E. 통계 분석
V. 결론
선행항암화학요법으로 AD 또는 AC-T 투여 후 근치적 수술이 가능했던 유 방암 환자에서 병리학적 완전관해율,임상적 반응율,유방보존율 및 치료 부작용 을 비교하여 우월한 항암화학요법을 확인하고 병리학적 관해 및 임상적 반응을 예측하는 생물학적 표지자를 찾고자 하였다.두 군에서 병리학적 관해율,임상적 반응율,유방보존율은 통계적으로 유의하지 않았으나 AD군에서 진행된 환자들이 더 많이 포함되었음을 고려할 때 결론내리기는 어렵다.부작용 측면에서는 AD군 에서 혈액학적 부작용이 의미있게 많았고 심각한 부작용으로 입원치료가 필요한 경우가 많아 AC-T 요법이 견딜만한 치료법으로 여겨진다.향 후 두군간의 예후 를 비교하면 유방암 환자에게 좀 더 효과적인 치료 방법의 선택하는데 도움이 될 것으로 생각된다.
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20 -ABSTRACT
Compar i s onoft wone oa dj uva ntc he mot he r apyi nl oc a l l yadvanc e d br e a s tc anc e rpa t i e nt s ;Adr i amyc i nandDoc e t a xe l( AD)ve r s us
Adr i amyc i n,Cyc l ophos pha mi def ol l owe dbyPac l i t a xe l( AC-T)
JaYoungJeon
DepartmentofMedicalSciences,GraduateSchool,AjouUniversity (SupervisedbyProfessorSeokYunKang)
Background: Neoadjuvant chemotherapy (NAC) is one of the standard treatment for the patients with locally advanced breast cancer and is an option for the patients with operable breast cancer. Such as adjuvant chemotherapy inbreastcancer,anthracyclineandtaxane-basedregimenshave been studied and investigated as neoadjuvantsetting.But,no one regimen hasbeenshowntobesuperiorinefficacyandtoxicityview.
Materials and Methods:We compared thewomen received adriamycin and docetaxel (AD) with adriamycin, cyclophosphamide followed by paclitaxel (AC-T) as neoadjuvant chemotherapy from 1 November 2005 to 31 September2011.TheAD groupwasscheduled for6cyclesofAD (50mg/m2 and75mg/m2,respectively)in theintervalof3weeks.TheAC-T groupwas scheduled for4cyclesofAC regimen (60mg/m2and 600mg/m2,respectively) followedby 4cyclesofpaclitaxel(175mg/m2)in theintervalof3weeks.All patients received complete resection for localcontrolwithin 5 weeks after neoadjuvantchemotherapy.
21
-Results:The patients enrolled in this study were totally 75 (AD 37 and AC-T 38).Among thepatients’baselinecharacteristics,clinicalT stagewas differentbetween two groups.More advanced cases were included in AD group.Theresponsesofchemotherapywereequivalent,whichwereestimated by overallresponse rate (AD 89% versus AC-T 87%,p=1.000),pathologic completeresponse(pCR)rate(breastand axilla;AD 11% versusAC-T 8%, p=0.711,breastonly ;AD 19% versusAC-T 11%,p=0.346),breastconserving surgery rate (AD 62% versus AC-T 76%,p=0.184)and breastconserving surgery conversion rate (AD 24% versus AC-T 29%,p=0.651).Although non-hematologictoxicitieswerecomparable,hematologictoxicitiesweremore severe in AD group.Mostwomen in AD group suffered from grade 3/4 neutropenia (p<0.001) and neutropenic fever (p<0.001). Also, Gankyrin expressions were not different between two groups except HER-2 positivity(p=0.028).
Conclusions:AC-T regimenwasmoretolerablewithsimilarclinicaloutcome thanAD regimeninpatientswithbreastcancerreceivingNAC.
Key Words: Breast cancer, Neoadjuvant chemotherapy, Tumor response, Pathologiccompleteresponse,Gankyrin