摘要
目的 通过检测原代乳腺癌细胞对吡柔比星和表柔比星的药物敏感性,来综合评估吡柔比星用于乳腺癌辅助化疗的可行性.方法 收集2008年1月至2009年1月天津医科大学附属肿瘤医院乳腺科就诊的129例原发性乳腺癌患者的新鲜肿组织,采用胶原凝胶体包埋肿瘤细胞原代培养法培养原代乳腺痛细胞,检测其对吡柔比星和表柔比星的敏感性;并同时将139例Ⅱ b～Ⅲ C期原发性乳腺癌患者随机分为两组,分别采用TAC（多西他赛＋吡柔比星＋环磷酰胺）方案及TEC（多西他赛＋表柔比星＋环磷酰胺）方案进行4～6周期的新辅助化疗,并观察肿瘤大小、腋窝淋巴结的变化及毒副反应.通过回顾性分析2003至2006年收治的1241例乳腺癌患者的病例资料,根据患者所应用的化疗方案,将其分为CAF（环磷酰胺＋吡柔比星＋氟尿嘧啶）组及CEF（环磷酰胺＋表柔比星＋氟尿嘧啶）组,比较两组患者的远期预后.结果 原代乳腺癌细胞对吡柔比星和表柔比星的药物敏感性差异无统计学意义（P=0.743）;新辅助化疗总有效率为87.8%,TAC组和TEC组的总有效率、病理完全缓解率、临床完全缓解率、临床部分缓解率以及病情稳定率差异均无统计学意义（均P〉0.05）.化疗过程中两组白细胞下降、血小板减少、便秘、心脏毒性、肝肾功能异常方面差异均无统计学意义（均P〉0.05）.仅TAC组胃肠道反应（恶心或呕吐）为46.5%,低于TEC组的66.2%（P=0.019）：CAF组与CEF组5年无病生存率分别为79%、78%,5年总生存率分别为85%、82%,两组患者的无病生存期及总生存期差异均无统计学意义（均P〉0.05）.结论 吡柔比星及表柔比星在药物敏感性检测方面、乳腺癌新辅助化疗疗效和毒副反应方面、乳腺癌治疗的远期疗效方面差异均无统计学意义,吡柔比星可以与表柔比星一样用于乳腺癌辅助化疗的一线药物.
Objective To compare the chemosensitivity of pirarubicin（THP）and epimbicin （EPI）in primary breast cancer（PBC）cells so as to examine tIleir difierential chemosensitivity to THP and EPI by CD-DST（collagen gel droplet embedded culture-drug sensitivity test）system;To detect the differences in the short.term clinical efficacy and side effects between TAC（docetaxel＋pirarubicin＋cyclophosphamide）and IEC（docetaxel ＋ epirubicin ＋ cyclophosphamide）as the neoadjuvant chemotherapy regimens and the long-term clinical efficacy of CAF （ cyclophosphamide＋pirarubicin＋fluoroumcil）and CEF（cyclophosphamide＋epirubicin＋fluorouracil）as the chemotherapy regimens in breast callcer：To evaluate the feasibility of THP as an adjuvant chemotherapeutic regimen in the treatment of breast cancer.Methods From January 2008 to January 2009,a total of 129 fresh breast cancer samples were collected. The differential chemosensitivity of cultured PBC cells to THP and EPI was measured by CD-DST test. And 139 cases of PBC patients in II b-Ⅲ c phase were randomly divided into two groups： TAC and TEC groups. After 4-6 cycles of neoadjuvant chemotherapy, the primary lesion, axiltary lymph nodes and side effects were assessed; The clinical data and survival status of 1241 cases of PBC patients treated at our hospital from 2003 to 2006 were collected and divided into CAF and CEF groups according to their chemotherapeutic regimens. Long-term prognosis was compared between two groups. Results There was no significant difference of chemosensitivity between THP and EPI in PBC cells （ P = 0. 743 ） ; The overall response rate （RR） of neoadjuvant chemotherapy was 87.8% ; there was no significant difference between TAC and TEC groups （P 〉 0.05 ）. No significant differences existed between two groups in such side effects as leukopenia, thrombocytopenia, constipation, cardiotoxity and hepatorenal dysfunction （P 〉 0. 05 ）. The gastrointestinal reactions of nausea and vomiting was less frequent in the TAC group than that in the TEC group （46. 5% vs 66. 2% , P =0. 019） ; There was no significant difference in 5-year disease-free survival rate （79% vs 78% ） and overall survival rate between two groups （85% vs 82%, P 〉0. 05）. Conclusions There were no significant differences in chemosensitivity, clinical efficacy of neoadjuvant chemotherapy, side effects or long-term efficacy between THP and EPI. Both pirarubicin and epirubicin may be used as conventional chemotherapy in breast cancer.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2011年第20期1388-1392,共5页
National Medical Journal of China
基金
国家自然科学基金（30800355）
教育部长江学者和创新团队发展计划（IRT0743）
关键词
乳腺肿瘤
蒽环类
敏感性与特异性
新辅助化疗
Breast neoplasms
Anthracyclines
Sensitivity and specificity
Neoadjuvant therapy
