绝经前乳腺癌化疗致闭经的相关因素分析

发布时间：2018-05-10 21:30

本文选题：化疗致闭经 + 乳腺癌　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]CIA (chemotherapy-induced amenorrhea)定义为从化疗开始后6个月内出现闭经,闭经至少持续12个月。研究CIA在绝经前乳腺癌患者化疗后的发生率及其影响因素,以及CIA在绝经前乳腺癌患者中临床意义。[方法]回顾收集了 2012年9月至2013年9月云南省肿瘤医院收治的新发绝经前乳腺癌患者,从病历资料中收集患者信息,包括初治时的年龄、身高、体重、BMI、化疗方案、化疗周期、初潮年龄、生育史、手术方式、肿瘤临床病理特点、内分泌治疗、曲妥珠单抗的使用、放疗与否。化疗后月经状况的情况及预后通过电话随访获得。所有统计学资料采用SPSS24.0处理。各组构成比的比较采用卡方检验进行比较,采用ROC曲线探索年龄与BMI对CIA的预测界值。不同年龄组CIA时间的比较采用Kruskal-Wallis H检验进行多组比较;生存分析采用Kaplan-Meier法,log-rank检验比较组间差异。连续资料的相关性分析采用spearman相关进行分析,分类变量的相关性分析采用交叉表的列联系数进行观察[结果]中位随访时间为46个月(12-54月)。患者年龄分布在28-53岁,中位初诊年龄43岁。大部分为淋巴结阴性、激素受体阳性、HER2阴性、肿瘤直径小于等于2cm的早期乳腺癌患者。共有62例发生CIA, 46例未发生CIA。共56例患者化疗后在随访期间恢复月经,其中13例未停经。初诊年龄是绝经前乳腺癌化疗致闭经具有预测意义及影响其恢复的重要因素。大于42岁患者CIA风险增高,44岁以下患者更容易恢复月经。BMI值与CIA存在一定关联,BMI大于等于23.0的患者中发生CIA的比例更高。闭经距首次化疗时间越早,越有可能发展为CIA。未发现不同化疗方案、他莫昔芬和曲妥珠单抗对CIA的发生有影响。月经恢复时间与DFS、激素受体及化疗方案均无明显相关性。CIA对乳癌患者无病生存可能有潜在的获益。[结论]初诊年龄是绝经前乳腺癌化疗致闭经具有预测意义及影响其恢复的重要因素。大于42岁患者CIA风险增高,44岁以下患者更容易恢复月经。BMI值、闭经距首次化疗时间与CIA的发生存在一定关联。CIA对乳癌患者无病生存可能有潜在的获益。当患者化疗后符合绝经判断标准但小于44岁,给患者使用芳香化酶抑制剂前后仍需要规律监测雌激素、FSH。
[Abstract]:[objective] CIA chemotherapy-induced amenorrhea was defined as amenorrhea within 6 months after the onset of chemotherapy, and amenorrhea lasted for at least 12 months. To study the incidence and influencing factors of CIA after chemotherapy in premenopausal breast cancer and the clinical significance of CIA in premenopausal breast cancer. [methods] the data of newly diagnosed premenopausal breast cancer patients admitted to Yunnan Cancer Hospital from September 2012 to September 2013 were retrospectively collected, including age, height, weight and chemotherapy regimen. Chemotherapy cycle, menarche age, birth history, surgical method, clinicopathological features of tumor, endocrine therapy, use of trotozumab, radiotherapy or not. The status and prognosis of menstruation after chemotherapy were obtained by telephone follow-up. All statistical data were treated with SPSS24.0. The comparison of constitution ratio of each group was made by chi-square test. The ROC curve was used to explore the age and BMI's prediction bound of CIA. CIA time of different age groups was compared by Kruskal-Wallis H test and survival analysis by Kaplan-Meier method and log-rank test. The correlation analysis of continuous data was carried out by spearman correlation analysis, and the correlation analysis of classified variables was conducted by using the column association number of crossover tables. [results] the median follow-up time was 46 months (12-54 months). The age of the patients ranged from 28 to 53 years old, with a median age of 43 years. Most of them were lymph node negative, hormone receptor positive or HER2 negative, tumor diameter less than equal to 2cm in early breast cancer patients. There were 62 cases with CIAs, 46 cases without CIAs. A total of 56 patients recovered their menstruation after chemotherapy, 13 of them were unmenopausal. Age at first diagnosis is an important factor affecting the recovery of premenopausal breast cancer due to chemotherapy-induced amenorrhea. Patients over 42 years of age with increased risk of CIA and patients under 44 years of age were more likely to recover menstruation. There was a certain correlation between the value of menorrhagia and CIA. There was a higher incidence of CIA in those patients whose CIA was greater than or equal to 23.0. The earlier the amenorrhea is before the first chemotherapy, the more likely it is to develop into CIA. No different chemotherapy protocols were found, tamoxifen and tritozumab had an effect on the occurrence of CIA. There was no significant correlation between menstrual recovery time and DFS, hormone receptor and chemotherapy regimen. The CIA may have potential benefits for disease-free survival of breast cancer patients. [conclusion] the age of first diagnosis is a predictor of chemotherapy-induced amenorrhea in premenopausal breast cancer and an important factor affecting the recovery of premenopausal breast cancer. Patients over 42 years of age with increased risk of CIA and patients under 44 years of age are more likely to recover menstruation. The time of first chemotherapy in amenorrhea and the occurrence of CIA may have potential benefits for the disease-free survival of breast cancer patients. When the patient meets the criteria of menopause after chemotherapy but is less than 44 years old, it is necessary to monitor estrogen FSH regularly before and after the treatment of aromatase inhibitor.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

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