后, 影响因素, 补充化疗

Abstract: Objective To investigate the effect of postoperative chemotherapy on the prognosis of patients with stage ⅡA-ⅢB breast cancer who did not receive pathological complete response (pCR) after the complete cycle of neoadjuvant chemotherapy. Methods Clinical data of 208 breast cancer patients with stage Ⅱ A - Ⅲ B and without pCR after the complete cycle of neoadjuvant chemotherapy were retrospectively analyzed, including 81 patients underwent postoperative chemotherapy (supplemented chemotherapy group) and 127 patients without supplemental chemotherapy (no supplemented chemotherapy group). The 3-year overall survival rate, 3-year disease-free survival rate and factors affecting recurrence and metastasis were analyzed in two groups of patients. Results With a median follow-up of 40 months, the disease-free survival rate was 76.9% (160/208), and the 3-year overall survival rate was 88.9% (185/208) in whole group. The diseasefree survival rate was improved in supplemental chemotherapy group than that of no supplemented chemotherapy group (87.7% vs. 72.4%, P＜0.05). There was no significant difference in the 3-year overall survival rate between supplemental chemotherapy group and the no supplemented chemotherapy group (94.2% and 92.1%, respectively, P＞0.05). Univariate analysis showed that estrogen receptor (ER) status, pregnancy hormone receptor (PR) status, human epidermal growth factor receptor 2 (HER-2) status and postoperative adjuvant chemotherapy were the influencing factors for disease-free survival (P＜0.05). Multivariate analysis showed that no postoperative chemotherapy (HR=2.044, P=0.033) and HER-2 positive (HR=3.418, P＜0.001) were independent risk factors affecting the poor prognosis of patients with disease-free survival. Conclusion Postoperative chemotherapy can improve the disease-free survival rate of patients with stage ⅡA-ⅢB breast cancer who have not received pCR after the complete cycle of neoadjuvant chemotherapy. The prognosis of patients with positive HER-2 is even worse.

Key words: breast neoplasms, chemotherapy, adjuvant, prognosis, prognostic factors, supplemental chemotherapy