目的 探讨注射用紫杉醇（白蛋白结合型）联合放疗治疗不同分子亚型老年乳腺浸润性小叶癌患者的临床效果及预后的影响因素。方法 选择2016—2017年于邯郸市中心医院和河北医科大学第四医院就诊的晚期乳腺浸润性小叶癌患者200例进行前瞻性研究。按随机数字表法将患者随机分为对照组和试验组，每组100例，根据分子亚型又将两组分别分为Luminal A型、Luminal B型、HER-2过表达型和三阴型。对照组采用每天1次，每次1.8～2.0 Gy的常规分割放疗方案，每周照射5 d，共放疗25～28次。试验组放疗方式同对照组，在放疗期间给予注射用紫杉醇（白蛋白结合型），剂量为260 mg·m^-2，静脉滴注30 min，每3周给药1次，至放疗结束。分析比较两组患者近期疗效、治疗后1年乳房外形评级情况、5年无病生存率及复发率，记录治疗期间不良反应发生情况。结果 试验组三阴型、HER-2过表达型、Luminal B型、Luminal A型患者的总有效率（RR，60.00%、53.85%、83.33%、88.10%）均显著高于对照组同亚型的RR（10.00%、14.29%、62.50%、73.17%），差异显著（P<0.05）；试验组三阴型、HER-2过表达型、Luminal B型、Luminal A型患者的肿瘤控制率（DCR，80.00%、84.62%、93.33%、100.00%）均显著高于对照组同亚型的DCR（20.00%、50.00%、81.25%、92.68%），差异显著（P<0.05）。试验组三阴型、HER-2过表达型、Luminal B型、Luminal A型患者治疗后1年乳房外形优良率均高于对照组同亚型（P<0.05）。不同的年龄、临床近期疗效、分子分型、治疗措施的乳腺癌患者，其5年无病生存率比较差异均有统计学意义（P<0.05）。Logistics回归分析结果显示，65～70岁为5年无病生存的保护性因素，分子分型、治疗措施为5年无病生存的独立影响因素。试验组与对照组的胃肠道不良反应发生率分别为45.26%、41.24%（P>0.05），试验组与对照组的血液学异常不良反应发生率分别为56.84%、53.61%（P>0.05）。结论 注射用紫杉醇（白蛋白结合型）联合放疗能有效提升不同分子亚型老年乳腺浸润性小叶癌患者的近期疗效，改善治疗后1年乳房外形评级，提高患者5年无病生存率，安全性较高。而影响患者预后的主要因素为年龄、分子分型、治疗措施，临床上应考虑采取有效措施来改善预后。

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

河北省卫生和计划生育委员会重点科技研究计划项目（20190193）