乳腺癌辅助治疗中应用双膦酸盐的回顾性分析

A Retrospective Analysis of Adjuvant Therapy with Bisphosphonates for Breast Cancer

[目的]探讨双膦酸盐（bisphosphonates,BPs）在乳腺癌辅助治疗中的意义。[方法]收集接受标准辅助治疗的Ⅰ~Ⅲ期乳腺癌患者的病例资料,回顾性分析BPs对患者的无病生存时间（disease-free survival,DFS）、骨质疏松/骨量减少的发生的影响。[结果]301例Ⅰ~Ⅲ期乳腺癌病例中,57例接受BPs治疗,BPs组DFS较对照组延长,差异具有统计学意义（P=0.037）。多因素分析发现辅助治疗联合应用BPs（HR=2.198,P=0.071）、淋巴结转移数目少（HR=1.847,P=0.000）及激素受体阳性（HR=1.522,P=0.001）是改善DFS的独立因素。分层分析结果显示,绝经后（P=0.033）、60岁以内（P=0.023）的患者是BPs辅助治疗的最佳获益人群。301例患者中52例进行骨密度（bone mineral density,BMD）检测,其中BPs组23例,对照组29例,两组骨质疏松/骨量减少的发生情况存在统计学差异（P=0.003）。Logistic回归结果显示应用BPs与否（OR=0.239）及年龄（OR=1.081）是影响骨质疏松/骨量减少发生的主要因素（P〈0.05）。[结论]辅助治疗联合BPs治疗可改善绝经后乳腺癌患者的预后并可有效预防BMD降低。

[Purpose] To investigate the significance of adjuvant therapy with bisphosphonates（BPs） for breast cancer.[Methods] The data of breast cancer patients stage Ⅰ~Ⅲ who received standard adjuvant treatment were collected,and the impact of BPs on disease-free survival（DFS）and on the occurrence of osteoporosis/osteopenia were analyzed retrospectively. [Results] Of the 301 patients with breast cancer stage Ⅰ ~ Ⅲ,57 cases received BPs therapy. The DFS of BPs group was longer than that of control group,with significant difference between the two groups（P=0.037）. Multivariate analysis showed that the independent factors on improving DFS included BPs adjuvant therapy（HR =2.198,P =0.071）,less number of positive axillary lymph nodes（HR=1.847,P=0.000） and positive expressions of hormone receptors（HR=1.522,P=0.001）.Stratified analysis showed that patients with postmenopausal（P=0.033） and under 60 years old（P=0.023） benefited most from BPs adjuvant therapy. A total of 52 breast cancer cases had bone mineral density（BMD） examination,among them,23 patients received BPs therapy,29 patients did not. The rates of osteoporosis/osteopenia were significantly different（P=0.003） between the two groups. Logistic regression showed that BPs adjuvant therapy（OR =0.239） and age（OR =1.081） were important factors influencing the occurrence of osteoporosis/osteopenia（P〈0.05）.[Conclusion] Adjuvant therapy with BPs might improve prognosis in postmenopausal patients with breast cancer and prevent loss of BMD.