Smith Ian E, Yeo Belinda, Schiavon Gaia
From the Breast Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, United Kingdom; The Institute of Cancer Research, Fulham Road, London, United Kingdom.
Am Soc Clin Oncol Educ Book. 2014:e16-24. doi: 10.14694/EdBook_AM.2014.34.e16.
Women with estrogen receptor (ER)+ early breast cancer (BC) are at continuing risk of relapse up to at least 15 years after diagnosis, despite being on adjuvant endocrine therapy for approximately 5 years. Extended adjuvant endocrine therapy with an aromatase inhibitor (AI) after 5 years of tamoxifen further reduces the risk of recurrence in postmenopausal women. More recently, continuing tamoxifen for 10 years has also been shown to further reduce the risk of recurrence compared with 5 years. There are no direct comparative data on the relative merits of extended tamoxifen compared with an AI; indirect evidence suggests that an AI may have increased efficacy but a greater adverse effect on quality of life. Results are awaited on the need for continuing front-line adjuvant AIs for more than 5 years. The next challenge is to determine which patients will benefit from this long-term treatment. Currently, tumor size, nodal involvement, and gene expression profile as measured by the PAM50 Risk of Recurrence (ROR) score have all been shown to have prognostic significance for late recurrence beyond 5 years.
雌激素受体（ER）阳性的早期乳腺癌（BC）女性患者，即便接受了约5年的辅助内分泌治疗，在诊断后至少15年内仍持续存在复发风险。在接受5年他莫昔芬治疗后，使用芳香化酶抑制剂（AI）进行延长辅助内分泌治疗可进一步降低绝经后女性的复发风险。最近，与5年治疗相比，持续使用他莫昔芬10年也已显示出可进一步降低复发风险。关于延长使用他莫昔芬与AI相比的相对优势，尚无直接的对比数据；间接证据表明，AI可能疗效更高，但对生活质量的不良影响更大。目前正在等待关于一线辅助AI治疗超过5年必要性的结果。下一个挑战是确定哪些患者将从这种长期治疗中获益。目前，肿瘤大小、淋巴结受累情况以及通过PAM50复发风险（ROR）评分测量的基因表达谱，均已显示出对5年后晚期复发具有预后意义。
