中国普外基础与临床杂志

中国普外基础与临床杂志

内分泌治疗在乳腺癌原发灶激素受体阴性而腋窝淋巴结转移灶激素受体阳性患者中的疗效

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目的 探讨内分泌治疗在乳腺癌原发灶激素受体(HR)阴性(HR)而腋窝淋巴结转移灶 HR 阳性(HR+)患者中的疗效。 方法 纳入 2011 年 1 月至 2016 年 1 月期间笔者所在医院收治的 67 例原发灶 HR 而腋窝淋巴结转移灶 HR+ 乳腺癌患者,随机分为内分泌治疗组(33 例)和对照组(34 例),内分泌治疗组患者放化疗结束后口服三苯氧胺,2 次/d,10 mg/次,5 年;对照组放化疗结束后未予口服三苯氧胺。比较 2 组患者的生存情况。 结果 内分泌治疗组和对照组患者的年龄、月经情况、肿瘤直径、术前 TNM 分期等方面比较差异均无统计学意义(P>0.05)。所有患者均获随访,随访时间 12~60 个月,中位随访时间 48.5 个月。内分泌治疗组患者的复发率、转移率及复发转移死亡率与对照组比较差异均无统计学意义(P>0.05)。内分泌治疗组患者的 3、5 年无病生存率及总生存率均明显高于对照组(P<0.05),内分泌治疗组患者 5 年累积无病生存和累积总生存效果也均明显优于对照组(P<0.05)。 结论 重视乳腺癌患者原发灶与腋窝淋巴结转移灶的分子分型,内分泌治疗或许可以提高原发灶 HR 而腋窝淋巴结转移灶 HR+ 乳腺癌患者的生存率。

Objective To explore therapeutic effect of endocrine therapy in breast cancer patients with negative hormone receptor (HR) of primary lesion and positive HR (HR+) of metastatic axillary lymph node lesion. Methods Sixty-seven cases of breast cancer with HR of primary lesion and HR+ of metastatic axillary lymph node lesion from January 2011 to January 2016 were selected. All the patients were randomly divided into endocrine therapy group (33 cases) and control group (34 cases). The patients were given the oral drug of tamoxifen on the basis of conventional chemotherapy in the endocrine therapy group after the surgery, 10 mg/time, twice daily, 5 years; while the patients in the control group were not given the oral drug of tamoxifen but the other therapy same as the endocrine therapy group. The survivals were compared in both groups. Results There were no significant differences in the age, menstrual condition, tumor diameter, preoperative TNM stage, and so on between the endocrine therapy group and the control group (P>0.05). All the patients were followed up for 12–60 months with a 48.5 months of median time. There were no significant differences in the rates of the local recurrence and metastasis, or death rate due to the recurrence and metastasis in both groups (P>0.05). The progression-free survival and overall survival in the endocrine therapy group were significantly higher than those in the control group (P<0.05). The 5-year cumulative progression-free survival and overall survival in the endocrine therapy group were significantly better than those in the control group (P<0.05). Conclusion Pay attention to molecular classification of primary lesion and metastatic axillary lymph node lesion in patients with breast cancer, and endocrine therapy might be able to improve survival rate of breast cancer patients with primary lesion HR and metastatic axillary lymph node lesion HR+.

关键词: 乳腺癌; 分子分型; 雌激素; 孕激素; 内分泌治疗

Key words: breast cancer; molecular classification; estrogen; progesterone; endocrine therapy

引用本文: 郑向欣, 吴骥, 顾书成, 江小玲, 侍孝红, 袁牧, 陆柏林, 邱兴, 张旭旭, 柏建印, 管小青. 内分泌治疗在乳腺癌原发灶激素受体阴性而腋窝淋巴结转移灶激素受体阳性患者中的疗效. 中国普外基础与临床杂志, 2018, 25(2): 161-165. doi: 10.7507/1007-9424.201707089 复制

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1. Coleman MP, Forman D, Bryant H, et al. Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995-2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data. Lancet, 2011, 377(9760): 127-138.
2. 江泽飞, 徐兵河, 邵志敏, 等. 乳腺癌内分泌治疗专家共识与争议. 中国癌症杂志, 2013, 23(9): 772-776.
3. Davies C, Pan H, Godwin J, et al. Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet, 2013, 381(9869): 805-816.
4. Gradishar WJ, Anderson BO, Balassanian R, et al. Breast cancer Version 2. 2015. J Natl Compr Canc Netw, 2015, 13(4): 448-475.
5. Curtit E, Nerich V, Mansi L, et al. Discordances in estrogen receptor status, progesterone receptor status, and HER2 status between primary breast cancer and metastasis. Oncologist, 2013, 18(6): 667-674.
6. Joensuu K, Leidenius M, Kero M, et al. ER, PR, HER2, Ki-67 and CK5 in early and late relapsing breast cancer-reduced CK5 expression in metastases. Breast Cancer (Auckl), 2013, 7: 23-34.
7. Sun L, Yu DH, Sun SY, et al. Expressions of ER, PR, HER-2, COX-2, and VEGF in primary and relapsed/metastatic breast cancers. Cell Biochem Biophys, 2014, 68(3): 511-516.
8. Yang Y F, Liao Y Y, Yang M, et al. Discordances in ER, PR and HER2 receptors between primary and recurrent/metastatic lesions and their impact on survival in breast cancer patients. Med Oncol, 2014, 31(10): 214.
9. 田枫, 张建国, 仲雷. 乳腺浸润性导管癌病灶与腋窝转移淋巴结中 ER 和 HER2 表达的关系.中国普通外科杂志, 2012, 21(11): 1405-1409.
10. 刘琪, 左文述, 王新昭, 等. 乳腺癌原发灶和淋巴结转移灶激素受体及 HER-2 与 Ki-67 表达相关性分析. 中华肿瘤防治杂志, 2013, 20(15): 1153-1157.
11. 赵海波, 程雪雁, 刘金君, 等. 乳腺癌原发灶与腋淋巴结转移灶ER和PR及c-erbB-2表达的对照研究. 中华肿瘤防治杂志, 2011, 18(8): 594-596.
12. Hammond ME, Hayes DF, Dowsett M, et al; American Society of Clinical Oncology/College of American. Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol, 2010. DOI 10.1200/JCO.2009.25.6529.
13. DeSantis C, Ma J, Bryan L, et al. Breast cancer statistics, 2013. CA Cancer J Clin, 2014, 64(1): 52-62.
14. EBCTCG (Early Breast Cancer Trialists' Collaborative Group), McGale P, Taylor C, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet, 2014, 383(9935): 2127-2135.
15. Capelan M, Pugliano L, De Azambuja E, et al. Pertuzumab: new hope for patients with HER2-positive breast cancer. Ann Oncol, 2013, 24(2): 273-282.
16. 唐金海, 陈伟贤. 乳腺癌分子分型及其指导下的个体化治疗. 中国癌症防治杂志, 2013, 5(3): 187-191.
17. 齐元富. 乳腺癌内分泌治疗的研究进展. 国外医学•肿瘤学分册, 1998, 25(1): 32-34.
18. 曹璐, 陈佳艺, 许赪. 分子分型指导下乳腺癌个体化放疗. 中华放射肿瘤学杂志, 2016, 25(11): 1272-1276.
19. 梁越洋, 唐鹏, 王姝姝, 等. 乳腺癌新辅助化疗疗效与分子分型的关系. 中国普外基础与临床杂志, 2014, 15(3): 562-566.
20. 王雅杰, 应明真, 陈天然. 三阴性乳腺癌分子分型与个体化治疗. 医学研究杂志, 2016, 45(6): 1-5
21. Reis-Filho JS1, Pusztai L. Gene expression profiling in breast cancer: classification, prognostication, and prediction. Lancet, 2011, 378(9805): 1812-1823.
22. Viale G. The current state of breast cancer classification. Ann Oncol, 2012, 23 Suppl 10: x207-x210.
23. 江泽飞, 许凤锐. 乳腺癌分子分型对治疗的影响. 中华普外科手术学杂志 (电子版), 2015, 9(6): 12-15
24. Hammond ME, Hayes DF, Dowsett M, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer (unabridged version). Arch Pathol Lab Med, 2010, 134(7): e48-e72.
25. 吴世凯, 宋三泰. 对乳腺癌雌孕激素受体检测的认识. 中华乳腺病杂志 (电子版), 2012, 6(3): 39-41.
26. 姚自翔, 金梁斌, 孔令泉, 等. 乳腺癌原发灶与同期腋淋巴结转移灶雌、孕激素受体和人类表皮生长因子受体 2 的表达差异研究进展. 中华内分泌外科杂志, 2014, 8(2): 134-136.
27. Sari E, Guler G, Hayran M, et al. Comparative study of the immunohistochemical detection of hormone receptor status and Her-2 expression in primary and paired recurrent/metastatic lesions of patients with breast cancer. Med Oncol, 2011, 28(1): 57-63.
28. 冯爱强, 郝朋亮, 张彦武, 等. 年轻乳腺癌患者 108 例预后相关因素及分子分型分析. 中国综合临床, 2017, 33(1): 44-47
29. Amir E, Clemons M, Purdie CA, et al. Tissue confirmation of disease recurrence in breast cancer patients: pooled analysis of multi-centre, multi-disciplinary prospective studies. Cancer Treat Rev, 2012, 38(6): 708-714.