Harlan Linda C, Clegg Limin X, Abrams Jeffrey, Stevens Jennifer L, Ballard-Barbash Rachel
Applied Research Program, National Cancer Institute, Bethesda, MD 20892-7344, USA.
J Clin Oncol. 2006 Feb 20;24(6):872-7. doi: 10.1200/JCO.2005.03.5840.
We describe trends in the use of chemotherapy and hormonal therapy by nodal and estrogen receptor (ER) status in women with early-stage breast cancer.
Cases were randomly sampled from the population-based Surveillance, Epidemiology and End Results (SEER) program and physician verified treatment was examined. A total of 9,481 women, aged 20 years and older, diagnosed with early-stage breast cancer in 1987 to 1991, 1995, and 2000 were included in the study.
The use of chemotherapy plus tamoxifen increased between 1995 and 2000 for women with node-negative, ER-positive breast cancer > or = 1 cm (8% to 21%). Nearly 23% of women with node-negative and ER-positive tumors > or = 1 cm received no adjuvant therapy. The use of chemotherapy alone increased to nearly 60% in women with node-negative, ER-negative tumors > or = 1 cm (48% to 59%). However, in 2000, 16% of women with node-positive and ER-negative tumors received no adjuvant therapy and an additional 6% received tamoxifen alone. The influence of age can clearly be seen. Chemotherapy is given much less often in women 70 years or older.
The results from SEER areas across the United States suggest that physicians quickly responded to publications and guidelines regarding breast cancer therapy. The lack of definitive findings from clinical trials on the use of adjuvant therapy in women 70 years and older may explain the lower use in this group of women.
我们描述了早期乳腺癌女性患者根据淋巴结和雌激素受体（ER）状态使用化疗和激素治疗的趋势。
病例从基于人群的监测、流行病学和最终结果（SEER）项目中随机抽取，并检查经医生核实的治疗情况。共有9481名年龄在20岁及以上、在1987年至1991年、1995年和2000年被诊断为早期乳腺癌的女性纳入研究。
1995年至2000年期间，淋巴结阴性、ER阳性且肿瘤直径≥1 cm的女性使用化疗加他莫昔芬的比例有所增加（从8%增至21%）。近23%的淋巴结阴性、ER阳性且肿瘤直径≥1 cm的女性未接受辅助治疗。对于淋巴结阴性、ER阴性且肿瘤直径≥1 cm的女性，单纯使用化疗的比例增至近60%（从48%增至59%）。然而，在2000年，16%的淋巴结阳性、ER阴性肿瘤女性未接受辅助治疗，另有6%仅接受了他莫昔芬治疗。年龄的影响清晰可见。70岁及以上女性接受化疗的频率要低得多。
美国各地SEER地区的结果表明，医生对有关乳腺癌治疗的出版物和指南反应迅速。关于70岁及以上女性使用辅助治疗的临床试验缺乏明确结果，这可能解释了该组女性使用辅助治疗较少的原因。
