卵巢功能去势联合芳香化酶抑制剂治疗绝经前转移性乳腺癌的临床研究

目的 评价卵巢功能去势联合芳香化酶抑制剂（AI）治疗绝经前转移性乳腺癌患者的临床疗效及预后。方法 140例绝经前激素受体阳性的晚期乳腺癌患者，接受卵巢功能去势（包括双侧卵巢切除手术和戈舍瑞林）联合AI（包括阿那曲唑、来曲唑和依西美坦）的治疗。评价疗效并分析影响预后的因素。结果 全组患者的中位无进展生存时间（PFS）为8.0个月，临床获益率（CBR）为56.3％。接受一线内分泌治疗患者的中位PFS为9.0个月（95％CI：6.3～11.7个月），接受二线及以上内分泌治疗患者的中位PFS为6.0个月（95％CI：4.1～7.9个月），两者差异有统计学意义（P=0.002）；两组患者的临床获益时间分别为13.1个月（95％CI：10.9～16.3个月）和9.3个月（95％CI：6.8～11.8个月），CBR分别为66.7％和35.6％，差异均有统计学意义（P＜0.05）。全组患者的亚组分析显示，单个部位转移、无内脏转移、既往未接受过解救化疗者治疗后获得更长的中位PFS和更好的CBR。Cox多因素生存分析显示，转移灶数目是影响患者PFS的独立预后因素。结论 卵巢功能去势联合AI治疗绝经前激素受体阳性的转移性乳腺癌患者临床疗效肯定，耐受性好，可作为一线治疗的选择。

Ovarian function castration combined with aromatase inhibitors in the treatment of metastatic breast canc- er in premenopausal women

Objective To evaluate the clinical efficacy and prognosis in patients receiving ovarian function castration combined with aromatase inhibitors treatment for premenopausal metastatic breast cancer. Methods One hundred and forty hormone dependent mastatic breast cancer patients received ovarian function castration（ovarian resection surgery or goserelin） combined with aromatase inhib- itors （anastrozole,letrozole or exemestane） were analyzed retrospectively. The clinical efficacy and prognosis of all patients were evalua- ted. Results All the patients＇ median progression free survival（PFS） was 8. 0 months and the clinical benefit rate was 56. 3%. The PFS of patients received first-line treatment and second-line or above were 9. 0 months（95% CI：6. 3-11.7） and 6.0 months（95% CI：4. 1- 7.9）, respectively; the clinical benefit rates of two groups were 66. 7%, 39. 7% ; the median clinical benefit time were 13.1 months （95% CI：10. 9-16. 3 ） and 9. 3 months（95% C1：6. 8-11.8 ）. In subgroup analysis, the patients who had single organ metastasis, no viscer- al metastasis and non-received chemotherapy before obtained better curative effects. Cox regression analysis showed the number of meta- static position was independent factors of PFS. Conclusion The combination of ovarian function castration and aromatase inhibitors is ef- fective endocrine therapy regiment with well-tolerated toxicity for patients with premenopausal metastatic breast cancer. It can be recom- mended as first-line therapy for the premenopausal and hormone dependent matastatic breast cancer patients.