雌二醇对唑来膦酸预防乳腺癌骨转移疗效的影响

目的探讨雌二醇（E2）对唑来膦酸预防骨转移疗效的影响。方法收集新疆医科大学第一附属医院2006年1月至2009年12月期间收治的乳腺浸润性导管或小叶癌行改良根治术、术后常规化疗后给予唑来膦酸预防骨转移的患者216例，根据2011年St．Gallen乳腺癌专家共识分型，其中luminalA型55例，luminalB型63例，HER-2阳性型50例，三阴型48例。根据血清E2水平分为2组：①E2低水平组，39例，化疗后均行药物卵巢去势；②E2正常组，177例，未行卵巢去势。2组均给予唑来膦酸预防骨转移，临床总观察时间为化疗后3～5年或直至病情进展（包括出现复发、骨转移或远处其他脏器转移等病情进展视为观察终点）。结果发生骨转移情况：E2低水平组共发生7例（17．95％），E2正常组共发生105例（59．32％），E2低水平组发生骨转移率明显低于E2正常组钟：21．91，P〈0．05）；其中luminalA型、luminalB型、HER-2阳性型及三阴型患者中E2低水平组骨转移发生率亦均明显低于E2正常组（1uminalA型：5．13％（2／39）比12．43％（22／177），χ2=4．54，P〈0．05；luminalB型：7．69％（3／39）比13．56％（24／177），χ2=6．04，P〈0．05；HER-2阳性型：2．56％（1／39）比15．25％（27／177），χ2=3．95，P〈0．05；三阴型：2．56％（1／39）比18．08％（32／177），P〈0．05]。E2低水平组各型乳腺癌患者骨转移发生率比较差异无统计学意义（χ2=0．55，P〉0．05）。结论从本组有限的数据初步总结，绝经前年轻乳腺癌患者去势后应用唑来膦酸预防骨转移有明显临床获益，并且这种获益在各型乳腺癌中无明显差异；未行去势且雌激素水平正常或升高的患者应用唑来膦酸临床获益不明显。

Influence of Estrogen on Zoledronic Acid in Preventing Bone Metastasis of Breast Cancer

Objective To study the influence of estrogen on zoledronic acid in preventing bone metastasis of breast cancer. Methods Two hundred and sixteen breast cancer patients who accepted modified radical mastectomy, chemotherapy, and the prophylaxis of zoledronate acid from January 2006 to December 2009 in this hospital were collected, including luminal A 55 cases, luminal B 63 cases, HER-2 positive 50 cases, triple negative 48 cases. Then these patients were categorized into low estrogen group （n=39） and normal estrogen group （n=177） according to the estrogen level. The patients in the low estrogen group accepted drug induced menopause, in the normal estrogen group didn＇t accept drug induced menopause. All the patients accepted the therapy of zoledronate acid, then with clinical follow-up for 3-5 years until progressive disease （include neoplasm recurrence, bone metastasis, and other neoplasm metastasis etc.）. Results The rate of bone metastasis in the low estrogen group was significantly lower than that in the normal estrogen group（ χ2=21.91, P〈0.05）. For the patients with luminal A, luminal B, HER-2 positive, and triple negative, the rates of bone metastases in the low estrogen group were significantly lower than those in the normal estrogen group luminal A： 5. 13% （2/39） versus 12.43% （22/177）, χ2=4.54, P〈 0. 05; luminal B： 7. 69% （3/39） versus 13.56% （24/177）, χ2= 6. 04, P〈 0. 05; HER-2 postive： 2. 56% （1/39） versus 15.25% （27/177）, χ2=3.95, P〈0. 05; triple negative： 2. 56%（1/39） versus 18. 08% （32/177）, P〈0. 05]. The rate of bone metastasis among the different subtype of breast cancer in the low estrogen group was not significant difference （χ2=0. 55, P〉0. 05）. Conelusions From the limited preliminary data, the premenopausal women patients with breast cancer who accepted drug induced menopause afer application of zoledronate acid for preverttion of bone metastasis has a obviously efficacy, and the efficacy has no difference among four molecular subtypes of breast cancer.