Primary chemotherapy in breast cancer - Correlation between tumor response and patient outcome
Primary chemotherapy in breast cancer - Correlation between tumor response and patient outcome
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DOI：
10.1097/00000421-199804000-00003
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发表时间：
1998-04-01
影响因子：
2.6
通讯作者：
Chollet, P
中科院分区：
文献类型：
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作者：
Ferriere, JP;Assier, I;Chollet, P
本研究的重点是329例接受原发性化疗的乳腺癌患者的肿瘤反应与患者结局之间的相关性。有141例IIIB期肿瘤，包括109例炎性癌。其他恶性肿瘤（34例IIIA，99例IIB，55例IIA）可手术，但被认为太大（> 3 cm），无法进行保守手术，因此接受了主要化疗，以避免乳房切除术。所有患者均接受AVCF方案，包括4周周期的多柔比星（30 mg/m2）第1天，长春新碱（1 mg/m2）第1天，5-氟尿嘧啶（5-FU; 400 mg/m2）第2天至第5天，环磷酰胺（300 mg/m2）第2天至第5天。在189例病例中，在第2天和第3天添加甲氨蝶呤（15 mg/m2）。患者接受6个周期，然后根据肿瘤消退进行局部治疗（手术，放疗或两者兼而有之）。通过临床、乳腺X线摄影和超声心动图检查评估缓解率：观察到50%的客观缓解率，其中15%为完全缓解（68%的II期或IIIA期患者的肿瘤缩小允许保留乳房）。对于整个研究人群，中位随访时间为111个月（范围：60-196）。157例患者出现疾病复发（48例局部复发，14例对侧复发，95例远处复发）。Kaplan-Meier估计显示完全缓解患者的10年总生存率比非完全缓解患者的10年总生存率高：70%比50%（p < 0.03）。新辅助化疗的完全反应似乎是一个良好的预后因素。
This study focused on the correlation between tumor response and patient outcome in 329 breast cancers treated with primary chemotherapy. There were 141 stage IIIB tumors, including 109 inflammatory carcinomas. Other malignancies (34 IIIA, 99 IIB, 55 IIA) were operable but considered to be too large (> 3 cm) for conservative surgery and received primary chemotherapy to avoid mastectomy. All received the AVCF regimen, comprising 4-week cycles of doxorubicin (30 mg/m(2)) day 1, vincristine (1 mg/m(2)) day 1, 5-fluorouracil (5-FU; 400 mg/m(2)) days 2 through 5, cyclophosphamide (300 mg/m(2)) days 2 through 5. In 189 cases, methotrexate (15 mg/m(2)) was added at day 2 and day 3. Patients received 6 cycles, then underwent locoregional treatment (surgery, radiotherapy, or both) according to tumor regression. The response rate was assessed by clinical, mammographic, and echographic examinations: a 50% rate of objective responses were noted, of which 15% were complete responses (tumor shrinkage allowed breast conservation in 68% of patients who had stages II or IIIA). For the whole population studied, median follow-up was 111 months (range, 60-196). One hundred fifty-seven patients had disease relapse (48 local, 14 contralateral, 95 distant). Kaplan-Meier estimates showed an increased 10-year overall survival for patients in complete response, as compared with noncomplete response: 70% versus 50% (p < 0.03). Complete response to neoadjuvant chemotherapy seems a good prognostic factor.