中青年乳腺癌患者临床病理特点及内分泌治疗策略

Clinical pathological characteristics and endocrine therapy strategies in young and middle-aged breast cancer patients

目的:分析年龄<40岁的绝经前乳腺癌患者的临床资料,探讨其临床病理特点及内分泌治疗策略。方法:以185例年龄<40岁的乳腺癌患者为观察组,以同期收治的185例年龄≥40岁的患者为对照组,收集两组患者临床资料,探讨患者的临床病理特征与预后的关系,同时对观察组中具有高危复发风险的激素受体阳性患者采用戈舍瑞林(goserelin)联合芳香化酶抑制剂(aromatase inhibitors,AI)治疗或他莫昔芬(tamoxifen,TAM)单药内分泌治疗,比较治疗效果。结果:两组患者的肿瘤组织学分级、淋巴结转移分期以及分子分型比较,差异均有统计学意义(P<0.05);观察组患者的3年、5年无病生存率均低于对照组(P<0.05);观察组中,淋巴结转移阳性患者3年、5年无病生存率分别低于淋巴结转移阴性组(P<0.05);观察组中,luminal A型患者的3年、5年无病生存率均高于其他类型患者(P<0.05);绝经前激素受体阳性的95例高危复发风险患者中,接受goserelin联合AI治疗组患者3年、5年无病生存率均高于TAM组患者(P<0.05)。结论:依据肿瘤病理特点及分子分型对绝经前中青年女性乳腺癌患者进行个体化内分泌治疗,有助于改善预后。

Objective： To investigate the clinical data of patients with premenopausal breast cancer who were younger than 40 years old,and to explore the pathological characteristics and endocrine therapy strategy. Methods： A total of 185 patients with breast cancer younger than 40 years old（observation group） were reviewed and followed up. Another 185 patients aged over 40 years old in the same period were selected as the control group. The clinical data were analyzed and the relationship between clinical pathological characteristics and prognosis was analyzed. The hormone receptor positive patients with high-risk recurrence in the observation were treated with goserelin plus aromatase inhibitors（AI） or tamoxifen（TAM） alone,and the effect was compared between the two groups. Results： There was statistical difference of histological grade of breast cancer,lymphatic metastasis staging and molecular subtyping in the two groups（P〈0.05）. The 3 years and 5 years disease-free survival rates in the observation group were lower than those in the control group（P〈0.05）. The 3 years and 5 years disease-free survival rates in the lymphatic metastasis positive patients were lower than those in the lymphatic metastasis negative patients（P〈0.05）. The 3 years and 5 years disease-free survival rates in the Luminal A patients were higher than those in patients with other types（P〈0.05）. In the 95 cases of hormone receptor positive patients with high-risk recurrence,the 3 years and 5 years disease-free survival rates in the patients treated with goserelin plus AI were higher than those in the patients treated with TAM（P〈0.05）. Conclusion： The individualized endocrine therapy strategy,based on the pathological characteristics and molecular classification,is helpful to improve the prognosis in the treatment of young and middle-aged patients with premenopausal breast cancer.