乳腺癌术后应用ACT序贯方案/TAC联合方案辅助化疗的临床观察#br#

摘要/Abstract

摘要： 目的探讨阿霉素+环磷酰胺+多西他赛（ACT）序贯方案与多西他赛+阿霉素+环磷酰胺（TAC）用于乳腺癌术后辅助化疗的不良反应及远期疗效。
方法收集2012年2月至2013年9月130例乳腺癌术后患者，随机分为观察组和对照组，各65例。对照组采用TAC方案化疗：环磷酰胺500 mg／m2静滴，d1；阿霉素50 mg／m2静滴，d1；多西他赛100 mg／m2静滴，d1。21天为1个周期，共化疗6个周期。观察组采用ACT序贯方案化疗：环磷酰胺500 mg／m2静滴，d1；阿霉素50 mg／m2，静滴，d1。21天为1个周期，共化疗4个周期。4周后给予多西他赛100 mg／m2静滴，d1。21天为1个周期，共化疗4次。记录不良反应和淋巴结转移情况，并随访两组的无病生存时间（DFS）。分别检测两组治疗后血清促血管生成素2（ANG2）、血管内皮生长因子（VEGF）和nm23H1的表达情况。
结果治疗后观察组ANG2、VEGF水平分别为（341±39）ng／L和（518±43）ng／L，低于对照组的（581±36）ng／L和（817±44）ng／L，而nm23H1蛋白水平［（669±42）ng／ml］高于对照组［（533±33）ng／ml］，差异均有统计学意义（P＜005）。两组不良反应以1～2级为主，观察组白细胞减少、中性粒细胞减少、恶心、呕吐、腹泻、口腔黏膜炎、肝功能异常的发生率低于对照组，差异有统计学意义（P＜005）。观察组淋巴结转移数目低于对照组，且淋巴结发生转移时间长于对照组（P＜005）。观察组的中位DFS为424个月，优于对照组的346个月（P＜005）。
结论采用ACT序贯化疗方案治疗乳腺癌术后患者，远期疗效优于TAC联合化疗方案，且不良反应更低，能有效抑制乳腺癌发生淋巴转移，值得临床上推广。

关键词: 乳腺癌, 不良反应, 淋巴结转移, 促血管生成素2（ANG2）, 血管内皮生长因子（VEGF）, nm23H1

Abstract: ObjectiveTo investigate the adverse reactions and the efficacy of adriamycin+cyclophosphamide+docetaxel （ACT） sequential chemotherapy and docetaxel+adriamycin+cyclophosphamide （TAC） combined chemotherapy in postoperative treatment of breast cancer.
MethodsFrom February 2012 to September 2013， 130 postoperative breast cancer patients were randomly divided into observation group and control group with 65 cases in each group. Control group was treated with TAC combined chemotherapy： cyclophosphamide iv 500 mg／m2d1， adriamycin iv 50 mg／m2 d1， docetaxel 100 mg／m2 iv d1. Twentyone days was a cycle and 6 cycles was given. Observation group was given ACT sequential chemotherapy： cyclophosphamide 500 mg／m2 iv d1， adriamycin 50 mg／m2 iv d1. Twentyone days was a cycle and 4 cycles was given. And then docetaxel 100 mg／m2 iv d1was given with 21days as a cycle for 4 cycles. Adverse reactions and lymph node metastasis were recorded， and the dieasefree survival time（DFS） of the two groups was followed up. The level of serum angiopoietin 2 （ANG2）， vascular endothelial growth factor （VEGF） and nm23H1 protein were tested.
ResultsAfter treatment， the levels of ANG2 and VEGF in observation group were significantly lower than those in control group［（341±39） ng／L vs. （581±36） ng／L；（518±43） ng／L vs. （817±44） ng／L］， while the level of nm23H1 protein was significantly higher than that in control group［（669±42） ng／m vs. （533±33） ng／ml］. The differences had statistical significance between the two groups （P＜005）. The main adverse reactions were in grade 12. The incidence of leukopenia， neutropenia， nausea， vomiting， oral mucositis and hepatic dysfunction in observation group were lower than those in control group （P＜005）. The number of lymph node metastasis in observation group was significantly lower than that in control group （P＜005）. The occurrence time of lymph node metastasis in observation group was longer than that in control group （P＜005）. The median DFS was 424 months in observation group， longer than 346 months in control group （P＜005）.
ConclusionThe long term efficacy of ACT sequential chemotherapy is superior to TAC combined chemotherapy for postoperative breast cancer patients， which shows fewer adverse reactions and can effectively inhibit the lymph node metastasis of breast cancer. therefore it is worthy of clinical promotion.

Key words: Breast cancer, Adverse reactions, Lymph node metastasis, Angiopoietin 2 （ANG2）, Vascular endothelial growth factor （VEGF）, nm23H1

王青峰, 李金田, 吕敏, 张元颖, 吴永丰. 乳腺癌术后应用ACT序贯方案/TAC联合方案辅助化疗的临床观察#br#[J]. 临床肿瘤学杂志, 2018, 23(7): 640-643.

WANG Qingfeng, LI Jintian, LU Min, ZHANG Yuanying, WU Yongfeng.. Adverse reactions and efficacy of ACT sequential chemotherapy and TAC combined chemotherapy for postoperative treatment of breast cancer[J]. Chinese Clinical Oncology, 2018, 23(7): 640-643.

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