激素受体阳性乳腺癌患者卵巢抑制时机的选择及对预后的影响

发布时间：2019-03-30 20:52

【摘要】：目的评估绝经前激素受体阳性、腋窝淋巴结阳性(N1)乳腺癌患者辅助化疗同时卵巢抑制治疗,对远期复发、生存的影响。方法回顾性分析2001年1月-2009年10月该院诊治的激素受体阳性、腋窝淋巴结1~3个转移的167例绝经前乳腺癌患者。根据化疗期间有无接受卵巢抑制治疗,将患者分为A、B两组。A组55例激素受体阳性的乳腺癌患者,该组接受6周期化疗且化疗开始前给予戈舍瑞林缓释植入剂进行药物卵巢去势,化疗结束后接受5年、规范的内分泌治疗。B组112例激素受体阳性乳腺癌患者,该组患者仅接受6周期化疗+5年内分泌治疗。结果截止2015年底,中位随访时间58个月,单因素分析显示,A组的5年无病生存期优于B组;A组与B组的总生存期比较差异无统计学意义,但是5年生存期提高10%,具有临床意义。多因素分析显示,有无卵巢去势、脉管浸润结果及组织学分级是影响预后的独立因素。结论对年龄≤45岁、激素受体阳性及腋窝淋巴结1~3个转移的乳腺癌患者,化疗同时接受卵巢去势治疗可以显著改善治疗疗效。脉管浸润情况及乳腺癌组织学分级是影响激素受体阳性、腋窝淋巴结阳性乳腺癌预后的独立因素。
[Abstract]:Objective to evaluate the effects of adjuvant chemotherapy combined with ovarian suppression on long-term recurrence and survival in patients with premenopausal hormone receptor positive and axillary lymph node positive (N1) breast cancer. Methods from January 2001 to October 2009, 167 premenopausal breast cancer patients with positive hormone receptor and 3 axillary lymph nodes metastasis were retrospectively analyzed. Patients were divided into two groups: group A and group B. 55 patients with hormone receptor positive breast cancer were divided into two groups according to whether or not they were treated with ovarian suppression during chemotherapy. This group received 6 cycles of chemotherapy and Gosselelin slow-release implants for ovariectomy before the beginning of chemotherapy, 5 years after the end of chemotherapy, standard endocrine therapy. Group B 112 patients with hormone receptor positive breast cancer, the other 112 patients with hormone receptor positive breast cancer, and the other 112 patients with hormone receptor positive breast cancer. The patients in this group received only 6 cycles of chemotherapy and 5 years of endocrine therapy. Results by the end of 2015, the median follow-up time was 58 months. Univariate analysis showed that the 5-year disease-free survival period in group A was better than that in group B. There was no significant difference in the overall survival time between group A and group B, but the 5-year survival time was increased by 10%. Multivariate analysis showed that ovarian castration, vascular infiltration and histological grade were independent prognostic factors. Conclusion for breast cancer patients under 45 years of age, hormone receptor positive and axillary lymph node metastasis, chemotherapy combined with ovariectomy can significantly improve the therapeutic effect. Vessel infiltration and histological grade of breast cancer were independent factors affecting the prognosis of breast cancer with positive hormone receptor and positive axillary lymph nodes.
【作者单位】：中一东北国际医院乳腺外科;中国医科大学附属第四医院第五普通外科;
【分类号】：R737.9

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