Thewes Belinda, Meiser Bettina, Duric Vlatka M, Stockler Martin R, Taylor Alan, Stuart-Harris Robin, Links Matthew, Wilcken Nicholas, McLachlan Sue Anne, Phillips Kelly-Anne, Beith Jane, Boyle Frances, Friedlander Michael L
Prince of Wales Hospital, Randwick, Sydney, Australia.
Lancet Oncol. 2005 Aug;6(8):581-8. doi: 10.1016/S1470-2045(05)70254-0.
Adjuvant endocrine therapies such as tamoxifen, goserelin, and oophorectomy improve survival for premenopausal women diagnosed with early-stage breast cancer. However, these treatments often result in menopausal symptoms, sexual dysfunction, permanent infertility, or the need to delay pregnancy. We aimed to quantify the survival gains that premenopausal patients with early-stage breast cancer require to justify the side-effects and inconvenience of adjuvant endocrine treatments.
Participants consisted of 102 women who had been diagnosed with early-stage (stage I-II) breast cancer 6-60 months previously, who were aged 40 years or younger at diagnosis, and who had been treated for a minimum of 3 months with endocrine therapy (67 with tamoxifen alone, seven with goserelin alone, and 28 with tamoxifen and goserelin or oophorectomy). 76 patients also received chemotherapy, and 75 received radiotherapy. Participants attended a face-to-face patient-preference interview, in which they were presented with four hypothetical clinical scenarios that were used to quantify the gains in survival rate and life expectancy that women judged necessary to make their endocrine therapy worthwhile. They also completed a questionnaire on standard psychological measures.
About half of participants thought that adjuvant endocrine therapy was worthwhile for an absolute gain in survival of 2% from a baseline of either 65% or 85%, and for a gain in life expectancy of 3 months from a baseline of 5 years and of 6 months for a baseline of 15 years. Women who had had more severe endocrine side-effects required larger gains to make endocrine therapy worthwhile (univariate p=0.02, multivariate p=0.04).
Modest gains in survival are sufficient to make adjuvant endocrine treatment worthwhile for premenopausal women with early-stage breast cancer. Knowing and incorporating what women think should enhance shared decision-making.
他莫昔芬、戈舍瑞林和卵巢切除术等辅助内分泌疗法可提高早期乳腺癌绝经前女性的生存率。然而，这些治疗常常导致更年期症状、性功能障碍、永久性不孕或需要推迟怀孕。我们旨在量化早期乳腺癌绝经前患者为了使辅助内分泌治疗的副作用和不便变得合理而需要获得的生存获益。
参与者包括102名女性，她们在6 - 60个月前被诊断为早期（I - II期）乳腺癌，诊断时年龄在40岁及以下，且接受内分泌治疗至少3个月（67名单独使用他莫昔芬，7名单独使用戈舍瑞林，28名使用他莫昔芬和戈舍瑞林或卵巢切除术）。76名患者还接受了化疗，75名接受了放疗。参与者参加了一次面对面的患者偏好访谈，在访谈中向她们展示了四种假设的临床情景，这些情景用于量化女性认为使内分泌治疗值得所需的生存率和预期寿命的获益。她们还完成了一份关于标准心理测量的问卷。
约一半的参与者认为，从65%或85% 的基线生存率绝对提高2%，以及从5年的基线预期寿命提高3个月、从15年的基线预期寿命提高6个月，辅助内分泌治疗是值得的。内分泌副作用更严重的女性需要更大的获益才能使内分泌治疗值得（单变量p = 0.02，多变量p = 0.04）。
适度的生存获益足以使早期乳腺癌绝经前女性的辅助内分泌治疗变得值得。了解并纳入女性的想法应能加强共同决策。
