绝经前乳腺癌患者新辅助化疗相关闭经的影响因素及临床意义探讨

Influence Factors of Neoadjuvant Chemotherapy-Related Amenorrhea in Premenopausal Breast Cancer Women and Its Clinical Significance

目的分析绝经前乳腺癌患者接受新辅助化疗后闭经的相关影响因素,了解新辅助化疗相关的闭经(NCRA)与新辅助化疗后肿瘤降期的关系。方法回顾性随访观察我院2006年3月至2011年3月期间224例绝经前乳腺癌患者接受新辅助化疗后月经状态的改变及新辅助化疗后彩超下乳房肿瘤的变化情况,分析新辅助化疗时患者年龄、化疗方案、肿瘤病理组织学特征(ER/PR和Her-2)、术后服用他莫昔芬(tamoxifen,TAM)与NCRA及其随后月经恢复的关系,以及新辅助化疗后肿瘤的变化与NCRA的关系。结果 224例患者中有166例(74.11%)患者出现NCRA,其中有15例停经但雌激素水平增高而行卵巢切除或接受戈舍瑞林治疗,余151例NCRA患者中有40例(26.49%)出现月经恢复。单因素及多因素分析结果显示,NCRA的发生及随后的月经恢复均与患者的年龄有关(P<0.001,P=0.001);不同化疗方案对NCRA的发生无明显影响(P>0.05),但是对NCRA后月经恢复有重要影响(P<0.001);肿瘤的ER/PR和Her-2表达和是否服用TAM对NCRA发生及其随后的月经恢复均无明显影响(P>0.05)。发生NCRA时的化疗周期数随患者年龄的增长而减少,与NCRA后月经的恢复无关(P>0.05)。NCRA的发生与新辅助化疗后肿瘤的降期无关(P>0.05)。结论大多数绝经前乳腺癌患者接受新辅助化疗后会出现闭经,年龄越大的患者越容易发生NCRA,而且发生NCRA时接受化疗的周期数更少;年龄和化疗方案都会影响NCRA后月经的恢复;NCRA的发生未影响新辅助化疗的近期疗效。

Objective To analyze the influence factors of amenorrhea in premenopausal breast cancer women treated with neoadjuvant chemotherapy and the relationship of neoadjuvant chemotherapy-related amenorrhea（NCRA） to down-staging of tumor.Methods Two hundred and twenty-four premenopausal breast cancer patients undergoing neoadjuvant chemotherapy from March 2006 to March 2011 in this hospital were investigated retrospectively.The effects of age,chemotherapy regiment,ER/PR status,Her-2 status,and tamoxifen（TAM）on NCRA and recovery of menstruation were assessed.The average age of the patients who had accepted different chemotherapy cycles when NCRA occurred was described,and the effect of different chemotherapy cycles on recovery of menstruation was evaluated.Tumor volume change was estimated to analysis the relation between NCRA and tumor response to chemotherapy.Results One hundred and sixty-six（74.11%）cases occurred NCRA,40（26.49%）cases returned to normal menstruation apart from 15 cases who had accepted oophorectomy or the luteinizing hormone-releasing hormone analog goserelin before menstrual status change.The results of univariate analysis and multivariate analysis indicated that the NCRA and menstruation recovery were both related to age at diagnosis（P0.001,P=0.001）,and only menstruation recovery was related to chemotherapy regiments（P0.001）.However,the NCRA and menstruation recovery were not related to ER/PR status,Her-2 status,and TAM（P0.05）.Chemotherapy cycles when NCRA occurred decreased with the increase of age,and wasn’t associated with menstruation recovery（P 0.05）.There was no correlation between NCRA and downstage of tumor after neoadjuvant chemotherapy（P0.05）.Conclusions Amenorrhea resulted from neoadjuvant chemotherapy in most of breast cancer patients,which occurs more commonly in elder ones with less chemotherapy cycles.Quite a few patients resume menses after NCRA,which is associated with age and chemotherapy regiments.NCRA doesn’t influence tumor response to chemotherapy.