| Purpose: Through the analysis on a collection of previous clinical casesand data, the present research retrospectively studies on the comprehensivetreatments, treatment situation and the coincidence level with the cNCCNguidelines as well as an evaluation of current curative effect of Luminal Bbreast cancer.Methods:The clinical date of the present study are collected from the403cases of breast cancer patients who had received surgery treatment, andconfirmed by histopathology in Hebei Medical University Fourth Hospitalfrom January2006to December2010. All patients were ER and/or PRpositive, CerbB2++or+++. The collected clinical data includes patientsgenerally material, operation conditions, chemotherapy, radiation therapy,endocrine treatment, molecular target therapy. Excel database was establishedto record the follow-up visits on the patients.(1) Chemotherapy: In the present study, the clinical chemotherapymaterial data (whether carrying out chemotherapy or not, chemotherapyregimens,chemotherapy cycles, chemotherapy dosage) was analyzed andcompared with the level of cNCCN guidelines. The patients were categorizedinto three groups, group of0-3periods, group of4-6periods and group of6periods plus, and the disease-free survival rate as well as overall survival ratewas taken into analysis and comparison.(2) Radiation: The clinical radiation material (radiation indications,whether carrying out radiotherapy, radiation time, radiation performance) wasanalysed and taken into comparison with the level of cNCCN guidelines.According to the standard of wether receiving radiotherapy or not based on thecNCCN guidelines, patients were divided into the standard group andnon-standard group, and the disease-free surial rate and overall surial ratewere analysed and compared between the two groups. (3) Endocrine therapy: The clinical endocrine therapy material (whetherreceiving endocrine therapy, time, drugs and drug doses for endocrine therapy)was Statisticsed, and compared with the level of cNCCN guidelines.According to the condition that whether patients received the endocrinetherapy on the basis of cNCCN guidelines or not, patients were divided intostandard group and non-standard group,and the disease-free surial and overallsurial rates were analysed and compared between the two groups.(4) Molecular target therapy: The clinical molecular target therapymaterial (targeted drugs, drug dose, treatment time, treatment cycle, and therelationship between molecular target therapy and chemotherapy) wasanalysed and taken into comparison with the level of cNCCN guidelines.(5) Comprehensive treatment: According to the condition whetherpatients were taken under comprehensive treatment on the basis of cNCCNguidelines, patients were divided into standard group and non-standard group,and the disease-free surial and overall surial rates were analysed and comparedbetween the two groups.The statistical software SPSS13.0was adopted for statistical analysis.The Kaplan-Meier method was used to analysis the survival rate, the Log-ranktest was applied in the comparison of survival rate, and P <0.05is used as thesignificance test level.Results:(1) Chemotherapy:254patients (73.0%) who acceptpostoperative adjuvant chemotherapy regimens were in accordance withcNCCN guidelines.149patients (40.0%) with adjuvant chemotherapy cycleswere in accordance with cNCCN guidelines.403patients received2335cycleschemotherapy in total.1690cases of adjuvant chemotherapy regimens were inline with the cNCCN guidelines, among which there were134cases of drugdose zero case of all drug dosage are in accordance with cNCCN guidelines.Patients were categorized into the group of0-3periods, the group of4-6periods and the group of6plus periods. The disease free survival rate ofpatients in4-6-period group is higher than patients in0-3-period group and6-plus-period group, but the disease free survival rate of0-3-period group and 6-plus-period group didn't show a significant difference. The overall survivalrate of patients in4-6-period-group and6-plus-period-group are higher thanpatients in0-3-period-group, but overall survival rate of patients in4-6-period-group and6-plus-period-group didn't show a significant difference.(2) Radiation: In this study,227patients reveal radiation indications,136patients (59.9%) receive radiotherapy, among which97patients(71.4%)received the postoperative radiotherapy. The disease free survival rate of thestandard group is significantly higher than the that of non-standard group.(3) Endocrine therapy:271patients (67.2%) received the endocrinetherapy, the time for taking medicine, drug selection and drug dose were inaccordance with cNCCN guidelines. The disease free survival rate and theoverall survival rate of the standard group is significantly higher than that ofnon-standard group.(4) Molecular target therapy:9patients (2.2%) accepted the moleculartarget therapy, the drug is trastuzumab. And only one patient acceptingmolecular target therapy accords with cNCCN guidelines(5) Comprehensive treatment:227patients need to receive theradiotherapy, chemotherapy and endocrine therapy.106patients (46.7%)patients received comprehensive treatment.176patients need chemotherapyand endocrine therapy.105patients (59.7%) patients received comprehensivetreatment. The disease free survival rate and overall survival rate of patientswho need to receive radiation chemotherapy and endocrine therapy in thestandard group is significantly higher than that in the non-standard group. Andthe disease free survival rate of the standard group is significantly higher thanthat of the unstandard group in the patients who need to receive chemotherapyand endocrine therapy, the overall survival in two groups dosen't show asignificant difference.Conclusions:1.73.0%of the patients who accept postoperative adjuvantchemotherapy regimens accord with the level of cNCCN guidelines.40.0%ofthe patients with adjuvant chemotherapy cycles accord with the guidelines.The chemotherapy drug doses are relatively lower in comparison with the guidelines. Patients who received adjuvant chemotherapy according to thecNCCN guidelines can obtaine recent clinical benefit2.59.9%patients who accept radiation therapy accord with the cNCCNguidelines. Patients accepting radiation therapy in accordance with thecNCCN guidelines can obtaine recent clinical benefit.3.67.2%patients who accept endocrine therapy and selection of drugs,drug dose accord with cNCCN guidelines,86.7%of whom receive endocrinetherapy accord with the cNCCN guidelines. Patients who accept endocrinetherapy based on the cNCCN guidelines can obtaine recent clinical benefit.4. Molecular target therapy did not popular, only2.2%of the patientsadopt the molecular target therapy, and only1patient accepting moleculartarget therapy accords with cNCCN guidelines.5.46.7%patients who need radiotherapy, chemotherapy and hormonetherapy accept the comprehensive treatment. Recent clinical benefit of patientsaccepting comprehensive treatment is better than patients who didn't receivethe comprehensive treatment.59.7%patients who need chemotherapy andhormone therapy accept comprehensive treatment. Disease free survival rateof patients accepting comprehensive treatment is higher than that of patientswho didn't receive comprehensive treatment patients, but the situation ofrecent overall survival benefit remains to be the topic for abundant furtherstudies. |
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