Fornier Monica N, Modi Shanu, Panageas Katherine S, Norton Larry, Hudis Clifford
Breast Cancer Medicine Service, Division of Solid Tumor Oncology, Department of Medicine Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Cancer. 2005 Oct 15;104(8):1575-9. doi: 10.1002/cncr.21385.
Twenty-five percent of all women with breast carcinoma are premenopausal and are at risk for chemotherapy-induced menopause with long-term side effects. Although there is considerable documentation of the rates of chemotherapy-induced amenorrhea with classic adjuvant regimens, there are inadequate data that address the impact of taxanes on menstrual function in this setting. The objective of this analysis was to determine the incidence of long-term amenorrhea (> or = 12 mos) in women with breast carcinoma age 40 years and younger after adjuvant anthracycline and taxane-based chemotherapy, with or without subsequent tamoxifen.
The authors identified 235 premenopausal women with breast carcinoma age 40 years or younger who were treated with adjuvant anthracycline and taxane-based chemotherapy at Memorial Sloan-Kettering Cancer Center from January 1997 to June 2003.
One hundred sixty-six patients met all eligibility criteria and had sufficient follow-up for evaluation. The median age of patients at diagnosis was 36 years (range, 27-40 yrs). All patients had regular pretreatment menses, 25 patients (15%) developed long-term amenorrhea, and 141 patients (85%) resumed menstruation. Eighty-two patients (49%) also received tamoxifen: The incidence of amenorrhea among them was 17%. There was a statistically significant association between age and the development of amenorrhea, with older women at higher risk (P < 0.01).
The sequential addition of a taxane to standard adjuvant anthracycline-based chemotherapy did not appear to produce a high rate of chemotherapy-related amenorrhea compared with historic controls. To increase the information available to assist young patients who are considering adjuvant therapy, prospective studies should incorporate menstrual function ascertainment by patient-reported history and assays of ovarian function.
所有乳腺癌女性患者中有25%处于绝经前，面临化疗导致绝经及长期副作用的风险。虽然有大量文献记录了经典辅助治疗方案导致化疗性闭经的发生率，但关于紫杉烷类在此情况下对月经功能影响的数据却不充分。本分析的目的是确定40岁及以下乳腺癌女性患者在接受蒽环类和紫杉烷类辅助化疗后（无论是否后续接受他莫昔芬治疗）长期闭经（≥12个月）的发生率。
作者确定了1997年1月至2003年6月在纪念斯隆 - 凯特琳癌症中心接受蒽环类和紫杉烷类辅助化疗的235名40岁及以下绝经前乳腺癌女性患者。
166名患者符合所有入选标准并具有足够的随访时间用于评估。诊断时患者的中位年龄为36岁（范围27 - 40岁）。所有患者治疗前月经规律，25名患者（15%）出现长期闭经，141名患者（85%）恢复月经。82名患者（49%）还接受了他莫昔芬治疗：其中闭经发生率为17%。年龄与闭经的发生之间存在统计学显著关联，年龄较大的女性风险更高（P < 0.01）。
与历史对照相比，在基于蒽环类的标准辅助化疗中序贯添加紫杉烷类似乎并未导致高发生率的化疗相关闭经。为增加可用于帮助考虑辅助治疗的年轻患者的信息，前瞻性研究应纳入通过患者报告病史确定月经功能以及卵巢功能检测。
