Objective: To analyze adjuvant chemotherapy decisions for triple negative breast cancer (TNBC), and explore the influencing factors in the multidisciplinary treatment (MDT) modality. Methods: A retrospective analysis was performed. The cases with invasive TNBC who underwent surgery and MDT discussion for adjuvant treatment in Ruijin Hospital, from April 2013 to June 2015, were recruited. The patients' clinicopathological characteristics were analyzed and adjuvant treatment suggestions from MDT were obtained. Here the chemotherapy decision alteration was defined as a disagreement in chemotherapy or not, or inconsistence in regimens between the attending doctor and the multidisciplinary team. Results: A total of 194 patients aged ≤70 years old were enrolled in the multidisciplinary discussion, and 187 patients (96.4%) were suggested to receive chemotherapy. When compared the opinions of the attending doctor to suggestions of the multidisciplinary team, we found that the percentage of chemotherapy decision alteration reached 22.7% (39/172), of which 94.9% (37/39) were inconsistence in chemotherapy regimens. There were 119 patients who were recommended to receive epirubicin plus cyclophosphamide (EC) followed by docetaxel (T) or weekly paclitaxel (wP) regimens. Before the announcement of results for the E1199 trial, EC-T accounted for 62.5% (55/88), and EC-wP accounted for 37.5% (33/88) for this group of patients. After that, the proportion of EC-T was decreased to 22.6% (7/31) and proportion of EC-wP increased to 77.4%(24/31) (P<0.001). In addition, a total of 20 patients were suggested to receive platinum based chemotherapy. The proportions were 9.3% in cases with invasive ductal carcinoma, and 33.3% in cases with metaplastic carcinoma, respectively (P=0.016). Conclusions: The adjuvant chemotherapy decision for TNBC patients is altered in 22.7% of the patients after MDT discussion. After the announcement of SABCS E1199 results, more patients are suggested to receive EC followed by weekly paclitaxel. There is a lack of detailed evidence for platinum based adjuvant chemotherapy for TNBC, and more patients with metaplastic carcinoma receive platinum based adjuvant chemotherapy.
目的： 探讨多学科综合治疗(MDT)模式下三阴性乳腺癌辅助化疗的选择及影响因素。 方法： 回顾性分析2013年4月至2015年6月在上海交通大学医学院附属瑞金医院乳腺疾病诊治中心，接受手术和MDT讨论，并制订术后辅助治疗方案的浸润性三阴性乳腺癌患者的临床病理特征和MDT辅助治疗方案。化疗决策改变定义为主诊医师和MDT团队在化疗与否或化疗方案的意见不一致。 结果： 194例≤70岁的患者中，187例(96.4%)患者推荐予以化疗。主诊医师的意见与MDT团队的推荐意见不一致导致化疗决策的改变率达22.7%(39/172)，其中94.9%(37/39)是化疗方案改变。119例患者推荐予以EC－T方案(表柔比星联合环磷酰胺序贯多西他赛)或wP方案(每周紫杉醇)化疗；在E1199研究结果公布前， EC－T方案占62.5%(55/88)，EC序贯wP方案占37.5%(33/88); 2014年圣安东尼奥乳腺癌大会(SABCS)E1199研究结果公布后，EC－T方案的比例下降至22.6%(7/31)，而EC－wP方案则升高至77.4%(24/31)(P<0.001)。共有20例患者推荐含铂类方案化疗，乳腺浸润性导管癌患者中，推荐铂类化疗方案的患者占9.3%(15/162)；化生性癌患者中，推荐含铂类化疗方案的患者占33.3%(5/15)，差异有统计学意义(P＝0.016)。 结论： MDT模式下三阴性乳腺癌辅助化疗决策的改变率为22.7%。SABCS E1199结果公布后，推荐EC序贯wP辅助化疗方案增多。铂类药物在三阴性乳腺癌辅助化疗中缺乏详实数据，较多化生性癌患者接受含铂类药物辅助化疗。.
Keywords: Antineoplastic combined chemotherapy protocols; Breast neoplasms; Chemotherapy; Multidisciplinary treatment pattern; Platinum; Triple negative breast cancer.