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目的探讨局部晚期乳腺癌新辅助化疗(NCT)前后血清基质金属蛋白酶-9(MMP-9)水平的变化及其对疗效的预测价值。方法检测本院2012年7月至2013年6月收治的80例Ⅱ~Ⅲ期乳腺癌患者NCT前后的血清MMP-9水平并评价NCT疗效。64例ER、PR阳性乳腺癌患者采用EC-T方案化疗(表阿霉素90mg/m2静滴,d1;环磷酰胺600mg/m2静滴,d1,21天为1周期,共4个周期;序贯多西他赛80mg/m2静滴,d1,21天为1周期,共4个周期),16例ER、PR阴性者采用TEC方案化疗(多西他赛75mg/m2静滴,d1;表阿霉素75~85mg/m2静滴,d1;环磷酰胺600mg/m2静滴,d1,21天为1周期,共4个周期)。分析血清MMP-9水平与NCT疗效及临床病理特征的关系。结果 80例患者共完成NCT 290个周期,有效率(RR)为78.8%(63/80),其中获CR 4例,PR 59例。38例(47.5%)临床分期降低。NCT前血清MMP-9阳性组(>900U/L)和阴性组(≤900U/L)的RR分别为85.2%(46/54)和65.4%(17/26),差异有统计学意义(P<0.05)。血清MMP-9水平与乳腺癌化疗前分期、HER-2、ER/PR状态及病理学反应性分级均有关(P<0.05)。在化疗有效、化疗前分期Ⅲ期、HER-2+、ER+、PR-/+、病理学反应性分级G1~G3和G4~G5及绝经和未绝经的患者中,化疗2个周期后的血清MMP-9水平与化疗前比较明显降低(P<0.05)。结论血清MMP-9水平对乳腺癌NCT疗效具有一定的预测价值,可减少NCT的盲目性,有助于制定有效的治疗方案。
Objective To investigate the changes of serum matrix metalloproteinase-9 (MMP-9) levels and their predictive value before and after neoadjuvant chemotherapy (NCT) in locally advanced breast cancer. Methods The serum levels of MMP-9 in 80 patients with stage II-III breast cancer before and after NCT from July 2012 to June 2013 in our hospital were measured and the efficacy of NCT was evaluated. Sixty-four patients with ER, PR positive breast cancer were treated with EC-T chemotherapy (epirubicin 90 mg / m2, d1; cyclophosphamide 600 mg / m2, d1, 21 days for 1 cycle for 4 cycles; Sequential docetaxel 80mg / m2 intravenous infusion, d1, 21 days for a cycle, a total of 4 cycles), 16 cases of ER, PR negative chemotherapy using TEC regimen (docetaxel 75mg / m2 intravenous infusion, d1; Epirubicin 75 ~ 85mg / m2 intravenous infusion, d1; cyclophosphamide 600mg / m2 intravenous infusion, d1, 21 days for a cycle, a total of 4 cycles). The relationship between serum MMP-9 level and the curative effect of NCT and clinicopathological features were analyzed. Results 80 patients completed a total of 290 cycles of NCT. The effective rate (RR) was 78.8% (63/80), of which 4 were CR and 59 were PR. 38 cases (47.5%) clinical stage decreased. The RR of serum MMP-9 positive group (> 900U / L) and negative group (≤900U / L) before NCT were 85.2% (46/54) and 65.4% (17/26) respectively, the difference was statistically significant <0.05). Serum MMP-9 levels were correlated with the status of breast cancer before chemotherapy, HER-2, ER / PR status and pathological grade (P <0.05). In chemotherapy-effective, pre-chemotherapy stage III, HER-2 +, ER +, PR- / +, pathological reactivity classification G1 ~ G3 and G4 ~ G5 and postmenopausal and non-menopausal patients, chemotherapy after 2 cycles of serum MMP-9 levels were significantly lower than before chemotherapy (P <0.05). Conclusion The serum level of MMP-9 has some predictive value for the treatment of breast cancer NCT, which can reduce the blindness of NCT and help to develop an effective treatment plan.