Jatoi I
Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas 78234-6200, USA.
Breast Cancer Res Treat. 1998;52(1-3):217-25. doi: 10.1023/a:1006121117336.
The hormonal milieu of the patient at the time of surgery may influence the prognosis of patients with primary breast cancer. Circulating unopposed estrogen is perhaps detrimental, while circulating progesterone may confer a survival advantage. This hypothesis has particular relevance to the timing of surgery in relation to the menstrual cycle. After all, the first 14 days of the menstrual cycle (follicular phase) are characterized by high levels of circulating unopposed estrogen, while circulating progesterone is present during the second 14 days of the cycle (luteal phase). Several retrospective studies have shown that surgery during the follicular phase of the menstrual cycle results in a worse disease-free and overall survival. Randomized controlled trials addressing the effect of timing of surgery or neoadjuvant hormonal therapy on breast cancer mortality are urgently needed to confirm or refute the unopposed estrogen hypothesis. Such trials may provide important insights into the natural history of breast cancer, and a basis for significantly reducing breast cancer mortality.
手术时患者的激素环境可能会影响原发性乳腺癌患者的预后。循环中未受拮抗的雌激素可能有害，而循环中的孕酮可能带来生存优势。这一假设与手术时间和月经周期的关系尤为相关。毕竟，月经周期的前14天（卵泡期）的特点是循环中存在高水平的未受拮抗的雌激素，而循环中的孕酮则出现在周期的后14天（黄体期）。几项回顾性研究表明，在月经周期的卵泡期进行手术会导致无病生存期和总生存期较差。迫切需要进行随机对照试验，以证实或反驳未受拮抗的雌激素假说，该试验旨在研究手术时间或新辅助激素治疗对乳腺癌死亡率的影响。此类试验可能会为乳腺癌的自然史提供重要见解，并为显著降低乳腺癌死亡率奠定基础。
