Love Richard R, Duc Nguyen Ba, Dinh Nguyen Van, Shen Tian-Zhen, Havighurst Thomas C, Allred D Craig, DeMets David L
Department of Medicine, Section of Medical Oncology, University of Wisconsin School of Medicine, Madison, 53705, USA.
J Natl Cancer Inst. 2002 May 1;94(9):662-9. doi: 10.1093/jnci/94.9.662.
It is unclear whether the phase of the menstrual cycle in which primary surgical treatment occurs influences disease-free survival (DFS) and overall survival (OS) in premenopausal women with breast cancer. We investigated this question in the context of a clinical trial comparing mastectomy alone with mastectomy plus adjuvant oophorectomy and tamoxifen in premenopausal women with operable breast cancer.
The date of the first day of the last menstrual period (LMP) was used to estimate the phase of the menstrual cycle when the surgeries were done. Follicular phase was defined as day 1-14 from LMP. Luteal phase was defined as day 15-42 from LMP. DFS and OS statistics were determined and analyzed by Cox proportional hazards ratios and Kaplan-Meier methods. All statistical tests were two-sided.
We analyzed results for 565 women who reported an LMP within 42 days before surgery. For women in the mastectomy only arm (n = 289), there were no differences in DFS or OS by menstrual cycle phase. For women in the adjuvant treatment arm (n = 276), those whose surgery occurred during the luteal phase (n = 158) had better DFS (relative risk [RR] = 0.54; 95% confidence interval [CI] = 0.32 to 0.96; P =.02) and OS (RR = 0.53; 95% CI = 0.30 to 0.95; P =.03) than those whose surgery occurred during the follicular phase (n = 118). Moreover, women whose surgery occurred during the luteal phase and who received adjuvant therapy had better 5-year DFS than did women whose surgery occurred during the follicular phase (84%; 95% CI = 78% to 90% versus 67%; 95% CI = 58% to 78%; P =.02); they also had better OS (85%; 95% CI = 78% to 92% versus 75%; 95% CI = 66% to 84%; P =.03).
The phase of the menstrual cycle at which surgery was done had no impact on survival for women who received mastectomy only. However, women who received a mastectomy and surgical oophorectomy and tamoxifen during the luteal phase had better outcomes than women who received surgery during the follicular phase.
对于患有乳腺癌的绝经前女性，进行初次手术治疗时的月经周期阶段是否会影响无病生存期（DFS）和总生存期（OS）尚不清楚。我们在一项临床试验的背景下研究了这个问题，该试验比较了单纯乳房切除术与乳房切除术加辅助性卵巢切除术及他莫昔芬在患有可手术乳腺癌的绝经前女性中的疗效。
末次月经首日（LMP）的日期用于估算手术时的月经周期阶段。卵泡期定义为自LMP起的第1 - 14天。黄体期定义为自LMP起的第15 - 42天。DFS和OS统计数据通过Cox比例风险比和Kaplan - Meier方法进行确定和分析。所有统计检验均为双侧检验。
我们分析了565名在手术前42天内报告LMP的女性的结果。对于仅接受乳房切除术的女性组（n = 289），月经周期阶段对DFS或OS没有影响。对于接受辅助治疗的女性组（n = 276），手术发生在黄体期的女性（n = 158）的DFS（相对风险[RR] = 0.54；95%置信区间[CI] = 0.32至0.96；P = 0.02）和OS（RR = 0.53；95% CI = 0.30至0.95；P = 0.03）均优于手术发生在卵泡期的女性（n = 118）。此外，手术发生在黄体期且接受辅助治疗的女性的5年DFS优于手术发生在卵泡期的女性（84%；95% CI = 78%至90%对67%；95% CI = 58%至78%；P = 0.02）；她们的OS也更好（85%；95% CI = 78%至92%对75%；95% CI = 66%至84%；P = 0.03）。
对于仅接受乳房切除术的女性，手术时的月经周期阶段对生存期没有影响。然而，在黄体期接受乳房切除术、手术性卵巢切除术及他莫昔芬治疗的女性比在卵泡期接受手术的女性预后更好。
