Rusz Orsolya, Vörös András, Varga Zoltán, Kelemen Gyöngyi, Uhercsák Gabriella, Nikolényi Alíz, Ormándi Katalin, Simonka Zsolt, Kahán Zsuzsanna
Department of Oncotherapy, University of Szeged, Korányi fasor 12, 6720, Szeged, Hungary.
Pathol Oncol Res. 2015 Sep;21(4):977-84. doi: 10.1007/s12253-015-9911-1. Epub 2015 Mar 10.
The evaluation of the effects of 1-year endocrine therapy (NET) was aimed at. A retrospective analysis of 42 cases with 46 stage II-III invasive, hormone receptor-positive, HER2-negative breast cancers was performed. One-year NET was planned with letrozole (n = 33, postmenopausal group), or with goserelin plus letrozole (n = 7) or with goserelin plus tamoxifen (n = 2) (premenopausal group). Surgery was performed in accordance with the initial stage and the response to therapy. With regard to the tumor remaining in the surgical specimen, risk groups were constructed: Group 1: stage 0, pathological complete regression (pCR); Group 2: stages IA-IIA; Group 3: stages ≥ IIB + cases with clinical progression. Due to local progression, NET was replaced by neoadjuvant chemotherapy in three patients (four tumors). In two postmenopausal patients, letrozole was replaced by tamoxifen because of the insufficient treatment effect. In 19/42 cases, breast-conserving surgery was performed. Within Group 1, there was no cancer in four cases, while only DCIS remained in 2 (pCR: 13 %); Groups 2 and 3 comprised 25 and 15 cases, respectively. The likeliness of a good response (Groups 1 and 2 vs. Group 3) to NET was increased by 7 % for every 1 % increase of the expression of ER (OR = 1.070; 95 % CI: 1.007-1.138, p = 0.029). Progression-free survival differed according to treatment response (p = 0.001). The post-therapy Ki67 value of ≤ 15 % had only a marginal effect on survival. No other associations were detected between the tumor characteristics and the therapeutic response or survival. Long-duration NET is effective and safe in cases of hormone-sensitive breast cancer.
本研究旨在评估1年内分泌治疗（NET）的效果。对42例46个II - III期浸润性、激素受体阳性、HER2阴性乳腺癌患者进行回顾性分析。计划对绝经后组33例患者使用来曲唑进行1年NET治疗，对7例绝经前患者使用戈舍瑞林加利曲唑，对2例绝经前患者使用戈舍瑞林加他莫昔芬进行1年NET治疗。根据初始分期和治疗反应进行手术。对于手术标本中残留的肿瘤，构建风险组：第1组：0期，病理完全缓解（pCR）；第2组：IA - IIA期；第3组：≥IIB期 + 临床进展病例。由于局部进展，3例患者（4个肿瘤）的NET被新辅助化疗取代。2例绝经后患者因治疗效果不佳，来曲唑被他莫昔芬取代。42例患者中有19例接受了保乳手术。在第1组中，4例无癌，2例仅残留导管原位癌（pCR：13%）；第2组和第3组分别包括25例和15例。ER表达每增加1%，NET获得良好反应（第1组和第2组与第3组相比）的可能性增加7%（OR = 1.070；95%CI：1.007 - 1.138，p = 0.029）。无进展生存期根据治疗反应而有所不同（p = 0.001）。治疗后Ki67值≤15%对生存仅有微小影响。未检测到肿瘤特征与治疗反应或生存之间的其他关联。对于激素敏感型乳腺癌，长期NET有效且安全。
