Li Hui-ping, Ma Li-wen, Zhang Shu-lan, Jia Ting-zhen, Deng Hui-jing, Zhang Zhao-hui, Liang Li, Wang Mo-pei, Xiao Yu, Cao Bao-shan, Chen Sen, Wang You-fan
Department of Oncological Chemotherapy, Third Hospital, Peking University, Beijing 100083, China.
Zhonghua Zhong Liu Za Zhi. 2006 Nov;28(11):848-51.
A retrospective analysis of 160 pre-menopausal breast cancer patients was carried out to elucidate the the menstrual outcome in those cases who had undergone adjuvant chemotherapy after surgery, and evaluate the relationship between chemotherapy-induced amenorrhea (CIA) and recurrence of the disease.
160 pre-menopausal breast cancer patients were collected, 62/159 (39.0%) of them were node positive, 91/158 (57.6%) were ER positive, and 95/155 (61.3%) were PR positive. 111 cases had infiltrative ductal carcinoma, 26 cases had infiltrative lobular carcinoma, and 22 cases with others. In 152 cases data were collected by face-to-face interview and 8 cases by phone conversation. Types and cycles of chemotherapy regimen as well as menstrual abnormalities were recorded before, during, and after chemotherapy completion. Follow up duration was 12-72 months after chemotherapy completion for all patients.
107 (66.9%) developed CIA, 24 cases returned to normal menses (22.4%), 83 cases continued CIA during more than 12-month follow up (77.6%). The rate of CIA increased with age (P < 0.01). During the follow up, disease free survival (DFS) rate was 85.9% in CIA group and 79.2% in non-CIA group, with no statistically significant difference. But in hormonal receptor positive patients, DFS was 80.0% in non-CIA and 90.1% in CIA, respectively (P = 0.04), showing a significant difference. Because of the small number of died cases, no analysis of the overall outcome was carried out.
Adjuvant chemotherapy causes ovarian function suppression, and may further leading to amenorrhoea. Women who experienced amenorrhoea after chemotherapy had a significantly better disease-free survival (DFS) rate showed by univariate analysis than women who continued normal menstruation. Chemotherapy is insufficient therapy for very young patients who are in high risk with hormone responsive disease, particularly when chemotherapy fails to induce amenorrhea. Further research is needed to evaluate interventional chemotherapy to improve the quality of life in women with early stage breast cancer who experienced ovarian toxicity. The post-chemotherapy menstruation status is a clinically valuable, objective and salient marker for sufficient endocrine effect of chemotherapy in ER/PR-positive premenopausal patients.
对160例绝经前乳腺癌患者进行回顾性分析，以阐明术后接受辅助化疗患者的月经结局，并评估化疗所致闭经（CIA）与疾病复发之间的关系。
收集160例绝经前乳腺癌患者，其中62/159例（39.0%）淋巴结阳性，91/158例（57.6%）雌激素受体（ER）阳性，95/155例（61.3%）孕激素受体（PR）阳性。111例为浸润性导管癌，26例为浸润性小叶癌，22例为其他类型。152例通过面对面访谈收集数据，8例通过电话交谈收集数据。记录化疗方案的类型和周期以及化疗前、化疗期间和化疗结束后的月经异常情况。所有患者化疗结束后的随访时间为12 - 72个月。
107例（66.9%）发生CIA，24例恢复正常月经（22.4%），83例在超过12个月的随访期间持续闭经（77.6%）。CIA发生率随年龄增加而升高（P < 0.01）。随访期间，CIA组无病生存率（DFS）为85.9%，非CIA组为79.2%，差异无统计学意义。但在激素受体阳性患者中，非CIA组DFS为80.0%，CIA组为90.1%（P = 0.04），差异有统计学意义。因死亡病例数较少，未对总生存情况进行分析。
辅助化疗会导致卵巢功能抑制，并可能进一步导致闭经。单因素分析显示，化疗后出现闭经的女性无病生存率（DFS）显著高于月经持续正常的女性。对于激素反应性疾病高危的非常年轻患者，化疗是不足够的治疗方法，尤其是当化疗未能诱导闭经时。需要进一步研究评估干预性化疗，以改善经历卵巢毒性的早期乳腺癌女性的生活质量。化疗后月经状态是ER/PR阳性绝经前患者化疗内分泌效应充分的一个具有临床价值、客观且显著的标志物。
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