ER阳性乳癌病人全身辅助治疗的研究

A clinical study on adjuvant systemic therapy for Er-positive breast cancer

目的 研究雌激素受体阳性 (ER + )乳癌病人接受不同全身辅助治疗的预后 ,以期指导病人的治疗。方法 3 87例ER +乳癌病人分成三组 :辅助内分泌治疗组 (178例 ) :绝经后 (绝经前病人先切除卵巢 )病人服用三苯氧胺(TAM ) 5年。辅助化疗组 (15 4例 ) :主要化疗方案有CMFVP ;CMF ;CF ;FVC等。联合治疗组 (5 5例 ) :化疗 +TAM ,其中绝经前病人未切除卵巢。采用生命表的方法观察三组病人的 5年无病生存率 (DFS)和总生存率 (OS)。结果 在不同年龄、不同月经状态、不同局部肿瘤T期及不同转移淋巴结数目的病人中 ,都显示出辅助内分泌治疗的 5年无病生存率和总生存率明显好于辅助化疗者 ,差异有显著意义。在转移淋巴结≥ 10个组内 ,虽然仍是内分泌治疗结果好于化疗组 ,但未显示统计学意义。联合治疗的病人 ,在各个亚组分析中 ,都不优于辅助内分泌治疗。结论 ER及绝经状态应作为决定取舍辅助内分泌治疗的主要依据 ,对于ER阳性乳癌病人 。

Objective To search a treating guidance for the ER positive breast cancer.Methods From 1980 to 1995,we had studied the prognosis of 387 ER positive patients with adjuvant systemic therapy,whom were divided into three groups:(1) 178 patitents received endocrine therapy,(2)154 patients received chemotherapy,(3)55 patients(premenopausal patients did not receive oophorectomy) received both therapy in other hospital with fully data enrolled.Adjuvant systemic therapy regimens were as follows:(1)Endocrine therapy group:Both of the premenopasual patients after receiving oophorectomy and the postmenapasual patients took TAM oraly for 5 years.60mg/day for the first 3 months,40mg/day for the next 3 months and then 20mg/day for the rest of the 5 year,while 40mg/day for the high risk patients.(2) Chemotherapy group:Chemotherapy regimens were as follows:CMFVP,CMF,CF,or FVC.(3) Combination therapy group:A combination of both treatments,except for that the premenopausal patients did not receive oophorectomy.Actuarial disease free survival (DFS) and overall survival(OS) were determined according to age,menopausal status,tumor stage or the number of involved nodes.Results 5 year disease free survival(DFS) and overall survival (OS) in endocrine therapy group were higher than those in chemotherapy group,(P<0.05 or P<0.01),but in patients with more than 10 metastased lymph nodes the difference was not significant.The DFS and OS in combination therapy group were not higher than those of endocrine therapy alone.Conclusions We consider the circulating estrogen in the premenopausal patients is so high that the TAM in body is insufficient to block estrogen binding to ER at the target tissues.So premenopausal women should receive oophorectomy followed by long term TAM orally. [