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目的:探讨新辅助化疗分别在Ⅱ期和Ⅲ期乳腺癌中的应用价值。方法:选取1994年9月～1999年9月术前经病理确诊可手术乳腺癌426例,分为新辅助化疗组(A组)和对照组(B组)。分析两组的术式选择、局部控制和5年生存率,评价新辅助化疗在Ⅱ、Ⅲ期乳腺癌治疗中的价值。结果:Ⅱ期可保乳率由24.7%提高到44.6%(P=0.000),两组5年总生存率(OS)和无瘤生存率(DFS)无差异(P=0.525、0.581)。Ⅲ期A组患者5年OS和DFS(62.9%、58.1%)均高于B组(39.5%、32.6%)(P=0.014、0.010)。Ⅱ、Ⅲ期化疗后需植皮术均下降(P=0.000、0.000),3年内复发转移A组均低于B组(P=0.035、0.027)。结论:新辅助化疗可提高Ⅱ、Ⅲ期可手术乳腺癌患者的保乳率、减少植皮术、降低局部复发转移;可提高Ⅲ期乳腺癌患者的5年生存率。
Objective: To investigate the value of neoadjuvant chemotherapy in stage Ⅱ and stage Ⅲ breast cancer. Methods: From September 1994 to September 1999, 426 patients with operable breast cancer were diagnosed by pathology before operation. The patients were divided into neoadjuvant chemotherapy group (A group) and control group (B group). The surgical procedures, local control and 5-year survival rates of the two groups were analyzed to evaluate the value of neoadjuvant chemotherapy in the treatment of stage II and III breast cancer. Results: The rate of breast-conserving in stage Ⅱ increased from 24.7% to 44.6% (P = 0.000). There was no difference in 5-year overall survival (OS) and disease free survival (DFS) between the two groups (P = 0.525,0.581). The 5-year OS and DFS (62.9%, 58.1%) in stage Ⅲ A patients were significantly higher than those in patients in group B (39.5%, 32.6%) (P = 0.014,0.010). Grade II and III skin grafts were decreased after chemotherapy (P = 0.000,0.000), and the recurrence and metastasis within 3 years in group A were lower than those in group B (P = 0.035,0.027). Conclusion: Neoadjuvant chemotherapy can improve the breast-conserving rate, reduce the skin-graft and reduce the local recurrence and metastasis in patients with stage II and III breast cancer. It can improve the 5-year survival rate of patients with stage III breast cancer.