芳香化酶抑制剂在早期男性乳腺癌治疗中的生物学效益及临床意义

Biological and clinical implications of aromatase inhibitors in early male breast cancer patients

目的探讨芳香化酶抑制剂治疗早期男性乳腺癌的生物学行为、疗效和安全性。方法采用数字随机分配药物，对12例I、Ⅱ期男性乳腺癌患者给予芳香化酶抑制剂治疗，治疗前后均进行雌激素水平检测，另12例服用他莫昔芬为对照组。监测两组复发、死亡及不良反应。结果芳香化酶组和他莫昔芬组无一例患者因不良反应而停止治疗。两组患者在T、N、TNM分期、雌激素受体阳性（9例比10例）、孕激素受体阳性（10例比9例）、人表皮生长因子受体2阳性（2例比3例）的分布方面差异均无统计学意义（均P〉0．05）。两组5年无病生存率、5年总生存率差异均无统计学意义（69．4％比77．0％，75．0％比83．4％，均P〉0．05）。芳香化酶组服药后的血浆雌二醇水平降低，但一患者雌二醇降至不可测及水平后又显著上升，并出现疾病进展。结论芳香化酶治疗早期男性乳腺癌同他莫昔芬一样有效，可以降低血浆雌二醇水平，部分患者可能存在次级耐药的情况。

Objective To evaluate the efficacy, biological behaviors and safety of aromatase inhibitors in early male breast cancer. Methods A total of 12 male breast cancer patients of stages I and Ⅱ took aromatase inhibitors. Their levels of estradiol were measured before and after medication. Another 12 patients received tamoxifen as controls. The recurrence, mortality and side effects were monitored and analyzed. Results Their 5-year disease-free survival rates were 69.40/6 , 77.0% and 5-year overall survival rates 75.0% , 83.4% respectively. No drug withdrawal occurred because of side effects. No inter-group statistical significance existed in estrogen receptor （9 vs 10 cases） , progesterone receptor （10 vs 9 cases ）, human epidermal growth factor receptor 2 （2 vs 3 cases ） , stage T, N, M and disease-free survival rate, disease related 5-year overall survival rate （ both P 〉 0. 05 ）. There was statistical difference in the level of estradiol before and after medication. The level of estradiol was initially 〈 5 ng/L in one patient, but rose during disease progression. Conclusions The efficacy of aromatase inhibitors and tamoxifen in early male breast cancer patients is comparable. And the activity of aromatase inhibitors is correlated with a significantly reduced level of E2 level. Some patients may develop secondary resistance.