| [Objective] The objective of this study was to determine whether there exists different therapeutic effectiveness between the different neoadjuvant chemotherapeutic (NAC) regimens-TAC(Combining docetaxel, anthracycline, and cyclophosphamide,TA (Combining docetaxel, and anthracycline),TC (Combining docetaxel, and cyclophosphamide,FAC(Combining 5-fluorouracil, anthracycline, and cyclophosphamide)-in locally advanced breast cancers(LABCs). Using pathological complete response pCR, objective response OR,complete response CR,partial response PR,Stable Disease SD and Progressive Disease PD as the assessing criterias, hoping to find more agreeable NAC regimens for LABCs. And in LABCs neoadjuvant chemotherapy, to find the effectiveness of anthracycline and the cyclophosphamide's practical value based on the TA chemotherapy regimen.[Methods] one hundred and eighty women with core biopsy-confirmed locally advanced breast cancer were randomly assigned to receive neoadjuvant chemotherapy regime(Usages:TAC:docetaxel:75mg/m2, per 3 week*6, Epirubicin,60mg/m2, per 3 week*6, or Pirarubicin,50 mg/m2, per 3 week*6, cyclophosphamide,600 mg/m2 per 3 week*6; TA:docetaxel:75mg/m2,per 3 week*6, Epirubicin,60mg/m2, per 3 week*6,or Pirarubicin,50 mg/m2, per 3 week*6; TC: docetaxel:75mg/m2,per 3 week*6, cyclophosphamide,600 mg/m2 per 3 week*6; FAC:5-fluorouracil,500 mg/m2, anthracycline per 3 week*6, Epirubicin,60mg/m2, per 3 week*6,or Pirarubicin,50 mg/m2, per 3 week*6, cyclophosphamide,600 mg/m2 per 3 week*6). All patients were evaluated per NAC cycle during the 17-19th day after the first day of the cycle. All tumors were evaluated by immunohistochemistry(IHC) for estrogen(ER) and progestrone(PR) receptors as well as CerbB2. And if CerbB2 is 2+ or 2+-3+ in IHC, then determine the Her-2/neu by fluorescence in situ hybridization(FISH) and/or (chromogenic in Situ Hybridization, CISH). All patients are evaluated by RECIST 1.1 made by European Organization for Research on Treatment of Cancer(EORTC) and pCR. The data is analyzed by SPSS13.0.[Results]1:after the NAC, only 4 cases of 180 patients have PD, total effective rate: 97.78%, the 4 PDs are 2 cases in FAC and 2 cases in TA. Only one patient (T1N2) chose breast conservative surgery, the others all chose modified radical mastectomy. 21 patients have pCR(11.93%) in all, TAC:22.22%, TA:9.3%, TC:13.33%, FAC: 2.33%. pCR is statistical difference(p=0.04) in 4 chemotherapeutic regimens, between TAC and FAC (p=0.005) (a'=0.0083). Best overall response (TAC=91.11%,FAC=60%,TA=86.67%,TC=77.78%) is statistical difference (p=0.02) in 4 chemotherapeutic regimens, between TAC and FAC (p=0.001),and between TA and FAC(p=0.002) (a'=0.0083). In all 180 patients, PD:4 cases (2.22%), SD:35 cases (19.44%), PR:130cases (72.22%), CR:11 cases (6.1%), objective response (OR=CR+PR):141cases(78.32%); OR in TAC:91.11%,in TA:84.44%,in TC:77.78%,in FAC:60.00%. OR is statistical difference(p=0.003) in 4 chemotherapeutic regimens, between TAC and FAC (p=0.001) (a'=0.0083)2:the level of the target lesions percentage'diminish has grow as the first NAC cycle to the fifth in all four chemotherapeutic regimens. In the fifth NAC cycle, TAC is superior to FAC (p=0.007), and TA superior to FAC (p=0.004) (a'=0.0083). The level of the breast lesions percentage'diminish has grow as the first NAC cycle to the fifth in all four chemotherapeutic regimens. In the fifth NAC cycle, TAC is superior to FAC (p=0.003), and TA superior to FAC (p=0.004), (a'=0.0083); in other chemical cycles, no difference of the breast lesion's change exists in four arms. The level of the axillary lymph nodes lesions percentage'diminish has grow as the first NAC cycle to the fifth in all four chemotherapeutic regimens. Comparing with the baseline of the axillary lymph nodes lesions, four chemotherapeutic regimens have no statistical difference in the level of the target diminish in the first cycle (p=0.284).In the second NAC cycle, TAC is superior to FAC (p<0.0001) (a'=0.0083). In the third NAC cycle, TA is superior to FAC (p=0.003) (a'=0.0083)3:the decrease in tumor stage is TAC superior to FAC (p=0.005), and TAC superior to TC (p=0.007) (a'=0.0083).â‘ :in TAC, theâ…¡B,â…¢A,â…¢B of breast lesions stage decrease isâ…¢B superior toâ…¡B (p=0.002), andâ…¢B superior toâ…¢A (p<0.0001) (a'=0.016); in axillary lymph nodes lesions stage' decrease isâ…¢A superrior toâ…¡B (p=0.001), andâ…¢A superior toâ…¢B (p<0.0001) (a'=0.016).â‘¡: in TA, theâ…¡B,â…¢A,â…¢B of breast lesions stage isâ…¢B superior toâ…¡B (p<0.0001), andâ…¢B superior toâ…¢A (p<0.0001) (a'=0.016); in axillary lymph nodes lesions stage'decrease (p=0.004) (mean rank:â…¡B=16.75,â…¢A=27.15,â…¢B=17.93), but no difference has been found in every two stage (a'=0.016).â‘¢:in FAC, theâ…¡B,â…¢A,â…¢B of breast lesions stage isâ…¢B superior toâ…¢A (p=0.002) (a'=0.016); no difference in axillary lymph nodes lesions stage'decrease (p=0.669).â‘£:in TC, theâ…¡B,â…¢A,â…¢B of breast lesions stage isâ…¢B superior toâ…¡B (p<0.0001), andâ…¢B superior toâ…¢A (p<0.0001) (a'=0.016); in axillary lymph nodes lesions stage' decrease isâ…¢B superior toâ…¡B (p<0.0001), andâ…¢B superior toâ…¢A (p=0.007) (a'=0.016).â‘ :the breast lesions(p=0.051) and axillary lymph nodes lesions (p=0.165) stage' decreases ofâ…¡B have no statistic difference in four chemotherapeutic regimens;â‘¡:the breast lesions stage'decrease ofâ…¢A has no statistic difference in four chemotherapeutic regimens (p=0.062), but the axillary lymph nodes lesions stage' decrease is TAC superior to FAC (p=0.002) (a'=0.0083).â‘¢:the breast lesions stage'decrease ofâ…¢B is TA superior to FAC (p=0.001), and TAC superior to FAC (p<0.0001) (a'=0.0083); the axillary lymph nodes lesions stage'decrease of 3A is TAC superior to FAC (p=0.003) (a'=0.0083).4:TNBC:50 cases; Her2 positive:34 cases; non-TNBC-non-Her2+:96 cases.â‘ :the breast lesions stage'decrease of triple-negtive breast cancer TNBC(ER-,PR-,Her2-) is TAC superior to FAC (p=0.001) (a'=0.0083); the axillary lymph nodes lesions stage'decrease (p=0.278) and OR (p=0.39) of TNBC has no statistic difference in four chemotherapeutic regimens;â‘¡:the breast lesions (p=0.134) and the axillary lymph nodes lesions (p=0.379) stage'decrease and OR (p=0.161) of Her2+ have no statistic difference in four chemotherapeutic regimens. Maybe the reason is the sum of the Her2+ patients is too small to find the difference.â‘¢:the breast lesions stage' decrease of non-TNBC-non-Her2+ is TAC superior to FAC (p<0.0001), TC superior to FAC (p=0.001), and TA superior to FAC (p=0.005) (a'=0.0083); the axillary lymph nodes lesions stage'decrease of TNBC is TAC superior to FAC (p=0.001) (a'=0.0083); the OR of TNBC is TAC superior to FAC (p=0.007), and TA superior to FAC (p=0.004) (a'=0.0083)5:in 180 patients,95 cases are menstruation while 85 cases are menopause, and no OR difference between the two groups (p=0.635)6:the different total NAC cycles(3 cycles,4 cycles,5 cycles,6 cycles) have statistic difference in OR (p<0.0001) (mean rank:3 cycles=56.30,4 cycles=84.43, 5 cycles=102.75,6 cycles=108.89),between 3 cycles and 4,5,6 cycles (p |
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