乳腺癌术后辅助内分泌治疗64例体会

Endocrine Therapy of Breast Cancer( 64 Cases Report)

目的总结雌、孕激素受体阳性乳腺癌患者内分泌治疗的体会，从而进一步改进治疗方法，提高治疗效果。方法我院2004年1月至2008年1月间收治的64例雌、孕激素受体阳性乳腺癌患者，均为女性，平均年龄50（28—62）岁。其中未绝经31例，平均年龄46（28～49）岁；绝经33例，平均年龄54（48—62）岁。均行乳腺癌改良根治术，术后完成化疗。未绝经31例给予他莫昔芬（Tamoxifen，TAM）20mg／d口服；绝经33例中，15例给予阿那曲唑，1mg／d口服，18例给予国产来曲唑，10mg／d口服。服用TAM2年后符合绝经状态的23例患者中，15例年龄大于45岁的患者换用依西美坦25mg／d口服，继续完成5年内分泌治疗，其余8例继续服用TAM完成5年内分泌治疗。比较4组不同内分泌药物的治疗效果，并分析其临床不良反应。结果在临床疗效方面，4组患者5年生存率、5年无病生存率均无显著性差异（P〉0．05））。服用TAM的患者主出现食欲下降、子宫内膜增厚等不良反应，4组间比较差异显著（P〈0．01）。而服用阿那曲唑和来曲唑的腰腿酸痛发生率高于另2个组（P〈0．01）。结论对于雌、孕激素受体阳性的乳腺癌患者，灵活综合患者个体实际情况选择用药，可增加患者治疗依从性。

Objective To summarize the experiences of endocrine therapy in ER-positive patients. Methods From January 2004 to January 2008, 64 female patients with breast neoplasms treated in our hospital were included as respondents. The age ranged from 28 to 62 years old, with the average of 50 years. Among the 64 patients, 31 were premenopausal （ aged from 28 to 49 years, averaged 46 years） and 33 were postmenopausal （ aged from 48 to 62 years, averaged 54 years） . All of them received radical mastectomy followed by chemo- therapy. A comparison of four different endocrine drugs was carried out to analyze the 5-year survival rates and the adverse reactions. Results There was no significant difference among the 4 groups in 5-year survival rates as well as disease-free survival rates （P 〉 0.05）. However, the compliance rates of Aromatase inhibitors （AI） groups were fewer than that of the tamoxifen （TAM） group, including loss of appetite and endometrial thickening（P 〈0.01 ）. The incidences of waist and leg pain were higher in groups using Anastrozole and Letro- zole（P 〈 0.01 ）. Conclusions AI can prevent the postoperative recurrence and metastasis for the estrogen recepor positive （and/or） progesterone receptor positive breast cancer patients. And the selection should be based on individual circumstances.