激素受体阳性发转移乳腺癌的治疗选择

目录

一、中文摘要 (1)

二、英文摘要 (2)

三、正文 (3)

1.对象与方法 (3)

1.1一般资料 (3)

1.2 ER、PR、HER-2判定、术后分期、疗效及毒性评价标准 (3)

1.3 统计学方法 (4)

2.结果 (4)

2.1术后的无病生存情况 (4)

2.2 Her-2状态对无病生存期的影响 (4)

2.3 辅助治疗的情况 (5)

2.4出现复发转移后的一线治疗情况 (5)

2.5 一线内分泌治疗情况 (6)

2.6姑息化疗情况 (6)

2.7 在两种不同一线治疗中观察到的毒副作用 (6)

2.9死亡情况 (7)

3.结论................................................ .7

4.讨论................................................ .7

四、参考文献 (14)

五、致谢 (18)

六、综述 (19)

激素受体阳性复发转移乳腺癌的治疗选择

[摘要]目的：观察激素受体阳性复发转移乳腺癌治疗的疗效、毒副作用。方法：回顾性的分析激素受体阳性的术后复发转移乳腺癌患者共83例。结果：术后分期IIA期的病人（12.0%）中位DFS为46月；IIB期的病人（20.5%）中位DFS 为41月；IIIA期的病人（27.7%）中位DFS为27月；IIIB期的病人（24.1%）中位DFS为23月；IIIC期的病人（15.7%）中位DFS为16月。Her-2阳性者有38例（45.8%），中位DFS为23月；Her-2阴性者有45例（54.2%），中位DFS 为41月。采用t检验，P＜0.001，组间差异有统计学意义。肿瘤复发转移后在一线治疗中选择内分泌者为25例（30.1%），选择化疗者为58例（69.9%）。内分泌组的患者在一线治疗后疗效为PR9例，SD10例，PD6例，ORR为36.0%。化疗组的患者在一线治疗后疗效PR 27例，SD 19例，PD12例，ORR为46.6%。内分泌组的中位TTP为15.5个月，化疗组为7.0个月，对两组TTP采取t检验，P=0.033，组间差异有统计学意义。一线姑息治疗中内分泌治疗耐受良好，化疗观察到的毒性较大。在Her-2阳性病人的一线姑息治疗中，仅6例（15.8%）使用了曲妥珠单抗抗Her-2治疗。至本文完成时，全组病例中共死亡2例（2.4%）。结论：激素受体阳性的患者在出现复发转移后更多的病例在一线治疗时选择了化疗而非内分泌治疗。考虑到治疗的获益和毒性，临床上应提高内分泌治疗的地位，也应注意到内分泌联合靶向治疗的作用。

[关键词]乳腺癌，转移，内分泌治疗

Therapeutic options for hormone receptor-positive advanced breast cancer [Abstract] Objective To observe the effect and side-effect of hormone receptor-positive advanced breast cancer.Methods To analysis retrospectively of 83 cases of hormone receptor-positive advanced breast cancer.Results Median DFS of patients with stage IIA (12.0%)was 46 months;median DFS of patients with stage IIB (20.5%)was 41 months;median DFS of patients with stage IIIA(27.7%)was 27 months;median DFS of patients with stage IIIB(24.1%)was 23 months;median DFS of patients with stage IIIC(15.7%)was 16 months.Median DFS of patients with Her-2 positive(45.8%)was 23 months;Median DFS of patients with Her-2 negative(54.2%)was 41 ing t test, P＜0.001, there was statistically significant difference between the groups.In first-line palliative treatment,25 cases（30.1%）accepted endocrine therapy ,and 58 cases(69.9%) accepted chemotherapy.In endocrine therapy group,the effect was PR in 9 cases,SD in 10 cases,PD in 6 cases,ORR was 36.0%.In chemotherapy group,the effect was PR in 27 cases,SD in 19 cases,PD in 12 cases,ORR was 46.6%.Median TTP of patients with endocrine therapy was 15.5 months.Median TTP of patients with chemotherapy therapy was 7.0 ing t test,P=0.033, there was statistically significant difference between the groups.Patients with endocrine therapy were well tolerated.More side-effect of chemotherapy was observed.Only 6 cases （15.8%） accepted trastuzumab therapy in patients with Her-2 positive.2 cases(2.4%) dead before completing of this article.Conclusions More hormone receptor-positive advanced breast cancer accepted chemotherapy in first-line palliative treatment.According to effect and toxicity ,the clinical position of endocrine therapy should be improved.The advances in targeted therapy plus endocrine therapy would be paied more attention. [Key words]Breast cancer; metastasis;endocrine therapy