原发灶激素受体阴性腋淋巴结转移灶激素受体阳性乳腺癌患者的内分泌治疗

目的:探讨内分泌治疗对原发灶激素受体(HR)阴性,腋淋巴结转移灶HR阳性乳腺癌患者的临床效果。方法:将2011年1月—2016年1月收治的67例原发灶HR阴性,腋淋巴结转移灶HR阳性乳腺癌患者随机分为观察组(33例)与对照组(34例),两组术后放化疗方案相同,观察组化疗结束后给予三苯氧胺(绝经前患者)或来曲唑(绝经后患者),比较两组患者的复发转移及生存情况。结果:所有患者随访12~60个月,期间观察组有13例患者出现复发转移,死亡7例;对照组有19例患者出现复发转移,死亡15例;两组复发转移发生率无统计学差异(P0.05),观察组复发转移死亡的比例明显低于对照组(P0.05)。观察组患者1、3、5年无病生存率(DFS)分别为100%、81.8%、72.7%,1、3、5年总生存率(OS)分别为100%、90.9%、81.8%(27/33);对照组患者1、3、5年DFS分别为100%、58.8%、47.1%,1、3、5年OS分别为100%、70.6%、58.8%;观察组3、5年DFS和OS均明显高于对照组(均P0.05)。结论:乳腺癌患者原发灶与腋淋巴结转移灶的分子分型值得重视;术后内分泌治疗可以提高原发灶HR阴性,腋淋巴结转移灶HR阳性乳腺癌患者的生存率,降低死亡风险。

Efficacy of endocrinotherapy in breast cancer patients with hormone receptor negative primary lesion and positive axillary lymph node metastasis

Objective: To investigate the clinical efficacy of endocrinotherapy in treatment of breast cancer patients with hormone receptor (HR)-negative primary lesion and HR-positive axillary lymph node metastases. Methods: Sixty-seven breast cancer patients with HR-negative primary lesion and HR-positive axillary lymph node metastases admitted from January 2011 to January 2016 were randomly designated to observation group (33 cases) and control group (34 cases). Patients in both groups received the same chemoradiotherapy regimen, while those in observation group were additionally given administration of tamoxifen (pre-menopausal patients) or letrozole (post-menopausal patients) after chemotherapy. The recurrence/metastasis and survival rates of the two groups of patients were compared. Results: All patients were followed up for 12 to 60 months, during which time, recurrence/metastasis occurred in 13 cases and death occurred in 7 cases in observation group, and recurrence/metastasis occurred in 19 cases and death occurred in 15 cases in control group. The incidence of recurrence/metastasis of the two groups showed no significant difference (P>0.05), while the rate of death due to recurrence/metastasis was significantly lower in observation group than that in control group (P<0.05). The 1-, 3- and 5-year disease-free survival (DFS) rate was 100%, 81.8% and 72.7% in observation group and was 100%, 58.8% and 47.1% in control group respectively; the 1-, 3- and 5-year overall survival (OS) rate was 100%, 90.9% and 81.8% in observation group and was 100%, 70.6% and 58.8% in control group. Both 3- and 5-year DFS and OS in observation group were significantly higher than those in control group (all P<0.05). Conclusion: Attention should be paid to the molecular classification of primary lesion and axillary lymph node metastasis in breast cancer patients. Postoperative endocrinotherapy may improve the survival and reduce the risk of death for breast cancer patients with HR-negative primary lesion and HR-positive axillary lymph node metastases.