绝经前高危复发乳腺癌辅助内分泌治疗的最佳方案研究

Optimal adjuvant endocrine therapy for premenopausal high-risk recurrence breast cancer

目的探讨绝经前激素受体阳性高危复发乳腺癌患者辅助内分泌治疗的最佳方案。方法选择绝经前高危复发乳腺癌患者共150例,随机分为3组,每组50例。T组:他莫昔芬(TAM);G+T组:戈舍瑞林+TAM;G+A组:戈舍瑞林+阿那曲唑。观察并随访患者的3年无病生存(DFS)率和4年总生存(OS)率。结果中位随访49个月,G+A组3年DFS率为90.00%,显著高于T组(74.00%)(χ~2=5.986,P<0.05),高于G+T组(84.00%),但差异无统计学意义(χ~2=1.764,P>0.05),3组的4年OS率分别为T组89.50%,G+T组92.9%,G+A组95.70%,差异无统计学意义(P>0.05)。T组中Her-2阳性者,3年DFS率显著低于Her-2阴性者(P<0.05)。在Her-2阳性者中,G+A组的3年DFS率显著高于G+T组和T组(P<0.05)。在淋巴结转移数目≥10枚、年龄≤40岁者中,G+A组的3年DFS率显著高于T组(均P<0.05)。不良反应3组各有不同,但均可耐受。结论对绝经前激素受体阳性的高危复发乳腺癌患者,卵巢功能抑制联合芳香化酶抑制剂的疗效优于单用TAM,值得临床应用。

Objective To assess regimes of adjuvant endocrine therapy for premenopausal women with high-risk recurrence breast cancer. Methods One hundred and fifty two premenopausal women with high-risk recurrence breast cancer were enrolled. Patients were randomly divided into three groups with 50 cases each: Group T(tamoxifen alone), group G+T(goserelin + tamoxifen) and group G+A(goserelin+anastrozole). The patients were followed-up and the 3-year disease-free survival(DFS) rate and 4-year overall survival(OS) rate were observed and compared among three groups. Results The median follow-up was 49 months, the 3-year DFS rate in G+A group was 90.00%, which was significantly higher than group T(74.00%)(χ2=5.986, P<0.05); the 4-year OS rate in groups G+A, G+T and T were 95.70%, 92.90% and 89.50%, respectively(P >0.05). The3-year DFS rate in Her-2 positive patients of group T was significantly lower than that in Her-2 negative patients. For Her-2 positive patients the 3-year DFS rate in group G+A was significantly higher than that in groups G +T and T. The 3-year DFS rate in G +A group was significantly higher than that in group T for patients aged <40 years or with >10 metastatic lymph nodes. The side-effects were slightly different among the 3 groups while all tolerable. Conclusion In premenopausal women with high-risk recurrence breast cancer, adjuvant endocrine therapy with ovarian suppression combined aromatase inhibitors can significantly reduce the risk of recurrence, compared to TAM alone.