| Objective: Breast cancer dose-dense chemotherapy(Dose-dense chemotherapy)refers to a method of applying standard-dose chemotherapy drugs at shorter intervals without reducing the drug concentration in each cycle.Generally,the usual chemotherapy once every three weeks is shortened to once every two weeks in order to shorten the treatment time,improve the treatment effect,extend the survival time of patients,and improve the quality of life.Neoadjuvant chemotherapy(NACT)for breast cancer refers to chemotherapy given before surgery or radiation therapy,and then the purpose of surgery or radiation therapy is to reduce the tumor burden,so that breast cancer patients benefit from subsequent treatments(such as surgery).Detecting the advantages of tumor cell responses can translate higher tumor response rates into breast-conserving treatment rates.At present,there are more and more researches on adjuvant chemotherapy and neoadjuvant chemotherapy in dose-dense chemotherapy regimens,and there have been positive conclusions in adjuvant chemotherapy,but whether there is absolute benefit to patients in neoadjuvant chemotherapy,there is no uniform conclusion on the results of various trials.There are few studies on the efficacy of dose-dense regimens in neoadjuvant chemotherapy,and the conclusions are not completely consistent.Based on this situation,we conducted a survey of breast cancer patients undergoing neoadjuvant treatment in our hospital,observed the efficacy of the dose-dense and traditional regimens,and compared the two.Methods: The data of female breast cancer patients undergoing preoperative neoadjuvant chemotherapy in the breast center of the Fourth Hospital of Hebei Medical University were selected for retrospective analysis,and the age,menstruation,tumor size,and stage of patients undergoing intensive neoadjuvant chemotherapy and non-intensive neoadjuvant chemotherapy were compared and analyzed.,The relationship between axillary condition and molecular typing,pathological type and pCR of patients.Results: Data from 872 women with breast cancer undergoing preoperative neoadjuvant chemotherapy from December 2016 to August 2019 were retrospectively analyzed.All patients had breast cancer confirmed by biopsy before treatment.All patients were treated with modified radical mastectomy for breast cancer after chemotherapy,and follow-up treatment was performed according to the pathological results after surgery.1 In the pathological complete remission(complete pCR,including tumor pCR + lymph node pCR):1.1 The complete pCR rates of triple-negative breast cancer patients in the intensive chemotherapy and non-intensive chemotherapy groups were 42.3% and 22.2%,respectively(P=0.034),the difference was statistically significant,showing that triple-negative patients had better complete pCR.1.2 The complete pCR rates of T4 patients in the intensive and non-intensive chemotherapy groups were 31.3% and 10.3%,respectively(P =0.054),and the complete pCR rates of LuminalA patients in the intensive and non-intensive chemotherapy groups were 22.2% and 7.6%,respectively(P=0.404),although the complete pCR of the above two groups is higher than that of the non-intensive program,the difference is not statistically significant.1.3 The complete pCR rates of HER-2 positive patients in the intensive chemotherapy and non-intensive chemotherapy groups were 10.3% and 24.2%,respectively(P=0.050).1.4 The complete pCR rates of premenopausal patients in the intensive and non-intensive chemotherapy groups were 16.7% and 18.2%(P=0.776),and the complete pCR rates of postmenopausal patients in the intensive and non-intensive chemotherapy groups were 15.8% and 15.3%(P=0.918).Complete pCR rates of T1 patients in the intensive and non-intensive chemotherapy groups were 25.0% and 23.2%(P=1.000),and T2 patients’ complete pCR rates in the intensive and non-intensive chemotherapy groups were 13.4% and 18.7%,respectively.(P=0.293).The complete pCR rates of T3 patients in the intensive and non-intensive chemotherapy groups were 6.3% and 10.9%,respectively(P=0.900).The complete pCR rates of N1 patients in the intensive and non-intensive chemotherapy groups were 19.3% and 18.1%(P=0.828),and the N2 patients’ complete pCR rates in the intensive and non-intensive chemotherapy groups were 5.3% and 16.0%,respectively.(P=0.379).The complete pCR rates of N3 patients in the intensive and non-intensive chemotherapy groups were 17.1% and 15.4%,respectively(P=0.792).The complete pCR rates of stage II patients in the intensive and non-intensive chemotherapy groups were 22.0% and 20.2%,respectively(P=0.796),and the complete pCR rates of stage III patients in the intensive and non-intensive chemotherapy groups were 12.9% and 14.5%(P=0.723).The complete pCR rates of Luminal B patients in the intensive and non-intensive chemotherapy groups were 2.7% and 9.3%,respectively(P=0.304).The rates of complete pCR for patients ≥50 years of age in the intensive and non-intensive chemotherapy groups were 16.9% and 16.0%,respectively(P=0.850),and the rates of complete pCR in the patients of <50 years old in the intensive and non-intensive chemotherapy groups were 15.2% and 18.1%(P=0.627).Patients with invasive ductal carcinoma had a complete pCR rate of 18.6% and 18.8% in the intensive and non-intensive chemotherapy groups,respectively(P=0.967).Other patients with breast cancer had a complete pCR rate in the intensive and non-intensive chemotherapy groups 8.0% and 7.7%(P=1.000).2 In terms of tumor pCR:2.1 The tumor pCR rates of triple-negative patients in the intensive chemotherapy and non-intensive chemotherapy groups were 42.3% and 34.2%,respectively(P=0.434).The tumor pCR rates of T1 patients in the intensive and non-intensive chemotherapy groups were 50.0% and 39.4%(P =0.693),and the tumor pCR rates of T4 patients in the intensive and non-intensive chemotherapy groups were 37.5% and 17.8%,respectively.(P =0.134).The tumor pCR rates of patients with N3 in the intensive chemotherapy and non-intensive chemotherapy groups were 31.4% and 25.1%(P=0.434).The tumor pCR rates of Luminal A patients in intensive chemotherapy and non-intensive chemotherapy groups were 44.4% and 15.2%(P=0.089).Each of the above subgroups showed a higher tumor pCR rate in the intensive regimen,but there was no statistical difference.2.2 The tumor pCR rates of premenopausal patients in the intensive chemotherapy and non-intensive chemotherapy groups were 25.9% and 28.1%,respectively(P=0.735),and the tumor pCR rates of postmenopausal patients in the intensive chemotherapy and non-intensive chemotherapy groups were 26.3% and 25.4%(P=0.888).The tumor pCR rates of T2 patients in the intensive chemotherapy and non-intensive chemotherapy groups were 23.9% and 28.9%,respectively(P=0.398),and the tumor pCR rates of T3 patients in the intensive chemotherapy and non-intensive chemotherapy groups were 6.3% and 16.8%,respectively.(P=0.473).The tumor pCR rates of N1 patients in the intensive chemotherapy and non-intensive chemotherapy groups were 24.6% and 27.1%(P=0.687),and the tumor pCR rates of N2 patients in the intensive chemotherapy and non-intensive chemotherapy groups were 21.1% and 30.3%,respectively.(P =0.412).The tumor pCR rates of patients with stage II in the intensive chemotherapy and non-intensive chemotherapy groups were 29.3% and 29.8%(P=0.947),and the tumor pCR rates of patients with stage III in the intensive chemotherapy and non-intensive chemotherapy groups were 24.3% and 24.8%,respectively.(P=0.924).The tumor pCR rates of HER-2 positive patients in the intensive chemotherapy and non-intensive chemotherapy groups were 28.2% and 35.0%,respectively(P=0.402),and the tumor pCR rates of Luminal B patients in the intensive chemotherapy and non-intensive chemotherapy groups were 8.1 % and 18.1%(P=0.127).The tumor pCR rates in intensive and non-intensive chemotherapy groups for patients aged ≥50 years were 29.2% and 28.2%,respectively(P=0.863),and the tumor pCR rates in intensive and non-intensive chemotherapy groups for patients aged <50 years were 21.7% and 26.0%(P=0.529).The tumor pCR rates of invasive ductal carcinoma patients in the intensive chemotherapy and non-intensive chemotherapy groups were 30.2% and 28.4%,respectively(P=0.726),The tumor pCR rates of other types of breast cancer patients in the intensive chemotherapy and non-intensive chemotherapy groups were 12.0% and 19.7%,respectively(P=0.539).In the above subgroups,the tumor pCR rates of intensive and non-intensive chemotherapy are comparable,and there is no statistical difference between the comparisons.Conclusions:1.The efficacy of the dose-dense neoadjuvant chemotherapy regimen is not weaker than that of the traditional 3-week chemotherapy regimen,and the dose-dense regimen can shorten the treatment time.2.For patients with special molecular typing,such as triple negative breast cancer patients,dose-dense neoadjuvant chemotherapy has a higher pCR rate in terms of complete pCR.3.For T4 patients,neoadjuvant chemotherapy in a dose-dense regimen also has certain advantages in terms of complete pCR.4.The pCR rate of HER-2 positive patients is greatly affected by anti-HER2 therapy,and the significance of intensive chemotherapy to these patients is not yet clear. |
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