| Objective:Neoadjuvant chemotherapy is widely used in clinic,because it is one of the indispensable treatments on breast cancer.It can reduce tumor stage in order to control the local disease and increase the chances of maximization of resection.Furthermore it can provide information on drug sensitivity to direct subsequent prescription.However,no one standards on neoadjuvant chemotherapy protocol,frequency and period make it difficult for patients to choose the suitable chemotherapy,which makes it a hotspot in research.In this study,by comparing clinical efficacy and side effects of TE,TEC and intensive paclitaxel neoadjuvant chemotherapy,the relationship between different molecular classification and efficiency of neoadjuvant chemotherapy was studied hoping to offer academic evidence on selection of individual neoadjuvant chemotherapy.Methods:269 primary unilateral female breast cancer patients of II-III tumor stage was enrolled in this study from January 2010 to December 2013 at breast cancer center of the Fourth Hospital of Hebei Medical University(China).All the patients were pathologically confirmed as breast cancer and had Immunohistochemistry.Before that,patients had no chemotherapy,radiotherapy and endocrine therapy.Patients were divided into three different groups: weekly paclitaxe group(paclitaxe 75mg/㎡ d1,every seven days).TE group(paclitaxe 175mg/㎡ or docetaxel 75mg/㎡ d1;epirubicin 75 mg/㎡ d1-2 q3w).TEC group(paclitaxe 175mg/ ㎡ or docetaxel 75mg/ ㎡ d1;epirubicin 75 mg/㎡ d1-2;cyclophosphamide600 mg/㎡,q3w).According to WHO treatment response evaluation criteria,clinical efficiency(),Pathological Complete Response(PCR)and side effect were compared in three different neoadjuvant chemotherapy.Moreover,the relationship between molecular classification of breast cancer and neoadjuvant chemotherapy was discussed by SPSS version 21.0 software package(SPSS Company,Chicago,IL)Results: 1 By using chi-square text,clinical features had no statistical difference among three groups include tumor size,lymph node status,histological type,molecular typing.But it had statistical in age and menstrual status.So In order to eliminate the bias,we analysis of subgroups of age and menstrual status.2 Evaluation of therapeutic efficiency of three different chemotherapy groups clinical effective rate.Clinical effective rate of the intensive paclitaxel group is 74.28%(26/35).Clinical effective rate of the TEC group is 91.37%(53/58).Clinical effective rate of the TE group is 82.95%(146/176).By using chi-square text,clinical effective rate had no statistical difference among three groups(P=0.165).Pathologic complete response of the intensive paclitaxel group is 5.71%(2/35);Pathologic complete response of the TEC group is 5.17%(3/58);Pathologic complete response of the TE group is 9.09%(16/176);By using chi-square text,pathologic complete response had no statistical difference among three groups(P=0.556)3 Stratified Analysis 3.1 In different age groups: 3.1.1 Clinical effective rate in different age groupsAge<45 subgroups:Clinical effective rate of the intensive paclitaxel group is25.0%(1/4).Clinical effective rate of the TEC group is 90.5%(19/21).Clinical effective rate of the TE group is 83.9%(50/62).By using chi-square text,clinical effective rate had no statistical difference among three groups(p=0.131).age ≥45& < 60 subgroups: Clinical effective rate of the intensive paclitaxel group is75.0%(9/12).Clinical effective rate of the TEC group is 93.5%(29/31).Clinical effective rate of the TE group is 85.1%(80/94).By using chi-square text,clinical effective rate had no statistical difference among three groups(P=0.887)Age > 60 subgroups:Clinical effective rate of the intensive paclitaxel group is84.2%(16/19).Clinical effective rate of the TEC group is 83.3%(5/6).Clinical effective rate of the TE group is 0.0%(16/20).By using chi-square text,clinical effective rate had no statistical difference among three groups(P=0.733).3.1.2 Pathologic complete response of three different group in different age groups.Age<45 subgroups :Pathologic complete response of the intensive paclitaxel group is 0.0%(0/4);Pathologic complete response of the TEC group is 9.5%(2/21);Pathologic complete response of the TE group is 8.1%(5/62);By using chi-square text,pathologic complete response had no statistical difference among three groups(P=0.861).age ≥45& < 60 subgroups:Pathologic complete response of the intensive paclitaxel group is8.3%(1/12);Pathologic complete response of the TEC group is 3.2%(1/31);Pathologic complete response of the TE group is 8.5%(8/94);By using chi-square text,pathologic complete response had no statistical difference among three groups(P=0.606)。 Age > 60 Pathologic complete response of the intensive paclitaxel group is5.3%(1/19);Pathologic complete response of the TEC group is0.0%(0/6);Pathologic complete response of the TE group is 20.0%(4/20);By using chi-square text,pathologic complete response had no statistical difference among three groups(P=0.145).3.2 Evaluation of therapeutic efficiency of three different chemotherapy groups in menopause or not.3.2.1Premenopausal subgroups : Clinical effective rate of the intensive paclitaxel group is40.0%(2/5).Clinical effective rate of the TEC group is 90.5%(38/42).Clinical effective rate of the TE group is 84.2%(90/114).By using chi-square text,clinical effective rate had no statistical difference among three groups(P=0.431).Postmenopausal subgroups:Clinical effective rate of the intensive paclitaxel group is80.0%(24/30).Clinical effective rate of the TEC group is 93.3%(14/15).Clinical effective rate of the TE group is 83.3%(50/60).By using chi-square text,clinical effective rate had no statistical difference among three groups(P=0.797).3.2.2 Pathologic complete response of three different group in menopause or not.Premenopausal subgroups:Pathologic complete response of the intensive paclitaxel group is 0.0%(0/5);Pathologic complete response of the TEC group is 7.1%(3/42);Pathologic complete response of the TE group is 7.9%(9/114);By using chi-square text,pathologic complete response had no statistical difference among three groups(P=0.621).Postmenopausal subgroups : Pathologic complete response of the intensive paclitaxel group is 6.67%(2/30);Pathologic complete response of the TEC group is 0%(0/15);Pathologic complete response of the TE group is 13.33%(8/60);By using chi-square text,pathologic complete response had no statistical difference among three groups(P=0.238).4 According to the immunohistochemical results,patients were divided into three groups as following:156 luminal subtype(ER/PR positive),58 HER-2 overexpression subtype(ER/PR negtive,HER2 positive)and 50 triple negtive subtype(ER,PR,HER2 negtive).Another 5 patients were not able to do the immunohistochemical text because of no enough tissue.4.1 Clinical effective rate in different molecular classification.4.1.1 Evaluation of therapeutic efficiency of three different molecular classification.Clinical effective rate of the luminal subtype group is 82.69%(129/156).Clinical effective rate of the HER2 overexpression group is 87.93%(51/58).Clinical effective rate of the triple negtive group is 86.0%(43/50).By using chi-square text,clinical effective rate had no statistical difference among three groups(P=0.608).4.1.2 Pathologic complete response of three different molecular classificationPathologic complete response of the lunimal subtype group is 4.48%(7/156);Pathologic complete response of the HER2 overexpression group is 13.79%(8/58);Pathologic complete response of the triple negtive group is 10.0%(5/50);By using chi-square text,pathologic complete response had no statistical difference among three groups(P=0.053).4.2 Comparative analysis between triple negtive and non-triple negtive breast cancer.4.2.1Clinical effective rate of the triple negtive group is 86.0%(43/50).Clinical effective rate of the non triple negtive group is 84.12%(180/214).By using chi-square text,clinical effective rate had no statistical difference among two groups(P=0.74).4.2.2 Pathologic complete response between triple negtive and non-triple negtive breast cancer.Pathologic complete response of the triple negtive group is 10%(5/50);Pathologic complete response of the non triple negtive group is 7.09%(15/214);By using chi-square text,pathologic complete response had no statistical difference among three groups(P=0.569).5 Analysis of side effectIn this study,IV arrest of bone marrow was studied in three different group.Preventing use drugs of increasing white cells was applied in all three chemotherapy.However,severe arrest of bone marrow even the febrile neutropenia(FN)was happened.21(36.21%)patients had IV arrest of bone marrow in TEC group and 13 of 21 accompanied by FN.40(22.73%)patients had IV arrest of bone marrow in TE group and 30 of 40 accompanied by FN.1(2.85%)patients had IV arrest of bone marrow in paclitaxel group.By using chi-square text,pathologic complete response had statistical difference among three groups(P=0.001).By paired compare,incidence of arrest of bone marrow in TEC group was higher than that in TE group(P=0.043).Incidence of arrest of bone marrow in TE group was higher than that in T group(P=0.007).Incidence of arrest of bone marrow in TEC group was higher than that in T group(P<0.01).Among those three neoadjuvant chemotherapy,TEC group had the highest rate of arrest of bone marrow,on the contrary,T group had the lowest rate of arrest of bone marrow.Conclusions:1 There is no difference on clinical efficacy and pCR among TEC,TE and weekly paclitaxel.2 There is no difference on clinical efficacy and pCR among TEC,TE and weekly paclitaxel.in different age groups(<45,≥45&<60,≥60),and in menopause or not.3 There is no difference on clinical efficacy and pCR among lunimal,HER-2 overexpression and triple negtive subtypes.There is no difference on Clinical efficacy between triple negtive and non triple negtive breast cancer.There is no difference on PCR between triple negtive and non triple negtive breast cancer.4 Among those three neoadjuvant chemotherapy,TEC group had the highest rate of arrest of bone marrow,on the contrary,T group had the lowest rate of arrest of bone marrow.Above-mentioned results point out that weekly paclitaxel had higher safety,which makes it a preferred neoadjuvant chemotherapy of breast cancer. |
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