三苯氧胺与来曲唑治疗ER阳性乳腺癌的临床疗效及对血清雌二醇水平和远期预后的影响

目的探讨三苯氧胺与来曲唑治疗雌激素受体(ER)阳性乳腺癌的临床疗效及对血清雌二醇(E2)水平和远期预后的影响。方法采用简单随机抽样法将110例ER阳性乳腺癌患者分为对照组(n=53)和研究组(n=57)。两组患者均接受长春瑞滨联合顺铂治疗,对照组患者在此基础上接受三苯氧胺治疗,研究组患者在此基础上接受来曲唑治疗,随访3年。比较两组患者的临床疗效、血清肿瘤标志物和E2水平、子宫内膜情况、不良反应发生率及生存情况。结果研究组患者的疾病控制率为92.98%,高于对照组的79.25%,差异有统计学意义(P<0.05)。治疗前,两组患者的血清糖类抗原153(CA153)、癌胚抗原(CEA)及E2水平比较,差异均无统计学意义(P>0.05)。治疗后3个月,两组患者的血清CEA和CA153水平均较本组治疗前降低,且研究组患者的血清CEA和CA153水平均低于对照组,差异均有统计学意义(P<0.05)。治疗后3、6、12个月,研究组患者的血清E2水平均低于治疗前,对照组患者的血清E2水平均高于治疗前,差异均有统计学意义(P<0.05)。病理结果提示,治疗后对照组中子宫内膜息肉2例,内膜不典型增生1例。两组患者恶心呕吐、便秘、肝肾功能不全、血小板减少、粒细胞减少及白细胞降低的发生率比较,差异均无统计学意义(P> 0.05)。研究组患者的3年生存情况优于对照组(P<0.05)。结论来曲唑治疗ER阳性乳腺癌的临床疗效优于三苯氧胺,且可降低血清肿瘤标志物和E2水平,改善远期预后。

Effect of tamoxifen and letrozole on serum estradiol level and long-term prognosis of ER-positive breast cancer

Objective To compare the effect of tamoxifen and letrozole on serum estradiol(E2) level and long-term prognosis of estrogen receptor(ER)-positive breast cancer.Method Totally,110 patients with ER-positive breast cancer were included in the analysis and further categorized by simple random sampling as control group(n=53) and study group(n=57).Both groups of patients were treated with vinorelbine combined with cisplatin,with the add-on therapy of tamoxifen in control group and letrozole in study group,all patients were followed up for 3 years.The clinical efficacy,serum tumor markers and E2 levels,endometrial conditions,adverse reactions as well as survival of patients in both group were observed and compared.Result The disease control rate in study group was 92.98%,which was higher than that of the control group at 79.25%,and the difference was statistically significant(P<0.05).Before treatment,there were similar findings with respect to serum carbohydrate antigen 153(CA153),carcinoembryonic antigen(CEA) and E2 between the two groups(P>0.05).While in 3 months after treatment,the levels of serum CEA and CA153 in the two groups were significantly decreased,with significantly greater reductions noted in study group versus control group(P<0.05).In 3,6,and 12 months after treatment,the levels of E2 in study group were reduced evidently,while that in control group were increased,indicating statistically significant differences(P<0.05).Pathological results included 2 cases of endometrial polyps and 1 case of atypical endometrial hyperplasia in control group after treatment.Adverse reactions in the two groups were mainly nausea and vomiting,constipation,liver and kidney dysfunction,thrombocytopenia,granulocytopenia and leukopenia,with comparable incidence between the two groups(P>0.05).Better 3-year survival was observed in study group compared to control group(P<0.05).Conclusion Letrozole is more clinically efficacious than tamoxifen in the treatment of ER-positive breast cancer,with reduced serum tumor marker levels and E2 concentration and improved long-term progno sis.