| Objective: Breast cancer is a type of hormone receptor regulation byhighly malignant tumor heterogeneity, different molecular subtypes ofdisease-free survival, recurrence rate and prognosis are not the same. Thisresearch discusses present treatment situation under the guidance for Her-2overexpressing breast cancer patients through analyzing the standardizationdegree of Her-2overexpressing breast cancer treatment retrospectively sincethe establishment of cNCCN. This will provide guidance for clinical diagnosisand treatment basis.To Her-2overexpressing breast cancer patients.Methods:1This research has selected1870hospitalized patients’ data withprimary breast cancer in the medical oncology department and the center ofthe mammary gland of Fourth Hospital of He bei Medical University fromJanuary2007to November2011.these data have specific histologic diagnosisor cytology By molecular biology subtype expression of ER, PRand Her-2,these patients are divided into four groups,LuminalA group,LuminalBgroup,Her-2overexpressing group,triple negative group.The differences ofbreast cancer clinical and pathological features and relapse and metastasis inthe four groups are compared We should focus observation the treatment andprognosis of Her-2overexpressing breast cancer.2We made continuous diagnose by telephone follow-up and collecthospitalized which ended on Nov.30.2012the starting point for patients withthe operation time and the end point can be decided as the last time ofdiagnose,lost in contact or the death of the patient,. During this time thepatients that are alive or lost in contact are processed with truncationvalues,truncation value of lost in contact is the end follow-up time Patientsdied of breast cancer related diseases are used as complete data. 3The data was organized and processed with SPSS16.0statisticalsoftware. The clinical and pathological features comparative analysis using χ2test; patient survival analysis using the Kaplan-Meier method.Multivariateanalysis using Cox regression analysis; data obtained with P values <0.05were considered statistically significant.Results:1The Her-2overexpressing breast cancer group of530cases accountedfor28.3%.Difference existed in age, tumor size, classification of risks, AJCCclinical stages,pathological types, Whether radiation and chemotherapyn inbreast cancer molecular subtypes.(P <0.05).2The Relapse and metastasis rate of Her-2overexpressing breastcancer were higher than Luminal A and Luminal B breast cancer (P <0.05),Her-2overexpressing breast cancer vulnerable to Multi-organ metastasis andbone metastases, Accounted for23.6%,20.8%.3Multivariate analysis showed that the number lymph node metastasisand AJCC clinical stages are independent factors that would affect theprognosis of Her-2overexpressing breast cancer.4According to the2007-2011each years cNCCN breast cancerguidelines, The specification rate of our Her-2overexpressing breast canceradjuvant chemotherapy which fit all the terms including drug, course,dose,intervals of treatment was respectively36%，41.4%，47.9%，59%，63%from2007to2011. Respectively.chemotherapy course of treatment of the AC,ECscheme, AC-T/D scheme, FEC-T/D scheme were71%，90%，91%，92%respectively.5Compared with practice guidelines, most of the chemotherapydrugdose is low. The total dose of Pirarubicin that in the same combinationchemotherapy regimen of our hospital in a cycle reduce16%,The total dose ofDocetaxel that in the same combination chemotherapy regimen of our hospitalin a cycle reduce24%.The total dose of cyclophosphamide that in the samecombination chemotherapy regimen of our hospital in a cycle reduce8%-35%.6Compared with the standard scheme of each year of the2007-2011 cNCCN breast cancer guidelines, the average OS of standard group on theTaxane-based was49.379month, non-standard group was42.087month, twogroups had difference in statistics（P=0.036）. but The PFS have no obviousdifferenc（eP=0.059）.Standard group and non-standard group of anthracyclinewere not statistically significant in PFS and OS（P=0.747,P=0.814）.7Compared with the standard scheme of2007-2011years cNCCNbreast cancer guidelines,the average PFS of standard group of anthracycline ofAJCC Ⅲ stage was31.594month, the average PFS of Taxane were49.875month. two groups had difference in statistics（P=0.024）. two groups ofAJCC Ⅲ stage had no difference in statistics In OS（P=0.369）. two groupsof AJCCⅠstage，Ⅱstage，Ⅳstage had no difference in statistics In OS andPFS（P <0.05）. Lymph node negativ to standard group of anthracycline andtaxane standard group was not statistically significant In PFS and OS(P=0.475，P=0.555). number of lumph node examined more than4were notobvious difference In PFS and OS (P=0.165,P=0.174). number of lumphnode examined less than3were not obvious difference In PFS and OS (P=0.603,P=0.467).8According to the2007-2011each years cNCCN breast cancerguidelines, the Specification of radiotherapy was79%, standard groupcompared with non-standard group average0S statistically significant （P=0.044）,the average OS of standard group was54.360month, non-standardgroup was45.927month. but The PFS of two group of patients have noobvious difference（P=0.059）.9According to the2007-2011each years cNCCN breast cancerguidelines, The Herceptin regulating utilization was respectively37.5%,44.4%,50%,53.5%,52.6%from the each year2007to2011. the average PFSof standard herceptin group was66.758month, non-standard herceptin groupwas52.863month. the PFS of two groups had difference in statistics（P=0.027）. but The0S of two group of patients have no obvious difference（P=0.059）. Conclusion:1Her-2overexpressing breast cancer of this group accounted for28.3%.The herceptin utilization rate is12.3%.2Compared with the other types of breast cancer, Her-2overexpressingbreast cancer more common in women after the age of50, has a high rate ofpositive lymph nodes, the number of high-risk, advanced clinical stagecharacteristics.The Relapse and metastasis rate of Her-2overexpressing breastcancer were higher than LuminalA and LuminalB breast cancer, Her-2overexpressing breast cancer vulnerable to Multi-organ metastasis and bonemetastases.3The lymph node metastasis and AJCC clinical stages wereindependent factors that would affect the prognosis of Her-2overexpressingbreast cancer.Her-2overexpressing breast cancer patients with highly lymph nodenumber and the AJCC clinical stage have poor prognosis.4The proportion of qualified of chemotherapy patients was37%, theradiotherapy was79%.Compared with the guidelines, the difference of thecyclophosphamide dose with a single drug in the combination ChemotherapyRegime. The total dose for the treatment of our hospital same ChemotherapyRegimen is Fairly low in parts of chemotherapy dose.5The standard group of the Taxane-based Chemotherapy can prolongoverall survive for Her-2overexpressing breast cancer patients.The patients ofour Her-2overexpressing breast cancer with AJCC Ⅲ stage，Standard groupof Taxane-based Chemotherapy can prolong overall survive.6Standardization radiation and chemotherapy can prolong overallsurvival for Her-2overexpressing breast cancer patients.7Standard application herceptin can improve the Her-2overexpressingbreast cancer patients disease-free survival. |
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