Shimizu Daisuke, Ishikawa Takashi, Tanabe Mikiko, Sasaki Takeshi, Ichikawa Yasushi, Chishima Takashi, Endo Itaru
Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan,
Breast Cancer. 2014 Sep;21(5):557-62. doi: 10.1007/s12282-012-0429-z. Epub 2012 Nov 25.
The use of preoperative endocrine therapy for breast cancer has increased during the last decade. Although several studies have reported favorable response rates in postmenopausal women, its effectiveness in premenopausal women remains unknown. This study therefore aimed to evaluate the potential benefits of preoperative endocrine therapy in premenopausal women.
Fifty-three patients with estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative invasive breast cancer were included in this study. Preoperative endocrine therapy with goserelin acetate and tamoxifen was administered for 3 months. Clinical evaluations were performed by ultrasonography before and after endocrine therapy. Pathological evaluations were performed using core biopsy and surgical specimens. Immunohistochemical evaluations of ER, progesterone receptor (PgR), HER2, and Ki-67 were performed before and after endocrine therapy.
Partial response (PR) was observed in 23 % (12/53) and progressive disease (PD) in 2 % (2/53) of patients. Significant suppression of Ki-67 was observed following endocrine therapy in 90 % (47/52) of patients (P < 0.0001). Significant downregulation of PgR was observed after endocrine therapy (P = 0.0002), which tended to be correlated with clinical response (P = 0.058).
Three months of preoperative endocrine therapy with goserelin acetate and tamoxifen was safe and effective in premenopausal patients with invasive breast cancer, with a 23 % PR rate. Changes in PgR and Ki-67 expression might be promising markers for endocrine responsiveness.
在过去十年中，乳腺癌术前内分泌治疗的应用有所增加。尽管多项研究报道了绝经后女性的良好反应率，但其在绝经前女性中的有效性仍不明确。因此，本研究旨在评估术前内分泌治疗对绝经前女性的潜在益处。
本研究纳入了53例雌激素受体（ER）阳性、人表皮生长因子受体2（HER2）阴性的浸润性乳腺癌患者。给予醋酸戈舍瑞林和他莫昔芬进行3个月的术前内分泌治疗。在内分泌治疗前后通过超声进行临床评估。使用芯针活检和手术标本进行病理评估。在内分泌治疗前后对ER、孕激素受体（PgR）、HER2和Ki-67进行免疫组织化学评估。
23%（12/53）的患者观察到部分缓解（PR），2%（2/53）的患者出现疾病进展（PD）。90%（47/52）的患者在内分泌治疗后观察到Ki-67显著抑制（P < 0.0001）。内分泌治疗后观察到PgR显著下调（P = 0.0002），这与临床反应有一定相关性（P = 0.058）。
对于绝经前浸润性乳腺癌患者，醋酸戈舍瑞林和他莫昔芬进行3个月的术前内分泌治疗安全有效，PR率为23%。PgR和Ki-67表达的变化可能是内分泌反应性的有前景的标志物。
