| Objective: Preoperative chemotherapy for breast cancer is also known as neoadjuvant chemotherapy or induction chemotherapy, which can be widely used in clinical surgery in patients with locally advanced breast cancer in order to achieve the purpose of reduction surgery and can improve the resection rate and conserving rate; and can be used as the body's sensitivity test, in order to evaluation of efficacy and adjust treatment programs in time; early systemic treatment of micrometastasis as soon as possible to eliminate the potential to improve long-term survival. Particularly through the preoperative chemotherapy to achieve pCR, patients can improve the long-term survival with clinical studies.Anthracycline chemotherapy drugs have been regarded as the cornerstone of breast cancer and currently almost all programs in preoperative chemotherapy contains anthracycline. With the widely use of taxinol in the clinical treatment, neoadjuvant chemotherapy for breast cancer has opened up new prospects and it has been reported that the effective rate is 75% to 80%, especially in patients with poor response to the treatment of anthracycline. And the effect in these patients is more obvious advantages. The efficiency of different chemotherapy treatment is not the same. According to reports, clinical studies have shown that the new chemotherapy drugs (taxol, etc.) with anthracyclines in combination neoadjuvant chemotherapy have a high clinical efficacy in breast cancer.This study comparing taxinol plus anthracycline chemotherapy program and the EC for the efficacy of preoperative chemotherapy in breast cancer, and comparing the efficacy of the of T plus pirarubicin (T + A) and T plus epirubicin ( T + E) program in paclitaxel plus anthracycline regimen, so as to provide the choice of reference in the preoperative chemotherapy in breast cancer treatment programs.Methods: Cases with primary breast cancer of stage II-III from 2008.8 to 2010.3 in Breast Center of 4th hospital of Hebei Medical University were given EC regimen (cyclophosphamide 600mg / m~2, d1; epirubicin 75-100mg / m~2, d1, 1 cycle every 3 weeks), and after 2-4 cycles of chemotherapy all cases were evaluated. All these cases composed of EC group data. From 2010.3 to 2011.1, the cases with primary breast cancer of stage II-III were given taxinol plus anthracyclines programs, these programs included: TA or TAC program (paclitaxel 175mg / m~2 or docetaxel 75mg / m~2, pirarubicin 50 mg / m~2, d1, TAC program plus cyclophosphamide 600mg / m~2, d1; 1 cycle every 3 weeks), TE or TEC program (paclitaxel 175mg / m~2 or docetaxel 75mg /m~2, epirubicin 75-100mg/ m~2, d1, TEC program plus cyclophosphamide 600mg/m~2, d1; 1 cycle every 3 weeks), and after 2-4 cycles of chemotherapy all cases were evaluated. All these cases composed of taxinol group data.Results: The evaluation of patients eventually: EC group contains 41 cases and the average age was 45.57 years old; taxinol plus anthracycline group contains 32 cases and the average age was 46.28. The data of two groups related to age of patients was normal distribution and the clinical characteristics of patients were balanced. There was no significant difference between the two groups. In EC group, the clinical efficiency was 68.3% (28/41), total pCR rate was 12.2% (5/41) and according to the pathological evaluation of MP the final classification response to chemotherapy was 41 cases and grade 4-5 chemotherapy was 14 cases (34.15% ); in taxinol plus anthracycline group the clinical efficacy was 84.4% (27/32), total pCR rate was 21.9% (7 / 32) and according to the pathological evaluation of MP the final classification response to chemotherapy was 32 cases and grade 4-5 chemotherapy was 19 cases (59.4%).1 the completion of treatmentIn the 41 cases of EC group, 35 cases finished 4 cycles of preoperative chemotherapy. 4 cases finished 3 cycles, 2 patients finished 2 cycles and 1 patient used the reduction of 2 cycles after 2 cycles of chemotherapy. In 32 cases of taxinol plus anthracycline group, 26 cases finished 4 cycles of preoperative chemotherapy. 5 cases finished 3 cycles. 1 patient after 4 cycles of neoadjuvant was evaluated CR and after giving another 4 cycles chemotherapy and operation, it was confirmed pCR .2 Clinical response evaluationThe clinical palpation of EC group's cases: in the 41 patients, the primary tumor of 11 patients could not be touched after chemotherapy; in taxinol plus anthracycline group: in the 32 patients, the primary tumor of 5 patients could not be touched after chemotherapy.Ultrasound evaluation of the situation: at the end of the scheduled chemotherapy none of EC group was CR; in taxinol plus anthracycline group , 4 cases were CR. The total effective rate (CR+PR): EC group was 70.7% (29/41) while in taxinol plus anthracycline group was 87.5% (28/32). In the two groups, P=0.086, and no significant difference. In the 18 patients of TE/TEC group, the effective rate was 88.89% (16/18), while 14 cases in TA/TAC group, the effective rate was 85.71% (12/14). The two groups P = 0.597, and there was no significant difference.3 pathological evaluation3.1Comparison of pCRIn the 41 cases of EC group, 5 patients achieved pCR (12.2%). In the 32 patients of taxinol plus anthracycline group, 7 patients achieved pCR (21.9%); In the 18 patients of TE/TEC group, 5 patients achieved pCR (23.8%), while in the 14 cases of TA/TAC group, 2 cases achieved a pCR (14.3%). EC group and the taxinol plus anthracycline group compared, P=0.268, no significant difference. TE/TEC group and TA/TAC group compared, P=0.318, no significant difference.3.2 The rate of lymph nodes negative patientsAfter neoadjuvant chemotherapy, in the 41 patients of EC group, 25 cases were lymph node negative (71.0%). In the 32 patients of taxinol plus anthracycline group, 18 cases were node-negative (56.3%), compared with two groups P=0.648, no significant difference.3.3 Response in Miller and Payne (MP) grading systemGrading system based on evaluation of MP, 41 cases in EC group could be evaluated by MP grading system and grade 4-5 chemotherapy response were 14 cases (34.15%); 32 cases in taxinol plus anthracycline group and grade 4-5 chemotherapy response were 19 patients (59.4%). Compared the two groups, P=0.032, there was significant difference.4 Relationship between subgroups of breast cancer in response to chemotherapy:According to the molecular subtypes of breast cancer, all cases were divided into 3 subgroups: ER-positive, HER-2 positive and triple negative breast cancer (TNBC): ER-positive were 38 cases, effective rate was 73.68% (28/38); HER2 positive were 17 cases, effective rate was 88.24% (15/17); TNBC are 12 cases, effective rate was 83.33% (10/12). Compared subgroups of breast cancer: (1) ER-positive and HER2 positive, P=0.393,no significant difference; (2) ER-positive and TNBC ,P=0.768, no significant difference; (3) HER2 positive and TNBC, P=1.000, no significant difference. 5 Compared all cases of the ER-positive and ER-negative, the HER-2 positive and HER-2 negative and the TNBC and non- TNBC.Combined statistics of all cases: (1) ER-positive 38 cases, effective rate was 73.68% (28/38), ER-negative 35 cases, effective rate was 85.71% (30/35), P=0.204, no significant difference; (2) HER-2 positive 17 cases, effective rate was 88.24% (15/17), HER-2 negative 56 cases, effective rate was 76.79% (43/56), P=0.660, no significant difference; (3) TNBC 12 cases, effective rate was 83.33%(10/12), 61 cases of non-TNBC, effective rate was 78.69% (48/61), P=1.000, no significant difference.6 the relationship between chemotherapy and Ki-67In the 41 cases of EC group, the Ki-67 high were 26 cases and effective rate was 73.1% (19/26), pCR 3 cases accounted for 11.5%; Ki-67 low 15 cases, effective rate was 66.7% (10/15), pCR 2 cases accounted for 13.3%. In the 32 patients of taxinol plus anthracycline group, high Ki-67 expression were 18 cases and the effective rate was 88.9% (16/18), pCR 5 cases accounted for 27.8%; Ki-67 low expression 14 cases, effective rate was 92.86% (13/14), pCR 2 cases 14.29%. Efficiency comparison between the two groups: Ki-67 high P=0.369, no significant difference; Ki-67 with low expression of P=0.169, no significant difference.Combined statistics of all cases: Ki-67 high were 44 cases, effective rate was 83.33% (35/44), Ki-67 low expression were 29 cases , effective rate was 78.69% (23/29), the two groups P=0.981, no significant difference.Conclusions:1 Compared taxinol plus anthracycline group with EC group, ultrasound evaluation of efficiency in taxinol plus anthracycline group is higher but no statistically significant.2 Compared taxinol plus anthracycline group with EC group, pCR rate in taxinol plus anthracycline group is higher, but no significant difference.3 Compared TE/TEC group with TA/TAC group, there is no significant differences between pCR rate; and ultrasound evaluation shows no significant difference between two groups.4, Compared taxinol plus anthracycline group with EC group, the lymph nodes negative rate is no statistical difference.5 Compared taxinol plus anthracycline group with EC group, grade 4-5 level in taxinol plus anthracycline group of pathological response to chemotherapy is higher than EC group, and has a significant difference.6 There is no significant difference between subgroups of breast cancer in response to chemotherapy.7 In all cases: ER-positive and ER negative, HER-2 positive and HER-2 negative and TNBC and non-TNBC show no statistically significant difference.8 taxinol plus anthracycline group and EC group of Ki-67 high expression cases and Ki-67 low expression cases shows no significant difference in efficiency; all cases, high Ki-67 expression and low expression of Ki-67 shows no statistical differences in efficiency.
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