CAJ | 학술논문

目的探讨芳香化酶抑制剂和三苯氧胺对绝经后Luminal B型乳腺癌患者的疗效.方法收集天津市肿瘤医院2002年7月至2005年3月间733例术后接受辅助内分泌治疗的原发性乳腺癌患者资料,肿瘤性质均经手术切除病理组织学证实.患者均为绝经后且ER阳性,其中501例接受三苯氧胺治疗,232例接受芳香化酶抑制剂治疗.采用免疫组化SP法进行ER、PR、HER2检测.随访时间36～90个月,中位随访时间46个月.结果芳香化酶抑制剂治疗组Luminal B型乳腺癌患者三年无瘤生存率高于三苯氧胺组(90.6% vs.88.6%,P=0.038).三苯氧胺组亚组分析显示:LN+/HER2+患者三年无瘤生存率低于LN+/HER2-患者(88.2% vs 90.4%,P=0.037);HER2+/PR+患者高于HER2+/PR-患者(90.8% vs.89.5%,P=0.032).芳香化酶抑制剂组内LN(+)和LN(-)亚组中,HER2(+)患者与HER2(-)患者的三年无瘤生存率差异均无统计学意义(P>0.05);而HER2+/PR+组高于HER2+/PR-组(91.9% vs.90.5%,P=0.029).芳香化酶抑制剂组潮热、阴道出血、静脉血栓形成的发生率低,肌肉骨骼疼痛、骨折的发生率则高于三苯氧胺组(P<0.05).结论芳香化酶抑制剂对绝经后Luminal B型患者疗效好于三苯氧胺,此效果不受患者腋窝淋巴结状态的影响,且耐受性和安全性较好.
목적 탐토방향화매억제제화삼분양알대절경후Luminal B형유선암환자적료효.방법 수집천진시종류의원2002년7월지2005년3월간733례술후접수보조내분비치료적원발성유선암환자자료,종류성질균경수술절제병리조직학증실.환자균위절경후차ER양성,기중501례접수삼분양알치료,232례접수방향화매억제제치료.채용면역조화SP법진행ER、PR、HER2검측.수방시간36～90개월,중위수방시간46개월.결과 방향화매억제제치료조Luminal B형유선암환자삼년무류생존솔고우삼분양알조(90.6% vs.88.6%,P=0.038).삼분양알조아조분석현시:LN+/HER2+환자삼년무류생존솔저우LN+/HER2-환자(88.2% vs 90.4%,P=0.037);HER2+/PR+환자고우HER2+/PR-환자(90.8% vs.89.5%,P=0.032).방향화매억제제조내LN(+)화LN(-)아조중,HER2(+)환자여HER2(-)환자적삼년무류생존솔차이균무통계학의의(P>0.05);이HER2+/PR+조고우HER2+/PR-조(91.9% vs.90.5%,P=0.029).방향화매억제제조조열、음도출혈、정맥혈전형성적발생솔저,기육골격동통、골절적발생솔칙고우삼분양알조(P<0.05).결론 방향화매억제제대절경후Luminal B형환자료효호우삼분양알,차효과불수환자액와림파결상태적영향,차내수성화안전성교호.
Objective To evaluate a therapeutic strategy using aromatase inhibitors and TAM in postmenopausal Luminal B breast cancer patients. Methods The clinical data of 733 primary breast cancer cases receiving postoperative endocrine thempy from July 2002 to Mar 2005 in Tianjin Cancer Hospital were retrospectively analyzed.Diagnosis was confirmed by pathology in all the cases.All patients were post-menopausal and ER-positive.501 patients were given tamoxifen(TAM 2.5 mg qd,po),232 patients were given aromatase inhibitors(Letrozole 10 mg bid,po).The follow-up time ranged from 36 to 90 months.Median follow-up time was 46 months.Results The disease-free-survival(DFS)rate of Luminal B breast cancer patients in aromatase inhibitors(AIS)group was higherthan that in TAM group(90.6% vs.88.6%,P=0.038).In TAM group,subgroup analysis showed 3-year DFS of node-positive with HER2(+)is lower than that of node-positive with Her-2-negative(88.2% vs.90.4%,P=0.037);3-year DFS of ER+/PR+ group in HER2(+) patients was higher than that of ER+/PR-group(90.8% vs.89.5%.P=0.032).In AIs group,in spite of the axillary lymph node status,there was no significant difference of 3-year DFS between HER2(+)patients and HER2(-)ones(P>0.05).3-year DFS of ER+/PR+with HER2(+) patients was higher than that of ER+/PR-ones with HER2(+)(91.9% vs.90.5%,P=0.029).Hot flush,vaginal bleeding and thromboembolics in AIS group is less frequent,but muscle pain and bone fracture is more common than that in TAM group(P<0.05).Conclusion Compared to TAM, AIs is more effective and safer with postmenopausal Luminal B patients,and the effect is independent on node stams.