栾炯地?罗兴扬?王鹤峰?张旭?赵文嫣

【摘要】目的 探討HER2阳性乳腺癌患者应用曲妥珠单抗联合顺铂化学治疗的临床疗效及对远期生存的影响。方法 选择76例行乳腺癌改良根治术的HER2阳性乳腺癌患者，根据患者选择的治疗方案，对照组术后应用顺铂化学治疗，研究组术后应用曲妥珠单抗（每3周进行1次，4 ～ 6个周期）联合顺铂化学治疗。比较2组临床疗效、36条目健康调查简表（SF-36）评分、总体生存率、不良反应及免疫功能。结果 2组乳腺癌术后患者临床疗效比较差异有统计学意义（P < 0.05），其中研究组总有效率高于对照组（P < 0.05）;研究组SF-36量表的精神健康、情感职能、社会功能、活力、总体健康、躯体疼痛、生理职能、生理功能得分均高于对照组（P均< 0.05）。研究组总体生存率高于对照组（P < 0.05）。2组白细胞减少、骨髓抑制、恶心呕吐、血小板减少、肝功能异常、腹泻的发生率比较差异均无统计学意义（P均> 0.05）;研究组CD3+、CD4+T淋巴细胞比例和CD4+/CD8+T淋巴细胞比值均高于对照组（P均< 0.05），CD8+T淋巴细胞比例低于对照组（P < 0.05）。结论 HER2阳性乳腺癌患者术后治疗中，曲妥珠单抗联合顺铂化学治疗有助提高疗效，改善患者免疫力，提升远期生存率。

【关键词】乳腺癌;曲妥珠单抗;顺铂;化学治疗;生存率;复发率;转移率

Efficacy and effect of trastuzumab combined with cisplatin chemotherapy on clinical response rate and long-term survival in patients with HER2 positive breast cancer Luan Jiongdi， Luo Xingyang， Wang Hefeng， Zhang Xu， Zhao Wenyan. Department of General Surgery， Dandong Central Hospital， Dandong 118002， China

Corresponding author， Luan Jiongdi， E-mail： 314557513@ qq. com

【Abstract】Objective To evaluate the influence of trastuzumab combined with cisplatin chemotherapy on clinical effect and long-term survival in patients with human epidermal growth factor receptor 2 （HER2） positive breast cancer. Methods Seventy-six patients with HER2 positive breast cancer undergoing modified radical mastectomy were selected and divided into two groups according to the therapeutic regime. In the control group， cisplatin chemotherapy was adopted. In the study group， trastuzumab （once every three weeks， 4-6 cycles） combined with cisplatin chemotherapy was performed. The clinical efficacy， SF-36 scale score， overall survival， adverse events and immune function were statistically compared between two groups. Results The postoperative clinical efficacy in the study group was significantly better than that in the control group （P < 0.05）. The mental health， role-emotional， social functioning， vitality， general health， bodily pain， role-physical function， and physical functioning scores of the SF-36 scale in the study group were significantly higher than those in the control group （all P < 0.05）. In the study group， the overall survival was significantly higher compared with that in the control group （P < 0.05）. The incidence of leukopenia， bone marrow suppression， nausea and vomiting， thrombocytopenia， abnormal liver function， diarrhea did not significantly differ between two groups （all P > 0.05）. In the study group， the CD3+ proportion， CD4+ proportion and CD4+/CD8+ ratio were all significantly higher compared with those in the control group （all P < 0.05）， whereas the proportion of CD8+ was significantly lower than that in the control group （P < 0.05）. Conclusions For HER2 positive breast cancer patients undergoing mastectomy， trastuzumab combined with cisplatin chemotherapy can effectively improve the clinical efficacy， enhance immune function and increase long-term survival.

【Key words】Breast cancer;Trastuzumab;Cisplatin;Chemotherapy;Survival rate;

Recurrence rate;Metastasis rate

乳腺癌是女性常见恶性肿瘤之一，其治疗方式有手术、放射治疗、化学治疗和内分泌治疗[1]。不同分期尤其是中晚期的乳腺癌术后患者多采用化学治疗，但单药治疗容易出现耐药，影响疗效[2]。抗肿瘤药物是当前研发热点，近年新靶点、新机制、新结构的抗肿瘤药物不断涌现，且研究显示多种不同作用机制抗肿瘤药物联合应用的疗效会更加明显[3]。曲妥珠单抗为抗人表皮生长因子受体2（HER2）单克隆抗体，可以刺激免疫细胞，抑制肿瘤细胞的生长，发挥抗肿瘤和提高免疫力的作用。为了解曲妥珠单抗靶向治疗联合顺铂化学治疗对HER2阳性乳腺癌患者临床疗效及远期生存的影响，本研究比较了曲妥珠单抗联合顺铂治疗及顺铂单药治疗对HER2阳性乳腺癌患者的疗效，现报告如下。……