Takuwa Haruko, Saji Shigehira, Takada Masahiro, Takahara Sachiko, Yamauchi Akira
Department of Breast Surgery, The Tazuke Kofukai Medical Research Institute Kitano Hospital, 2-4-20 Ogi-machi Kita-ku Osaka, 530-8480 Japan.
Department of Breast Surgery, Kyoto University, Kyoto, Japan.
Breast Dis. 2018;37(4):185-190. doi: 10.3233/BD-170307.
Among estrogens, estradiol (E2) has the strongest physiological activity as a stimulator in estrogen receptor (ER)-positive breast cancer. The aim of this study is to investigate E2 dynamics during endocrine therapy and to explore the optimal environment in which tamoxifen (TAM) exhibits better efficacy for ER-positive premenopausal early breast cancer patients.
This is a retrospective study enrolled 194 patients with premenopausal ER-positive early-stage breast cancer who aging ≤45 years at onset and receiving luteinizing hormone-releasing hormone-agonist (LHRH-a) and TAM-therapy. Approximately half of the patients also received pre- or post-operative chemotherapy as adjuvant systemic therapy. We studied the relationship between recurrence and serum hormonal dynamics during adjuvant therapy. We monitored the concentrations of E2 and, follicle-stimulating hormone (FSH) in the blood before, during, and after treatment. The median follow-up period was 80 (14-555) months.
Forty-six (23.7%) patients developed recurrent breast cancer after surgery. The prognoses were favorable in the group receiving longer LHRH-a exposure if those patients did not receive chemotherapy as their adjuvant therapy. Paradoxically, patients with high serum E2 levels after LHRH-a showed a low recurrence ratio. This phenomenon might be explained by the similar mechanisms of estrogen therapy after estrogen depletion by aromatase inhibitor (AI) therapy for metastatic breast cancer.
Among patients who received endocrine therapy without adjuvant chemotherapy, those with longer LHRH-a exposure had favorable prognoses. A potential association was observed between recurrence and E2 concentrations in women with premenopausal ER-positive early-stage breast cancer.
在雌激素中，雌二醇（E2）作为雌激素受体（ER）阳性乳腺癌的刺激物具有最强的生理活性。本研究的目的是调查内分泌治疗期间的E2动态变化，并探索他莫昔芬（TAM）对ER阳性绝经前早期乳腺癌患者表现出更好疗效的最佳环境。
这是一项回顾性研究，纳入了194例绝经前ER阳性早期乳腺癌患者，这些患者发病时年龄≤45岁，接受促黄体生成素释放激素激动剂（LHRH-a）和TAM治疗。大约一半的患者还接受了术前或术后化疗作为辅助全身治疗。我们研究了辅助治疗期间复发与血清激素动态变化之间的关系。我们监测了治疗前、治疗期间和治疗后血液中E2和促卵泡生成素（FSH）的浓度。中位随访期为80（14 - 555）个月。
46例（23.7%）患者术后出现乳腺癌复发。如果接受更长时间LHRH-a治疗且未接受化疗作为辅助治疗的患者，其预后良好。矛盾的是，LHRH-a治疗后血清E2水平高的患者复发率较低。这种现象可能是由芳香化酶抑制剂（AI）治疗转移性乳腺癌导致雌激素耗竭后雌激素治疗的类似机制所解释。
在未接受辅助化疗的内分泌治疗患者中，接受更长时间LHRH-a治疗的患者预后良好。在绝经前ER阳性早期乳腺癌女性中，观察到复发与E2浓度之间存在潜在关联。
