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目的探讨乳腺癌不同分子亚型与多西他赛密集新辅助化疗疗效及预后的关系。方法选取2007年3月—2010年3月我院收治的手术治疗的乳腺癌患者82例为研究对象,行4周期多西他赛(75 mg/m2,每2周为1周期)方案化疗,随后行外科手术治疗,术后再行4周期EC〔表阿霉素(EPI)75 mg/m2,环磷酰胺(CTX)600 mg/m2,每2周为1周期〕方案化疗;依据免疫组化方法及荧光原位杂交(FISH)法检测新辅助化疗前肿瘤病灶雌激素受体(ER)、孕激素受体(PR)、Her-2及Ki67的表达水平,将乳腺癌分为Luminal A亚型、Luminal B亚型、Her-2+亚型及三阴性亚型4型,分析4型乳腺癌在多西他赛密集新辅助化疗后的疗效及预后的差别。结果 82例患者均可评价疗效,完全缓解(CR)17例,部分缓解(PR)56例,稳定(SD)9例,无进展(PD)患者,有效率(RR)为89.0%(73/82)。11例免疫组化示Her-2染色(++)的患者行FISH测定,5例Her-2为过表达,根据免疫组化法及FISH法检测ER、PR、Her-2和Ki67的表达进行乳腺癌分子分型,Luminal A亚型39例(47.6%),Luminal B亚型19例(23.2%),Her-2+亚型11例(13.4%)及三阴性亚型13例(15.9%);不同乳腺癌分子分型患者的年龄、肿瘤大小、淋巴结转移、组织学类型及外科手术类型比较,差异均无统计学意义(P>0.05)。Luminal A亚型、Lumin-al B亚型、Her-2+亚型及三阴性亚型的RR分别为84.6%(33/39)、84.2%(16/19)、100.0%(11/11)、100.0%(13/13),不同乳腺癌分子分型患者RR比较,差异无统计学意义(χ2=4.185,P=0.242)。截至2012年6月82例乳腺癌患者3年无病生存率(DFS)、总生存率(OS)分别为85%、88%。Luminal A亚型、Luminal B亚型、Her-2+亚型、三阴性亚型的3年DFS及OS比较,差异有统计学意义(χ2值分别为9.584和9.414,P<0.05);其中Luminal A亚型与Her-2+亚型、Luminal A亚型与三阴性亚型的3年DFS及OS比较,差异均有统计学意义(P<0.05)。结论单药75 mg/m2多西他赛密集新辅助化疗对Luminal A亚型、Luminal B亚型、Her-2+亚型及三阴性亚型疗效相似,但Luminal A亚型比Her-2+亚型、三阴性亚型预后更好。
Objective To investigate the relationship between different molecular subtypes of breast cancer and the efficacy and prognosis of docetaxel-intensive neoadjuvant chemotherapy. Methods Eighty-two patients with breast cancer who underwent surgery in our hospital from March 2007 to March 2010 were enrolled in the study. Four weeks of docetaxel (75 mg / m2, once every two weeks) Followed by surgical treatment, 4 cycles after EC (epirubicin (EPI) 75 mg / m2, CTX 600 mg / m2, every 2 weeks for a period] regimen chemotherapy; according to the immune group (PR), Her-2 and Ki67 in neoadjuvant chemotherapy before treatment were detected by fluorescence in situ hybridization (FISH). The breast cancer was divided into Luminal A Luminal B subtypes, Her-2 subtypes, and triple negative subtypes type 4, the difference between the efficacy and prognosis of type 4 breast cancer after neoadjuvant chemotherapy with docetaxel was analyzed. Results In 82 patients, the response rate was 17 cases of complete remission (CR), 56 cases of partial remission (PR), 9 cases of stable (SD) and no progress (PD). The effective rate (RR) was 89.0% 82). Eleven patients with immunohistochemistry showed Her-2 staining (++) were subjected to FISH and 5 to Her-2 overexpression. The expression of ER, PR, Her-2 and Ki67 was detected by immunohistochemistry and FISH There were 39 (47.6%) Luminal A subtypes, 19 (23.2%) Luminal B subtypes, 11 (13.4%) Her-2 subtypes and 13 (15.9% ). There was no significant difference in age, tumor size, lymph node metastasis, histological type and surgical type between different breast cancer molecular typing patients (P> 0.05). The RR of Luminal A subtype, Lumin-al B subtype, Her-2 subtype and triple negative subtype were 84.6% (33/39), 84.2% (16/19) and 100.0% (11/11) , 100.0% (13/13). There was no significant difference in RR of different breast cancer molecular typing patients (χ2 = 4.185, P = 0.242). As of June 2012 82 cases of breast cancer patients with 3-year disease-free survival (DFS), the overall survival rate (OS) were 85%, 88%. Luminal A subtype, Luminal B subtype, Her-2 subtype, and triple negative subtype had significant difference (P < There were significant differences in 3-year DFS and OS between A subtype and Her-2 subtype, Luminal A subtype and triple negative subtype (P <0.05). Conclusion The single-agent 75 mg / m2 docetaxel-intensive neoadjuvant chemotherapy has similar effects on Luminal A subtype, Luminal B subtype, Her-2 subtype and triple negative subtypes. However, the Luminal A subtype is more effective than Her-2 + Subtype, triple negative subtype better prognosis.