乳腺癌化疗诱导闭经对预后的影响

Effect of Chemotherapy-induced Amenorrhea on the Prognosis of Breast Cancer

目的:研究乳腺癌患者化疗诱导闭经(chemotherapy-induced amenorrhea,CIA)的出现对预后的影响,探讨其临床意义。方法:共有88例绝经前乳腺癌患者,全部接受术前4个周期和术后4个周期紫杉醇蒽环联合方案化疗,根据实体瘤治疗疗效评价方法即RECIST(response evaluation criteria in solid tumors)标准对新辅助化疗疗效进行评估,统计病理完全缓解(pathologiccomplete response,pCR)的发生率。对患者进行随访,总结患者的无瘤生存(disease free survival,DFS)情况。分析患者CIA的出现与新辅助化疗疗效及DFS的关系。分析患者新辅助化疗疗效与CIA的关系采用卡方检验,分析CIA出现与患者无瘤生存率之间的关系应用Kaplan-Meyer生存曲线。结果:88例患者经过化疗后共有64例患者出现CIA。新辅助化疗后,22例(25.0%)患者获得临床完全缓解(complete response,CR),51例(58.0%)患者获得临床部分缓解(partial response,PR),12例(13.6%)患者获得疾病稳定(stable disease,SD),3例(3.4%)患者出现疾病进展(progressive disease,PD)。患者新辅助化疗的临床效果与CIA是否出现并无相关性(P=0.104)。新辅助化疗后14例(15.9%)患者获得pCR,CIA组患者获得pCR率(21.9%)要高于非CIA组(0),两者具有显著性差异(P=0.009)。中位随访时间48个月,出现CIA的患者中有4例患者出现局部复发或转移,另外24例未出现CIA的患者中有10例患者出现局部复发或转移,两组患者的DFS具有显著性差异(P<0.05)。结论:化疗诱导闭经的出现可能提示患者有更好的预后。

Objective： To evaluate the effect of chemotherapy-induced amenorrhea （CIA） on the prognosis of breast cancer and to study the clinical significance of CIA. Methods： A total of 88 premenopausal breast cancer patients were treated with a combined therapy of paclitaxel and anthracyclines with 4 cycles before and after surgery. The effect of neoadjuvant chemotherapy was evaluated according to the response evaluation criteria in solid tumors （RECIST）. The pathologic complete response （pCR） rate was also calculated. All patients were followed up and their disease free survival （DFS） was summarized. The correlation among occurrence of CIA, neoadjuvant chemotherapy effect and DFS were analyzed using the statistical methods of chi-square test and Kaplan-Meier survival curve. Results： CIA occured in 64 of the 88 patients after chemotherapy. Following the neoadjuvant chemotherapy, complete regression （CR） was seen in 22 （25.0%） of the patients, partial response （PR） was seen in 51 （58.0%）, stable disease （SD） was seen in 12 （13.6%）, and progression of disease （PD） was seen in 3 （3.4%）. There is no correlation between the incidence of CIA and clinical effects of neoadjuvant therapy （P=0.104）. pCR was found in 14 patients after neoadjuvant therapy. The pCR rate was higher in the CIA group （21.9%） than in the non-CIA group （0.0%）, and there were significant differences between the two （P=0.009）. After follow-up （median, 48 months）, local recurrence or distant metastasis occurred in 4 patients from the CIA group and 10 of the 24 patients from the non-CIA group. There were significant differences in the DFS between the two groups （P〈 0.05）. Conclusion： The occurrence of CIA seems to indicate a better prognosis for breast cancer patients treated with chemotherapy before and after surgery.