ER阳性绝经后乳腺癌术后化疗联合内分泌治疗的临床探讨

Clinical Study on the Efficacy of Adjuvant Chemotherapy Followed by Endocrine Therapy for ER-positive Postmenopausal Breast Cancer Patients after Modified Radical Mastectomy

目的:探讨化疗联合内分泌治疗对ER阳性绝经后乳腺癌患者术后生存率的影响。方法:将接受乳腺癌改良根治术后ER阳性的绝经后乳腺癌患者随机分为两组,联合组67例,术后应用CMF或CAF方案6个疗程后口服TAM5年;内分泌组59例,术后口服TAM5年。结果:临床Ⅱ、Ⅲ期及术后腋窝转移淋巴结≥4枚的患者两组5年无瘤生存率分别为82.7%、46.7%,58.3%、28.1%,63.9%、28.7%;5年总生存率分别为86.4%、49.5%,61.1%、33.8%,69.8%、34.8%(P<0.05);而临床Ⅰ期和腋窝淋巴结转移<4枚的患者两组5年无瘤生存率和总生存率无显著差异(P>0.05)。结论:ER阳性绝经后Ⅱ、Ⅲ期乳腺癌改良根治术后和腋窝转移淋巴结≥4枚的患者术后化疗联合内分泌治疗效果优于单纯内分泌治疗。

Objective: To study the influence of adjuvant chemotherapy followed by endocrine therapy on the survival rate of ER-positive postmenopausal breast cancer patients after modified radical mastectomy, retrospectively. Methods: ER-positive postmenopausal breast cancer patients were divided randomly into two groups, and were treated with chemotherapy followed by endocrine therapy (combined group) and endocrine therapy alone (endocrine group), respectively. The patients in combined group (N-67) received CMF(CTX+MTX+5-FU) or CAF(CTX+ADM+5-FU) for 6 courses of treatment, then tamoxifen (TAM) for 5 year orally; the patients in endocrine group (N-59) received tamoxifen(TAM) alone for 5 year orally. Results: The 5-year disease-free survival rates of the combined group and endocrine group who with stageⅡ?Ⅲ or ≥4 axillary lymph node metastasis were 82.7%, 46.7%, 58.3%, 28.1%, 63.9%, 28.7%, and the 5-year overall survival rates were 86.4%? 49.5%, 61.1%? 33.8%, 69.8%? 34.8%, respectively(P<0.05). No significant difference was observed in the patients with stageⅠand those with <4 axillary lymph node metastases(P>05). Conclusion: For ER-positive patients, the efficacy of chemotherapy followed by endocrine therapy is superior to endocrine therapy alone in the patients with stage Ⅱ Ⅲ and those with ≥4 axillary lymph node metastases.