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不同年龄化疗导致闭经乳腺癌患者内分泌治疗方案的选择 被引量:1

Optimal endocrine therapy for breast cancer patients in different age groups with chemotherapy-induced amenorrhea
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摘要 目的研究不同年龄乳腺癌患者发生化疗诱导闭经(CIA)和卵巢功能恢复(OFR)的情况,探讨不同年龄CIA乳腺癌患者内分泌药物的选择。方法回顾性分析2012年1月至2015年12月于中山大学附属第一医院初次诊断并接受化疗、绝经前、有完整月经来潮情况和性激素检测随访数据的患者共123例。按年龄分为≤40岁组(35例)、>40~45岁组(34例)和>45岁组(54例),采用一般线性模型来分析各个年龄组的OFR率。结果≤40岁组患者中26例(74.29%)出现CIA,29例(82.86%)患者在2年内OFR;>40~45岁组及>45岁组全部出现CIA(100.00%),2年内分别有17例(50.00%)及3例(5.56%)患者OFR,差异均有统计学意义(χ~2=24.42、54.97,均P<0.01)。在密切监测卵巢功能的情况下,对19例≥48岁、出现CIA、激素受体阳性高危乳腺癌患者使用芳香化酶抑制剂(AI)。使用AI时患者的中位年龄为51.08岁(48.00~54.25岁),从闭经到使用AI中位时间为9个月(2~21个月),中位随访32个月(8~68个月),无一例出现OFR。结论对于年龄≤45岁的CIA乳腺癌患者,由于OFR率高,内分泌药物应避免直接选用AI。对于≥51岁的CIA乳腺癌患者观察至少9个月,无OFR可开始使用AI,在使用AI时应定期监测卵巢功能。 Objective:To assess the incidence of ovarian function recovery (OFR) in women with breast cancer who were premenopausal at diagnosis and who underwent chemotherapy-induced amenorrhea (CIA) during treatment, and to explore the optimal endocrine therapy for breast cancer patients in different age groups with CIA. Methods:The data of one hundred and twenty-three women from January 2012 to December 2015 diagnosed with breast cancer at the First Affiliated Hospital of Sun Yat-sen University was analyzed retrospectively. The patients were divided into ≤40 years (n=35), 〉40 years and ≤45 years (n=34) and 〉45 years (n=54) subgroups. A general linear model was used to assess incidences of OFR by age subgroups. Results:26 patients (74.29%) developed CIA in ≤40 years group. Of these, 29 patinets (82.86%) regained ovarian function within 2 years; 100% of patients in 〉40 to 45 years and 〉45 years groups developed CIA, and 17 (50.00%) and 3 (5.56%) of these regained ovarian function within 2 years, and this was significantly lower in those who were elder (χ2=24.42, 54.97, both P〈0.01). In this retrospective study, 19 patients of median age 51.08 years (48.00 to 54.25 years) with hormone receptor positive high-risk breast cancer who had median 9 months (2 to 21 months) of CIA were treated with aromatase inhibitor (AI). None regained ovarian function with a median of 32 months (8 to 68 months) follow-up. Conclusions:For breast cancer patients with CIA age 45, AI should be avoided due to the high risk of OFR. For breast cancer patients age 51 who have at least 9 months of CIA, AI can be chosen with monitoring ovarian function regularly.
作者 于亮 叶润仪 贺菲 孙诗瑶 林颖 Yu Liang;Ye Runyi;He Fei;Sun Shiyao;Lin Ying(Department of Thyroid and Breast Surgery,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China;Department of Breast Surgery,Shenzhen Maternity & Child Healthcare Hospital,Shenzhen 518028,China;Department of Thyroid and Breast Surgery,the Second People's Hospital of Shenzhen,Shenzhen 518035,China)
出处 《中华普通外科学文献(电子版)》 2018年第6期418-421,共4页 Chinese Archives of General Surgery(Electronic Edition)
基金 中山大学临床医学研究5010计划资助(2016007)
关键词 乳腺肿瘤 闭经 化疗诱导 卵巢功能试验 芳香酶 酶抑制剂 Breast neoplasms Amenorrhea Chemotherapy-induced Ovarian function tests Aromatase Enzyme inhibitors
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