Namer M, Ramaioli A
Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice Cedex.
Bull Cancer. 2000 Feb;87(2):139-44.
Three treatment modalities have successively dominated adjuvant therapy of breast cancer in non-menopausal women, namely, castration, chemotherapy and tamoxifen administration. The benefits afforded by each of these modalities seem similar when the treatments are compared indirectly by meta-analysis. Once the anti-tumour action of LH-RH analogues and their reversible action on ovarian function had been established, these analogues were used instead of surgical castration in direct comparisons of the three treatment modalities. Most of the patients in these trials had estrogen and/or progesterone receptor positive tumours. According to the current state-of-the-art and whilst awaiting the final results of ongoing trials, we can conclude that: The survival of surgically castrated patients is the same as that of patients who have received CMF-type chemotherapy. The survival of patients on tamoxifen is the same as that of patients who have received CMF-type chemotherapy if tamoxifen is administered for 5 years. It is lower if tamoxifen is given for only 2 years. In 2 out of 3 trials, patients receiving the combined treatment castration plus tamoxifen had improved recurrence-free survival rates compared to patients on chemotherapy (regardless of whether an anthracyclin was included or not. It is too early to comment on overall survival. Combining castration and chemotherapy seems to be advantageous in patients less than forty and in those in whom chemotherapy has not induced amenorrhea. Combining tamoxifen and chemotherapy markedly decreases the risks of disease recurrence and of death but the high standard deviations recorded mean that this statement has to be tempered. Finally, an arrest of ovarian function by LH-RH analogues that is only temporary apparently does not adversely impinge upon results. This has, however, to be proved in an ad hoc trial and the optimum duration of analogue administration has to be established.
三种治疗方式先后主导了非绝经女性乳腺癌的辅助治疗，即去势、化疗和服用他莫昔芬。当通过荟萃分析间接比较这些治疗方式时，每种方式所带来的益处似乎相似。一旦促黄体生成素释放激素（LH-RH）类似物的抗肿瘤作用及其对卵巢功能的可逆作用得以确立，在这三种治疗方式的直接比较中，就使用这些类似物来替代手术去势。这些试验中的大多数患者患有雌激素和/或孕激素受体阳性肿瘤。根据当前的技术水平，在等待正在进行的试验的最终结果之际，我们可以得出以下结论：手术去势患者的生存率与接受CMF型化疗的患者相同。如果服用他莫昔芬5年，服用他莫昔芬患者的生存率与接受CMF型化疗的患者相同。如果仅服用他莫昔芬2年，生存率则较低。在三项试验中的两项试验中，与接受化疗的患者相比（无论是否包含蒽环类药物），接受去势加他莫昔芬联合治疗的患者无复发生存率有所提高。对总生存率进行评论还为时过早。对于年龄小于40岁以及化疗未导致闭经的患者，联合去势和化疗似乎具有优势。联合他莫昔芬和化疗可显著降低疾病复发和死亡风险，但所记录的高标准差意味着这一说法必须有所缓和。最后，LH-RH类似物导致的卵巢功能暂时抑制显然不会对结果产生不利影响。然而，这必须在一项专门试验中得到证实，并且必须确定类似物给药的最佳持续时间。
