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Objective: In recent years, the incidence of breast cancer in our country continues to improve, but the gradual decline in the risk of death in patients with individualized treatment based on comprehensive treatment on the basis of the rapid development of the concept, Since breast cancer is a heterogeneous group of tumors, their biological behavior very different, different individuals, despite the clinical and pathological features are the same, but the prognosis varies. St.Gallen consensus of the risk of recurrence of breast cancer is divided into high, medium and low risk into three categories, the risk of recurrence risk, prognosis varies. The prognostic factors different from those of low-risk and high-risk patients in the risk group of patients exists unclear. Breast cancer adjuvant chemotherapy with anthracycline-based and taxane applications in recent years, many patients survival benefit. Proposed program NCCN Guidelines for risk breast cancer patients in the adjuvant treatment of anthracycline, taxane risk patients not yet been determined. Therefore this paper to review the crisis in 248 cases of breast cancer cases, using the Cox proportional hazards model analysis of clinicopathological factors and treatment factors on the risk of breast cancer prognosis, and adjuvant chemotherapy application program of anthracycline and taxane-containing patients DFS comparison analysis to The whether taxane programs can improve the prognosis, whether there is a subgroup crowd paclitaxel drug in the risk group of patients, to provide guidance for the clinical optimize treatment program, to provide individualized treatment with new basis. Methods: Fourth Hospital of Hebei Medical University, Department of Medical Oncology March 1, 2007 to 2009, December 31, admitted to have clear pathological diagnosis of postoperative breast cancer risk in the I - III patients with 248 cases. Clinical data, clinical data Access database. Follow-up of all patients (telephone follow-up and patient review), the follow-up period ended December 31, 2010. The mean operative time as a starting point, to the patients died, lost or last follow-up time for the end. Died of breast cancer-related diseases during this period by the full data, if the survival or died of other diseases truncated value processing. The follow-up data to proofread and correct input SPSS13.0 statistical software for statistical, reference to the relevant literature and clinical situation, age, tumor size, axillary lymph node metastasis and other clinicopathological factors and postoperative treatment methods to quantify assignment, Cox proportional hazards model analysis, the impact-risk breast cancer patients disease-free survival (DFS) and overall survival (OS), prognostic factors. Product-limit method (Kaplan-Meier) statistical analysis of adjuvant chemotherapy application anthracycline program and impact of the program of taxane-risk patients DFS analysis, comparison between groups the application Log-rank test, chi-square of the count data inspection. All data P lt; 0.05 for statistically significant differences. Results: 1 survival: risk of breast cancer in patients with 1 -, 2 - and 3-year disease-free survival rate was 96.4%, 89.9%, 84.4%; 1 -, 2 - and 3-year overall survival rate was 99.6%, 97.4% and 93.6%, respectively. 2-risk breast cancer patients prognostic factors of COX impact of 2.1-risk breast cancer patients with disease-free survival (DFS) univariate analysis tumor size, lymph node metastasis, ER / PR expression and HER-2 expression, adjuvant chemotherapy adjuvant endocrine therapy are significant factors affecting patients DFS (P lt; 0.05). 2.2 affect risk breast cancer patients disease-free survival (DFS), multivariate analysis, tumor size, lymph node metastasis, adjuvant chemotherapy program is an independent prognostic factor in patients with DFS. 2.2.1 tumor size: tumor size T1 group as the reference standard (RR = 1), T2, T3 group risk of recurrence were T1 2.841 times (P = 0.003), 4.348-fold (P = 0.016), prompted impact-risk breast cancer patients DFS independent prognostic factor (P = 0.003), the higher the the tumor greater the risk of recurrence. 2.2.2 lymph node metastasis: N0 group (lymph node metastasis) as the reference standard (RR = 1), N1 lymph node metastasis (1 to 3), the risk of recurrence is 4.148 times (P = 0.000), suggesting that lymph node metastasis independent prognostic factors affect-risk breast cancer patients DFS. N1 compared with N0 high risk of recurrence. 2.2.3 chemotherapy: as a standard to anthracycline program group (RR = 1) and 0.368 for the risk of recurrence of the anthracycline group (P = 0.011), taxane-containing regimen group, suggesting that taxane program than anthracycline class program to further reduce the risk of recurrence. 2.3 affect risk breast cancer patients overall survival (OS) analysis: Univariate analysis showed that only lymph node metastasis, and OS was significantly related. 3 anthracycline and taxane-containing programs the DFS 3.1 balancing test applications anthracycline programs and anthracycline plus taxane program impact analysis in patients with moderate-risk patients from age, menopause, tumor size, surgical sub period, lymph node metastasis, ER / PR expression and HER-2 expression in terms of comparison, distribution was no significant difference between the two groups were well-balanced. 3.2-risk patients in the comparison of the overall DFS (this group DFS are the average of the the DFS) 3.2.1 with anthracycline regimen group's average the DFS: 58.13 months, the average program group containing taxane DFS: 65.89 months, statistically significant difference (P = 0.024). 3.2.2 Impact of DFS in patients stratified analysis showed: 3.2.2.1 tumor size tumor gt; 2cm taxane-containing regimen group compared with the anthracycline regimen group significantly prolong the patient's DFS, the difference was statistically significant (64.53 vs53.39 months, P = 0.016); tumors ≤ 2cm, the the anthracycline regimen group with taxane-containing regimen group no significant difference between patients DFS (71.41 vs. 58.89 months, P = 0.387) . 3.2.2.2 ER / PR expression of ER / PR double-negative patients with taxane-containing regimen group compared with anthracycline regimen group was significantly prolonged in patients with DFS, the difference was statistically significant (57.18 vs 46.04 months, P = 0.047); ER and / or PR-positive patients, two programs affect DFS was no statistically significant difference (61.54 vs 55.18 months, P = 0.160). 3.2.2.3HER-2 expression of HER-2 () patients with taxane-containing regimen group compared with anthracene ring class program group was significantly prolonged in patients with DFS, a statistically significant difference (61.75 vs 45.23 months, P = 0.027); of HER-2 (- /) of HER-2 () patients, two programs affect DFS was no statistical difference (P gt; 0.05). 3.2.2.4 risk factors N0 1 (node-negative and has a risk factor), the anthracycline program group and the program group containing taxane DFS were 64.81, 42.21 were statistically significant (P = 0.426); N0 2 group (node-negative and have two or more risk factors), anthracycline regimen group and the program group containing taxane DFS 55.15, 69.58, was statistically significant (P = 0.002); N1 (1 to 3 positive lymph nodes), the anthracycline program group and program group containing taxane DFS were 57.73, 62.23 months, was not statistically significant (P = 0.527). 3.2.2.5 As for the age, menopause, lymph node metastasis, the impact of the two programs on the patients DFS was no statistical difference (P gt; 0.05). Conclusion: an impact-risk breast cancer patients disease-free survival (DFS) were independent prognostic factors: tumor size, lymph node metastasis, postoperative adjuvant chemotherapy. 2 in the risk of breast cancer in patients with taxane programs adjuvant chemotherapy can significantly prolong tumor greater than 2cm, ER / PR double negative, HER-2 () patients with DFS. Risk breast cancer patients, regardless of lymph node metastasis status (0 to 3), adjuvant chemotherapy based on anthracycline plus taxane therapy did not prolong the patient's DFS. 4 in the risk of breast cancer patients, lymph node negative and merge any risk factors (pT gt; 2cm Ⅱ - Ⅲ level widely around the tumor vascular invasion, ER and / or PR (-), HER-2 / neu gene amplification or protein expression, age lt; 35 years old) ≥ 2, adjuvant chemotherapy based on anthracycline plus taxane prolong the patient's DFS.
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