目的 探討注射用紫杉醇（白蛋白結(jié)合型）聯(lián)合放療治療不同分子亞型老年乳腺浸潤性小葉癌患者的臨床效果及預(yù)后的影響因素。方法 選擇2016—2017年于邯鄲市中心醫(yī)院和河北醫(yī)科大學(xué)第四醫(yī)院就診的晚期乳腺浸潤性小葉癌患者200例進(jìn)行前瞻性研究。按隨機(jī)數(shù)字表法將患者隨機(jī)分為對(duì)照組和試驗(yàn)組，每組100例，根據(jù)分子亞型又將兩組分別分為Luminal A型、Luminal B型、HER-2過表達(dá)型和三陰型。對(duì)照組采用每天1次，每次1.8～2.0 Gy的常規(guī)分割放療方案，每周照射5 d，共放療25～28次。試驗(yàn)組放療方式同對(duì)照組，在放療期間給予注射用紫杉醇（白蛋白結(jié)合型），劑量為260 mg·m^-2，靜脈滴注30 min，每3周給藥1次，至放療結(jié)束。分析比較兩組患者近期療效、治療后1年乳房外形評(píng)級(jí)情況、5年無病生存率及復(fù)發(fā)率，記錄治療期間不良反應(yīng)發(fā)生情況。結(jié)果 試驗(yàn)組三陰型、HER-2過表達(dá)型、Luminal B型、Luminal A型患者的總有效率（RR，60.00%、53.85%、83.33%、88.10%）均顯著高于對(duì)照組同亞型的RR（10.00%、14.29%、62.50%、73.17%），差異顯著（P<0.05）；試驗(yàn)組三陰型、HER-2過表達(dá)型、Luminal B型、Luminal A型患者的腫瘤控制率（DCR，80.00%、84.62%、93.33%、100.00%）均顯著高于對(duì)照組同亞型的DCR（20.00%、50.00%、81.25%、92.68%），差異顯著（P<0.05）。試驗(yàn)組三陰型、HER-2過表達(dá)型、Luminal B型、Luminal A型患者治療后1年乳房外形優(yōu)良率均高于對(duì)照組同亞型（P<0.05）。不同的年齡、臨床近期療效、分子分型、治療措施的乳腺癌患者，其5年無病生存率比較差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。Logistics回歸分析結(jié)果顯示，65～70歲為5年無病生存的保護(hù)性因素，分子分型、治療措施為5年無病生存的獨(dú)立影響因素。試驗(yàn)組與對(duì)照組的胃腸道不良反應(yīng)發(fā)生率分別為45.26%、41.24%（P>0.05），試驗(yàn)組與對(duì)照組的血液學(xué)異常不良反應(yīng)發(fā)生率分別為56.84%、53.61%（P>0.05）。結(jié)論 注射用紫杉醇（白蛋白結(jié)合型）聯(lián)合放療能有效提升不同分子亞型老年乳腺浸潤性小葉癌患者的近期療效，改善治療后1年乳房外形評(píng)級(jí)，提高患者5年無病生存率，安全性較高。而影響患者預(yù)后的主要因素為年齡、分子分型、治療措施，臨床上應(yīng)考慮采取有效措施來改善預(yù)后。

Objective To investigate clinical effect and prognostic factors of Paclitaxel for Injection (albumin binding) combined with radiotherapy in treatment of different molecular subtypes of elderly patients with invasive lobular carcinoma of the breast. Methods A prospective study was conducted on 200 patients with advanced invasive lobular carcinoma of breast treated in Handan Central Hospital and the Fourth Hospital of Hebei Medical University from 2016 to 2017. The patients were randomly divided into control group and experimental group with 100 cases in each group according to the random number table method. According to the molecular subtypes, the two groups were divided into Luminal type A, Luminal type B, HER-2 overexpression type and triplenegative type respectively. Patients in the control group received conventional fractionated radiotherapy of 1.8-2.0 Gy once a day for five days a week, 25-28 times in total. The radiotherapy method of the experimental group was the same as that of the control group. During radiotherapy, Paclitaxel for Injection was given at a dose of 260 mg·m^-2, intravenous drip for 30 minutes, once every three weeks until the end of radiotherapy. The short-term curative effect, one-year breast shape rating, five-year disease-free survival rate and recurrence rate of the two groups were analyzed and compared, and the occurrence of adverse reactions during treatment was recorded. Results The total effective rates (RR, 60.00%, 53.85%, 83.33%, 88.10%) of patients with triple-negative, HER-2, Luminal B, and Luminal A in the experimental group were significantly higher than those of the same subtype in the control group (10.00%, 14.29%, 62.50%, 73.17%) (P<0.05). The tumor control rate (DCR, 80.00%, 84.62%, 93.33%, 100.00%) of patients with triple-negative, HER-2, Luminal B, and Luminal A in the experimental group was significantly higher than that of patients with the same subtype in the control group (20.00%, 50.00%, 81.25%, 92.68%) (P<0.05). One year after treatment, the excellent rate of oneyear breast shape rating of the triple-negative type, HER-2, Luminal B and Luminal A type patients in the experimental group was higher than that of the same subtype in the control group (P<0.05). The five-year disease-free survival rate of breast cancer patients with different ages, short-term clinical efficacy, molecular typing and treatment was significantly different (P<0.05). Logistic regression analysis showed that 65-70 years old was the protective factor for five-year disease-free survival, and molecular typing and treatment was the independent influencing factor for five-year disease-free survival. The incidence of gastrointestinal adverse reactions in the experimental group and the control group were 45.26% and 41.24% respectively (P > 0.05), and the incidence of hematological abnormal adverse reactions in the experimental group and the control group were 56.84% and 53.61% respectively (P > 0.05). Conclusion Albumin binding paclitaxel combined with radiotherapy can effectively improve the short-term efficacy of different molecular subtypes of elderly patients with invasive lobular carcinoma of the breast, improve the breast shape rating ong year after treatment, and improve the 5-year disease-free survival rate of patients with high safety. The main factors affecting the prognosis of patients are age, molecular typing and treatment. Effective measures should be taken to improve the prognosis.

R979.1

河北省衛(wèi)生和計(jì)劃生育委員會(huì)重點(diǎn)科技研究計(jì)劃項(xiàng)目（20190193）