2种化疗方案在人表皮生长因子受体2阳性乳腺癌患者新辅助化疗中疗效比较的回顾性研究

doi:10.3877/cma.j.issn.1674-0807.2023.02.004

目的

比较ACH-TH(脂质体多柔比星+环磷酰胺+曲妥珠单克隆抗体序贯紫杉醇+曲妥珠单克隆抗体)与TCH(多西他赛+卡铂+曲妥珠单克隆抗体)2种新辅助化疗方案在HER-2阳性乳腺癌患者中的疗效差别。

方法

回顾性收集2017年1月1日至2020年1月31日就诊于东南大学附属中大医院、南京市第一医院、江苏省中医院和江苏省肿瘤医院等4家医院的HER-2阳性并接受新辅助化疗的36例乳腺癌患者临床资料，其中ACH-TH组17例，TCH组19例，采用Fisher确切概率法比较2组患者的pCR率及不良反应发生率。

结果

ACH-TH组的pCR率高于TCH组(13/17比4/19，P＝0.002)。ACH-TH组骨髓抑制和脱发的发生率明显低于TCH组(2/17比10/19，P＝0.014；0比19/19，P<0.001)，而2组的心脏毒性、胃肠道反应、口腔黏膜反应、手足综合征等不良反应发生率比较，差异无统计学意义(P＝1.000、1.000、0.216、0.487)。

结论

ACH-TH方案是HER-2阳性乳腺癌患者新辅助化疗的优选方案。

关键词: 乳腺肿瘤, 受体，ErbB-2, 新辅助治疗, 多柔比星

Objective

To compare the efficacy of the ACH-TH regimen (liposomal-encapsulated doxorubicin+ cyclophosphamide+ trastuzumab, followed by paclitaxel+ trastuzumab) and the TCH regimen (docetaxel + carboplatin + trastuzumab) for neoadjuvant chemotherapy of HER-2 positive breast cancer.

Methods

We retrospectively collected the clinical data of 36 HER-2 positive breast cancer patients who received neoadjuvant chemotherapy in four hospitals (Zhongda Hospital of Southeast University, Nanjing First Hospital, Jiangsu Provincial Hospital of Traditional Chinese Medicine and Jiangsu Provincial Cancer Hospital) from January 1, 2017 to January 31, 2020, including 17 cases in the ACH-TH group and 19 cases in the TCH group. The pathological complete response (pCR) rate and incidence of adverse reactions between the two groups were compared using Fisher’s exact test.

Results

The pCR rate was 13/17 in the ACH-TH group, which was significantly higher than that in the TCH group (4/19) (P=0.002). The incidences of bone marrow suppression and alopecia in the ACH-TH group were significantly lower than those in the TCH group (2/17 vs 10/19, P=0.014; 0 vs 19/19, P<0.001). However, there was no significant difference in the incidence of other adverse events such as cardiotoxicity, gastrointestinal reactions, oral mucosal reactions and hand-foot syndrome between the two groups (P=1.000, 1.000, 0.216, 0.487).

Conclusion

ACH-TH regimen is the optimal regimen for neoadjuvant chemotherapy of HER-2 positive breast cancer patients.

Key words: Breast neoplasms, Receptor, ErbB-2, Neoadjuvant therapy, Doxorubicin

表1 接受2种不同新辅助化疗方案的HER-2阳性乳腺癌患者基线资料比较

组别	例数	年龄(岁)	TNM分期		腋窝淋巴结		激素受体		组织学分级
组别	例数	年龄(岁)	Ⅱ期	Ⅲ期	阴性	阳性	阴性	阳性	2级	3级
ACH-TH组	17^a	50.5±7.1	6	11	5	12	9	8	10	7
TCH组	19^a	51.7±8.7	9	10	2	17	4	15	13	6
检验值		t＝－0.394
P值		0.696	0.516^b		0.219^b		0.082^b		0.730^b

表1 接受2种不同新辅助化疗方案的HER-2阳性乳腺癌患者基线资料比较

组别	例数	年龄(岁)	TNM分期		腋窝淋巴结		激素受体		组织学分级
组别	例数	年龄(岁)	Ⅱ期	Ⅲ期	阴性	阳性	阴性	阳性	2级	3级
ACH-TH组	17^a	50.5±7.1	6	11	5	12	9	8	10	7
TCH组	19^a	51.7±8.7	9	10	2	17	4	15	13	6
检验值		t＝－0.394
P值		0.696	0.516^b		0.219^b		0.082^b		0.730^b

表2 2种不同新辅助化疗方案的不良反应比较

组别	例数	骨髓抑制	心脏毒性	脱发	口腔黏膜炎	手足综合征	胃肠道反应
ACH-TH组	17^a	2	0	0	2	0	0
TCH组	19^a	10	1	19	0	2	1
P值		0.014^b	1.000^b	<0.001^b	0.216^b	0.487^b	1.000^b

表2 2种不同新辅助化疗方案的不良反应比较

组别	例数	骨髓抑制	心脏毒性	脱发	口腔黏膜炎	手足综合征	胃肠道反应
ACH-TH组	17^a	2	0	0	2	0	0
TCH组	19^a	10	1	19	0	2	1
P值		0.014^b	1.000^b	<0.001^b	0.216^b	0.487^b	1.000^b

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Efficacy comparison of two neoadjuvant chemotherapy regimens in human epidermal growth factor receptor 2 positive breast cancer: a retrospective study

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Efficacy comparison of two neoadjuvant chemotherapy regimens in human epidermal growth factor receptor 2 positive breast cancer: a retrospective study