激素受体阳性乳腺癌患者卵巢抑制时机的选择及对预后的影响

摘要：目的  评估绝经前激素受体阳性、腋窝淋巴结阳性（N1）乳腺癌患者辅助化疗同时卵巢抑制治疗，对远期复发、生存的影响。方法  回顾性分析2001年1月-2009年10月该院诊治的激素受体阳性、腋窝淋巴结1～3个转移的167例绝经前乳腺癌患者。根据化疗期间有无接受卵巢抑制治疗，将患者分为A、B两组。A组55例激素受体阳性的乳腺癌患者，该组接受6周期化疗且化疗开始前给予戈舍瑞林缓释植入剂进行药物卵巢去势，化疗结束后接受5年、规范的内分泌治疗。B组112例激素受体阳性乳腺癌患者，该组患者仅接受6周期化疗＋5年内分泌治疗。结果  截止2015年底，中位随访时间58个月，单因素分析显示，A组的5年无病生存期优于B组；A组与B组的总生存期比较差异无统计学意义，但是5年生存期提高10%，具有临床意义。多因素分析显示，有无卵巢去势、脉管浸润结果及组织学分级是影响预后的独立因素。结论  对年龄≤45岁、激素受体阳性及腋窝淋巴结1～3个转移的乳腺癌患者，化疗同时接受卵巢去势治疗可以显著改善治疗疗效。脉管浸润情况及乳腺癌组织学分级是影响激素受体阳性、腋窝淋巴结阳性乳腺癌预后的独立因素。

Efficacy of adjuvant chemotherapy plus ovarian function suppression in premenopausal women with early-stage hormone-receptor-positive breast cancer

Abstract: Objective To assess the efficacy of chemotherapy plus ovarian function suppression therapy (Goserelin) for premenopausal women with hormone-receptor-positive and lymph-node-positive (N1) breast cancer. Methods The data of 167 premenopausal women treated in our hospital from January 2001 to October 2009 for hormone-receptor-positive and lymph-node-positive (1-3) breast cancer were retrospectively reviewed. On the basis of the use of ovarian function suppression (Goserelin) or not, the patients were categorised into two groups. In group A, 55 HR-positive patients received 6 courses of chemotherapy plus 6-month ovarian function suppression followed by 5-year endocrine therapy. In group B, 112 HR-positive patients only received 6 courses of chemotherapy with 5-year endocrine therapy. Results The median follow-up period was 58 months by the end of 2015. In univariate analysis, chemotherapy plus 6-month ovarian function suppression therapy improved 5-year disease-free survival (DFS) and 5-year overall survival (OS). In multivariate analysis, Goserelin treatment, lymphovascular invasion (LVI) and histological grade were the independent factors influencing DFS and OS. Conclusions For the patients ≤45 years with lymph node metastasis (1-3) and HR-positive breast cancer, chemotherapy plus 6-month ovarian function suppression therapy can result in significantly improved therapeutic efficacy. LVI and histological grade are powerful independent adverse prognostic factors and should be considered in decisions about adjuvant treatment in breast cancer patients with the positive hormone receptor and lymph node metastasis.