摘要目的 探讨以吡柔比星(THP)为主的联合方案不同应用方法新辅助和辅助治疗原发性乳腺癌的疗效.方法 289例原发性乳腺癌患者中于手术前接受2～8个周期新辅助化疗,其中94例患者采用CTF方案[环磷酰胺(CTX) +5-氟尿嘧啶(5-Fu)+HP],195例患者采用CTFci方案,观察其病理反应和疗效,并分析疗效与5-Fu用药方式之间的关系.结果 289例原发性乳腺癌患者总病理完全缓解率(pCR)为28.4％,5年无病生存率(DFS)为87.6％(95％ CI82.1％ ～92.7％),5年无远处转移生存率(DDFS)为89.9％(95％ CI84.0％～95.8％),总生存率99.6％.CTFci组和CTF组pCR率分别为32.3％和20.2％ (P =0.037),5年DDFS分别为92.9％和80.1％(P=0.015).pCR组与非pCR组5年DFS分别为92.4％和85.6％ (P =0.033).雌激素受体(ER)或孕激素受体(PR)阳性患者pCR低于阴性患者,差异有统计学意义(P=0.004)；人表皮生长因子受体2(HER-2)阳性和HER-2阴性患者5年DDFS分别为75.0％和91.9％ (P =0.043)；ER或PR阳性组中,CTFci组的DDFS高于CTF组,差异有统计学意义(P =0.047).结论 吡柔比星联合化疗方案用于乳腺癌新辅助和辅助化疗,近期疗效满意,持续泵入5-Fu患者的pCR率和DDFS高于常规输入患者.对于ER或PR阳性患者,CTFci方案比CTF方案化疗效果更佳.

abstractsObjective To evaluate the effect of anthracycline pirarubicin-based regimen in association with different ways of fluorouracil (5-Fu) as neoadjuvant and adjuvant chemotherapy for primary breast cancer. Methods Two hundred and eighty-nine primary breast cancer patients who were to be operated,two to eight cycles of pirarubicin in association with cyclophosphamide and 5-Fu ( CTF or CTFci regimen) were given before operation.The pathological response rate,effect and its relation with the infusion routes of 5-Fu were analyzed.Results The overall pathological complete remission (pCR) rate was 28.4％.The median follow-up period was 39 months.The 5-year DFS was 87.6％ (95％ CI:82.1％ to 92.7％ ),5-year DDFS was 89.9％ (95％ CI:84.0％ to 95.8％ ),and overall survival was 99.6％.CTFci (5-Fu,continuous infusion) regimen was superior to CTF regimen in pCR rates (32.3％ vs.20.2％,P =0.037 ),and 5-year DDFS were 92.9％ and 80.1％,respectively ( P =0.015).The pCR group was superior to non-pCR group in 5-year DDFS (92.4％ vs.85.6％,P =0.033 ).The pCR rate of patients with ER/PR-positive tumor was significantly lower than those of ER/PR-negative ( P =0.004).The 5-year DDFS rates of HER-2 (+) and HER-2(-) groups were 75.0％ and 91.9％,respectively (P=0.043).In the ER/PR-positve group,the 5-year DDFS of CTFci regimen was superior to those of CTF regimen,91.4％ vs.81.4％ (P =0.047).Conclusions CTF/CTFci regimen as neoadjuvant and adjuvant chemotherapy is effective for primary breast cancer.CTFci regimen is superior to CTF regimen in pathological complete response rate and 5-year DDFS.CTFci regimen may do better to ER/PR ( + ) patients' benefits compared with CTF regimen.