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目的探讨含蒽环类方案和蒽环类序贯紫杉类方案辅助化疗对绝经前早期乳腺癌患者致闭经的作用及影响因素。方法收集中国医学科学院北京协和医学院肿瘤医院2008至2010年收治的雌激素受体阳性且接受含蒽环类或蒽环类序贯紫杉类方案辅助化疗的绝经前早期乳腺癌患者的病历资料进行回顾性分析。化疗方案包括含蒽环类的6EC方案(环磷酰胺600 mg/m~2+表柔比星75mg/m~2,21 d为1个周期,共6个周期)和蒽环类序贯紫杉类的4EC-4T方案(环磷酰胺600 mg/m~2+表柔比星90 mg/m~2,21 d为1个周期,共4个周期;序贯紫杉醇175 mg/m~2或多西紫杉醇75 mg/m~2,21 d为1个周期,共4个周期)。按辅助化疗方案将患者分为2组,统计化疗所致闭经(CIA)发生率,记录CIA患者化疗结束后2年内月经和卵巢功能(以卵泡刺激素、黄体生成素和雌二醇水平反映)恢复情况,采用Logistic回归方法和χ~2检验分析CIA的影响因素。结果纳入分析的患者共96例。6EC方案组45例,中位年龄43岁;4EC-4T方案组51例,中位年龄42岁。化疗结束时96例患者中77例发生CIA(80.2%),化疗后2年内CIA患者中月经恢复者51例(66.2%),卵巢功能恢复者53例(68.8%)。6EC方案组和4EC-4T方案组CIA发生率、月经恢复率和卵巢功能恢复率差异无统计学意义[75.6%(34/45)比84.3%(43/51),70.6%(24/34)比62.8%(27/43),73.5%(25/34)比65.1%(28/43),均P<0.05]。年龄是CIA转归的重要影响因素(风险比=0.759,95%置信区间为0.448~0.968,P=0.048)。年龄>40岁和≤40岁者CIA发生率分别为86.9%(53/61)和68.6%(24/35)(P=0.022),卵巢功能恢复率分别为56.6%(30/53)和100.0%(24/24)(P=0.000)。年龄≤40岁者月经恢复时间与卵巢功能恢复时间同步,年龄>40岁者月经恢复时间(中位时间11个月)晚于卵巢功能恢复时间(中位时间9个月)。结论含蒽环类方案和蒽环类序贯紫杉类方案辅助化疗均可导致绝经前早期乳腺癌患者发生CIA,两组CIA的发生率及转归相似。年龄是CIA发生及其转归的重要影响因素。对于发生CIA的年轻患者,术后辅助化疗后的内分泌治疗选择应慎重。
Objective To investigate the effect of anthracyclines and anthracyclines sequential taxanes adjuvant chemotherapy on amenorrhea in early premenopausal women with breast cancer and its influencing factors. Methods The data of medical records of premenopausal women with early-stage breast cancer who were positive for estrogen receptor and received adjuvant chemotherapy with anthracyclines or anthracyclines sequential taxanes from 2008 to 2010 were collected from Cancer Center of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences. Retrospective analysis. The chemotherapy regimen consisted of a 6EC regimen containing anthracyclines (cyclophosphamide 600 mg / m ~ 2 + epirubicin 75 mg / m ~ 2 and 21 d for 1 cycle for a total of 6 cycles) and anthracyclines Sugarcane 4EC-4T program (cyclophosphamide 600 mg / m ~ 2 + epirubicin 90 mg / m ~ 2, 21 d for a period of 4 cycles; sequential paclitaxel 175 mg / m ~ 2 Or docetaxel 75 mg / m ~ 2,21 d for a period of 4 cycles). According to the adjuvant chemotherapy regimen, the patients were divided into two groups. The incidence of amenorrhea (CIA) caused by chemotherapy was recorded. Menstrual and ovarian function were recorded within 2 years after chemotherapy in CIA patients (follicle-stimulating hormone, luteinizing hormone and estradiol levels) Recovery, using Logistic regression and χ ~ 2 test analysis of CIA influencing factors. Results A total of 96 patients were included in the analysis. 45 cases of 6EC regimen group, the median age of 43 years; 4EC-4T program group of 51 patients, the median age of 42 years. Of the 96 patients at the end of chemotherapy, 77 had CIA (80.2%), 51 (66.2%) had recanalization during menstruation and 53 (68.8%) had ovarian function recovery within 2 years after chemotherapy. The rates of CIA, menstruation recovery and ovarian function recovery in 6EC and 4EC-4T groups were not significantly different (75.6%, 34/45, 84.3%, 70.6%, 24/34) (62/43), 73.5% (25/34), 65.1% (28/43), all P <0.05. Age was a significant contributor to CIA outcomes (hazard ratio = 0.759, 95% confidence interval 0.448 to 0.968, P = 0.048). The incidences of CIA were 86.9% (53/61) and 68.6% (24/35) respectively (P = 0.022), and the rates of ovarian function recovery were 56.6% (30/53) and 100.0 % (24/24) (P = 0.000). Menstruation recovery time of ≤40 years old is in synchronization with ovarian function recovery time, and menstruation recovery time (median 11 months)> 40 years old is later than ovarian function recovery time (median 9 months). Conclusions Both anthracycline and anthracycline sequential taxanes adjuvant chemotherapy can lead to CIA in early stage of premenopausal women with breast cancer. The incidence and outcome of CIA in both groups are similar. Age is an important factor in the occurrence of CIA and its outcome. For young patients with CIA, postoperative adjuvant chemotherapy should be carefully chosen endocrine therapy.