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目的分析新辅助化疗(NCT)后未达病理完全缓解(pCR)的局部晚期乳腺癌患者的预后,探讨影响患者预后的因素。方法回顾性分析1999年至2005年收治的75例经2~4个周期NCT后未达PCR的Ⅲ期乳腺癌患者的临床病理资料。NCT的疗效评价方法包括临床评价、组织学反应、病理残存程度和病理分期。结果 16例病理微小残存和63例病理残存患者的5年无病生存率分别为75.0%和50.4%(P=0.077),其中Ⅰ期、Ⅱ期、Ⅲ期患者的5年无病生存率分别为100.0%、72.2%和47.4%(P=0.039)。临床评价和组织学反应与患者的预后无关。多因素回归分析显示,NCT疗效是独立的预后影响因素(P=0.014),NCT足量化疗有改善预后的趋势(P=0.093),而临床分期、HER-2状态与患者的预后无关。结论局部晚期乳腺癌患者的预后差,在NCT未达pCR的患者中,术后病理分期是与患者预后最为相关的NCT疗效评价方法,并且是独立的预后影响因素。
Objective To analyze the prognosis of patients with locally advanced breast cancer who have not achieved complete remission (pCR) after neoadjuvant chemotherapy (NCT), and to explore the factors influencing the prognosis of patients. Methods The clinical data of 75 patients with stage Ⅲ breast cancer who failed to reach PCR after 2 ~ 4 cycles of NCT from 1999 to 2005 were retrospectively analyzed. The evaluation of efficacy of NCT includes clinical evaluation, histological reaction, pathological remnants and pathological staging. Results The 5-year disease-free survival rates of 16 patients with pathological residual disease and 63 patients with pathological residual disease were 75.0% and 50.4%, respectively (P = 0.077). The 5-year disease-free survival rates of patients in stage Ⅰ, Ⅱ and Ⅲ 100.0%, 72.2% and 47.4% (P = 0.039). Clinical evaluation and histological response have nothing to do with the patient's prognosis. Multivariate regression analysis showed that the effect of NCT was an independent prognostic factor (P = 0.014). The adequate chemotherapy with NCT showed a tendency of improving prognosis (P = 0.093). However, the clinical stage and HER-2 status were not associated with the prognosis of patients. Conclusions The prognosis of patients with locally advanced breast cancer is poor. Among the patients with NCT less than pCR, the postoperative pathological staging is the most effective method for assessing the effect of NCT on prognosis and is an independent prognostic factor.