白蛋白结合型紫杉醇对比多西紫杉醇在三阴性乳腺癌新辅助化疗中的疗效研究

Efficacy of Albumin-Bound Paclitaxel Compared to Docetaxel as Neoadjuvant Chemotherapy for Triple-Negative Breast Cancer

摘要: 目的：分析白蛋白结合型紫杉醇对比多西紫杉醇在三阴性乳腺癌患者新辅助化疗中的疗效，进一步证实白蛋白结合型紫杉醇在三阴性乳腺癌新辅助化疗中的优势。方法：在本回顾分析中，分析了2018年1月至2020年12月于千佛山医院行新辅助化疗且行根治手术治疗的三阴性乳腺癌患者，根据患者接受的新辅助化疗药物，将患者分为白蛋白结合型紫杉醇组(n = 63，白蛋白结合型紫杉醇260 mg/m²、多柔比星50 mg/m²和环磷酰胺500 mg/m²)和多西紫杉醇组(n = 62，多西紫杉醇75 mg/m²，多柔比星50 mg/m²和环磷酰胺500 mg/m²)，分析并评价两组的病理疗效、临床疗效、不良反应发生率以及生存期。结果：白蛋白结合型紫杉醇组与多西紫杉醇组的临床缓解率并无统计学差异(42.86% vs 46.78%, P = 0.660)；而白蛋白结合型紫杉醇组的病理完全缓解(pCR)率显著高于多西紫杉醇组(25.40% vs 8.06%, P = 0.019)，进一步亚组分析显示，组织学分级、淋巴结状态、Ki-67分数以及肿瘤分期是影响治疗结果的重要因素，而多变量分析显示，治疗药物和组织学分级是影响治疗结果的重要因素。关于不良反应，白蛋白结合型紫杉醇组患者出现肝功能损伤以及胃肠道反应的风险更低(P =0.020, P < 0.001)；分析患者的生存期显示白蛋白结合型紫杉醇方案的患者生存期更长(P = 0.002)。结论：对于三阴性乳腺癌患者，白蛋白结合型紫杉醇相比于多西紫杉醇具有更好的病理疗效，发生肝功能损伤及胃肠道反应的风险更低，且对患者的预后更好。

Abstract: Objective: To compare the efficacy of albumin-bound paclitaxel with docetaxel in neoadjuvant chemotherapy of tri-negative breast carcinoma and to confirm the superiority of albumin-bound paclitaxel in neoadjuvant chemotherapy of tri-negative breast carcinoma. Methods: In this retrospective analysis, we analyzed the data of triple-negative breast carcinoma treated with neoadjuvant chemotherapy and radical operation in Qianfoshan Hospital from January 2018 to December 2020. Based on the new adjuvant chemotherapy drugs the patients received, the patients were divided into the albumin-binding cisplatin group (n = 63, albumin-bound cisplatin 260 mg/m², doxorubicin 50 mg/m² and cyclophosphamide 500 mg/m²) and the dosicisplatin group (n = 62, dosicizumab 75 mg/m², doxorubicin 50 mg/m² and cyclophosphamide 500 mg/m²), the pathology, clinical efficacy, incidence of adverse reactions and survival of the two groups were analysed and evaluated. Results: There was no significant difference in clinical remission rate between the two groups (42.86% vs 46.78%, P = 0.660). The pathologic complete remission (pCR) rate of albumin binding paclitaxel group was significantly higher than that of docetaxel group (25.40% vs 8.06%, P = 0.019). Further subgroup analyses revealed that histologic grade, lymph node status, Ki-67 score, and tumor stage were important predictors of treatment outcome. However, multivariate analysis showed that therapeutic drugs and histological grade were important factors affecting treatment outcome. With regard to adverse reactions, patients in the albumin-binding paclitaxel group had a lower risk of hepatic dysfunction and gastrointestinal reactions (P = 0.020, P < 0.001). Analysis of patient survival revealed that patients with albumin-binding paclitaxel regimens had longer survival (P = 0.002). Conclusion: Compared with docetaxel, albumin-bound paclitaxel has better pathological efficacy, lower risk of liver injury and gastrointestinal response, and better prognosis for patients with triple-negative breast carcinoma.