SERM治疗绝经前乳腺癌的不良反应及与预后的相关性

Study on the correlation between the side effects of endocrine therapy of SERM drugs and the prognosis of premenopausal breast cancer patients

目的探讨选择性雌激素受体调节剂(SERM)他莫昔芬/托瑞米芬治疗绝经前乳腺癌患者的不良反应及其与预后的相关性。方法回顾分析诊治的乳腺癌患者资料,筛选出服用他莫昔芬或托瑞米芬内分泌治疗的绝经前ER/PR阳性乳腺癌患者,随访记录患者出现的治疗相关性不良反应和复发、转移及死亡情况,分析他莫昔芬和托瑞米芬的不良反应与无病生存率的相关性,以及它们对患者预后的影响。结果 174例(38.6%)乳腺癌患者在内分泌治疗过程中出现了潮热等更年期症状,其5年无病生存率比无出现更年期症状的乳腺癌患者低(P<0.05);内分泌治疗有引起妇科症状的乳腺癌患者的5年无病生存率较无出现该症状者有轻微提高趋势(98.9%vs 94.9%,P=0.070);使用托瑞米芬的患者更年期症状较使用他莫昔芬患者更常见(44.5%vs33.3%, P<0.05),而前者5年无病生存率也较后者高(97.2%vs 90.0%,P<0.05)。结论绝经前ER/PR阳性早期乳腺癌患者接受SERM内分泌治疗引起的更年期症状与无病生存率的改善有相关性。托瑞米芬引起的更年期症状比他莫昔芬更常见。使用托瑞米芬者较使用他莫昔芬者临床获益更多。

Objective To study the correlation between the side effects of selective estrogen receptor regulator(SERM) and the prognosis of premenopausal breast cancer patients.Methods The data of patients with breast cancer were analyzed retrospectively.the patients with premenopausal ER/PR positive breast cancer treated with SERM were screened out.The side effects of endocrine therapy and recurrence,metastasis and death were recorded.The correlation between side effects of endocrine therapy and disease-free survival rate(DFSR),as well as the influence of tamoxifen and toremifen on clinical prognosis were analyzed.Results 174 cases(38.6%) of breast cancer patients developed climacteric symptoms such as hot flash during endocrine therapy.The five-year DFSR was lower than that of breast cancer patients without climacteric symptoms(P<0.05).The five-year DFSR of breast cancer patients with gynecological symptoms caused by endocrine therapy was higher than that of patients without gynecological symptoms(98.9% vs.94.9%,P=0.070),and climacteric symptoms were more common in patients treated with tamoxifen than those treated with tamoxifen(44.5% vs.33.3%,P<0.05),and five-year DFSR in patients with tamoxifen was more beneficial than that in patients with tamoxifen(97.2% vs.90%,P<0.05).Conclusions The climacteric symptoms caused by selective estrogen receptor regulator(SERMs) endocrine therapy are correlated with the improvement of disease-free survival in patients with premenopausal ER/PR positive early breast cancer.Toremifen is more common than tamoxifen in endocrine therapy in premenopausal breast cancer patients.Patients with premenopausal breast cancer benefit more clinically from tamoxifen than those with tamoxifen.