国际肿瘤学杂志

国际肿瘤学杂志 ›› 2022, Vol. 49 ›› Issue (11): 671-676.doi: 10.3760/cma.j.cn371439-20220522-00132

• 论著 • 上一篇    下一篇

白蛋白紫杉醇治疗晚期乳腺癌的疗效和安全性分析

关格格1,2, 孙秋实1,2(), 王越华1,2, 陈德杰3, 梁金娥1,2   

  1. 1湖北文理学院附属医院 襄阳市中心医院肿瘤科，襄阳 441021
    2湖北文理学院肿瘤研究所，襄阳 441021
    3湖北文理学院附属医院 襄阳市中心医院普外科，襄阳 441021
  • 收稿日期:2022-05-22 修回日期:2022-07-09 出版日期:2022-11-08 发布日期:2022-12-06
  • 通讯作者: 孙秋实 E-mail:sqsde@126.com
  • 基金资助:
    吴阶平医学基金会临床科研专题资助基金(320.6750.2020-20-22)

Efficacy and safety analysis of albumin paclitaxel in the treatment of advanced breast cancer

Guan Gege1,2, Sun Qiushi1,2(), Wang Yuehua1,2, Chen Dejie3, Liang Jin'e1,2   

  1. 1Department of Oncology， Xiangyang Central Hospital， Affiliated Hospital of Hubei University of Arts and Science， Xiangyang 441021， China
    2Institude of Oncology， Hubei University of Arts and Science， Xiangyang 441021， China
    3Department of General Surgery， Xiangyang Central Hospital， Affiliated Hospital of Hubei University of Arts and Science， Xiangyang 441021， China
  • Received:2022-05-22 Revised:2022-07-09 Online:2022-11-08 Published:2022-12-06
  • Contact: Sun Qiushi E-mail:sqsde@126.com
  • Supported by:
    Clinical Research Fund of Wu Jieping Medical Foundation(320.6750.2020-20-22)

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摘要：

目的 观察白蛋白紫杉醇在晚期乳腺癌患者中的疗效及安全性。方法 回顾性分析2018年6月至2021年6月在襄阳市中心医院收治的138例晚期乳腺癌患者，按照分子分型、白蛋白紫杉醇治疗线数、转移部位数、具体转移部位、既往是否使用多西他赛和紫杉醇以及白蛋白紫杉醇联合治疗方式进行分组，探讨不同亚组患者在接受白蛋白紫杉醇治疗后的中位无进展生存期（mPFS）及治疗相关不良反应，采用Kaplan-Meier法绘制生存曲线图并进行log-rank检验，采用Cox模型进行多因素分析。结果 整体人群mPFS为8.2个月。三阴性乳腺癌、人表皮生长因子受体-2（HER-2）阳性乳腺癌、Luminal型乳腺癌的mPFS分别为6.4个月、11.2个月、8.1个月，差异有统计学意义（χ2=7.42，P=0.025）。白蛋白紫杉醇为一、二线治疗患者的mPFS为9.5个月，三线至七线治疗患者的mPFS为6.3个月（χ2=3.86，P=0.049）。转移部位≤3个患者的mPFS为8.1个月，>3个患者的mPFS为7.0个月（χ2=0.38，P=0.535）。存在肝、脑转移患者的mPFS为6.8个月，肝、脑以外转移患者的mPFS为9.6个月（χ2=7.53，P=0.006）。既往接受过多西他赛、紫杉醇治疗的患者mPFS为8.2个月，既往未接受过多西他赛、紫杉醇治疗的患者mPFS为9.6个月（χ2=0.03，P=0.862）。白蛋白紫杉醇联合靶向治疗、联合免疫治疗、联合化疗、单药治疗患者的mPFS分别为12.1个月、7.8个月、9.0个月、7.1个月，差异有统计学意义（χ2=8.96，P=0.030）。多因素分析显示分子分型（三阴性：RR=1.87，95%CI为1.24~4.22，P=0.008；HER-2阳性：RR=0.63，95%CI为0.52~0.94，P=0.042）、治疗线数（RR=0.67，95%CI为0.32~0.86，P=0.011）、具体转移部位（RR=1.26，95%CI为1.12~2.75，P=0.014）及联合治疗方式（联合靶向治疗：RR=0.74，95%CI为0.16~0.86，P=0.021；联合化疗：RR=0.93，95%CI为0.48~0.96，P=0.045；联合免疫治疗：RR=0.81，95%CI为0.17~0.78，P=0.032）是患者预后的独立影响因素。不良反应主要有脱发、中性粒细胞减少、周围神经毒性、皮疹，未有因不良反应导致的死亡。结论 白蛋白紫杉醇治疗晚期乳腺癌疗效确切，不良反应可控。

关键词: 乳腺肿瘤, 紫杉醇, 预后

Abstract:

Objective To observe the efficacy and safety of albumin paclitaxel in patients with advanced breast cancer. Methods A retrospective analysis was performed on 138 patients with advanced breast cancer admitted to Xiangyang Central Hospital from June 2018 to June 2021. The patients were divided into groups according to molecular type， number of treatment lines for albumin paclitaxel， number of metastatic sites， specific metastatic sites， past use of docetaxel and paclitaxel and combination therapy of albumin paclitaxel. Median progression-free survival （mPFS） and treatment-related adverse reactions in different subgroups treated with albumin paclitaxel were investigated. Survival curves were plotted by Kaplan-Meier method and log-rank test was performed， and multivariate analysis was performed by Cox model. Results The mPFS of the overall population was 8.2 months. The mPFS of triple negative breast cancer， human epidermal growth factor receptor-2 （HER-2） positive breast cancer and Luminal breast cancer were 6.4 months， 11.2 months and 8.1 months respectively， with a statistically significant difference （χ2=7.42， P=0.025）. The mPFS of patients treated with first- and second-line albumin paclitaxel was 9.5 months， and the mPFS of patients treated with third- to seventh-line was 6.3 months （χ2=3.86， P=0.049）. The mPFS of patients with ≤3 metastatic sites was 8.1 months， and the mPFS of patients with >3 metastatic sites was 7.0 months （χ2=0.38， P=0.535）. The mPFS of patients with liver and brain metastases was 6.8 months， and the mPFS of patients with extrahepatic and extracerebral metastases was 9.6 months （χ2=7.53， P=0.006）. The mPFS of patients who had previously treated with docetaxel and paclitaxel was 8.2 months， and the mPFS of patients who had not previously received docetaxel or paclitaxel was 9.6 months （χ2=0.03， P=0.862）. The mPFS of patients with albumin paclitaxel combined with targeted therapy， combined with immunotherapy， combined with chemotherapy and monotherapy were 12.1， 7.8， 9.0 and 7.1 months respectively， with a statistically significant difference （χ2=8.96， P=0.030）. Multivariate analysis showed that molecular type （triple negative breast cancer RR=1.87， 95%CI： 1.24-4.22， P=0.008； HER-2 positive breast cancer RR=0.63， 95%CI： 0.52-0.94， P=0.042）， number of treatment lines （RR=0.67， 95%CI： 0.32-0.86， P=0.011）， specific metastatic sites （RR=1.26， 95%CI： 1.12-2.75， P=0.014） and combination therapy （combined with targeted therapy RR=0.74， 95%CI： 0.16-0.86， P=0.021； combined with chemotherapy RR=0.93， 95%CI： 0.48-0.96， P=0.045； combined with immunotherapy RR=0.81， 95%CI： 0.17-0.78， P=0.032） were independent factors for prognosis. The main adverse reactions were alopecia， neutropenia， peripheral neurotoxicity and rash， and there was no death caused by adverse reactions. Conclusion Albumin paclitaxel is effective in the treatment of advanced breast cancer with controllable adverse reactions.

Key words: Breast neoplasms, Paclitaxel, Prognosis