Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisbon, Portugal; Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal.
Clin Breast Cancer. 2019 Oct;19(5):e654-e667. doi: 10.1016/j.clbc.2019.06.003. Epub 2019 Jun 26.
Ovarian function suppression (OFS) with tamoxifen or aromatase inhibitors (AIs) improves disease-free survival in premenopausal women with breast cancer, mostly in those at higher risk of recurrence. However, its real-world use and impact remain poorly understood.
This is a multicenter retrospective cohort study of premenopausal women with stage I to III hormone receptor-positive breast cancer diagnosed from 2006 to 2015 that aimed to look at the uptake and effectiveness of the addition of OFS to backbone endocrine therapy (tamoxifen or AI). To deal with confounding, we used both multivariate modeling and propensity score matching.
Of 1717 eligible patients, 17.1% were treated with OFS. There was a substantial increase of use of OFS over time, especially from 2014 onward (16% vs. 25% after 2014), particularly for the combination with AI (0.4% vs. 8% after 2014). In a multivariate model, only younger age and year of diagnosis ≥ 2014 were associated with OFS utilization (both P < .001). With a median follow-up of 38 months (P25-P75, 19.6-66.4 months), patients receiving OFS had a better overall survival than those not receiving OFS (adjusted hazard ratio, 0.44; 95% confidence interval, 0.19-0.96; absolute benefit at 5 years, 2.1% [95.3% vs. 93.2% in those not receiving OFS]). A similar benefit was identified using propensity score matching.
In the real-world setting, there was an increase in the use of OFS after 2014. After 2014, one-quarter of premenopausal women received adjuvant OFS, of which more than 30% received it in combination with an AI. In this study, the use of adjuvant OFS was associated with an overall survival benefit.
他莫昔芬或芳香化酶抑制剂（AIs）的卵巢功能抑制（OFS）可改善乳腺癌绝经前妇女的无病生存，主要是那些复发风险较高的患者。然而，其实际应用和影响仍知之甚少。
这是一项多中心回顾性队列研究，纳入了 2006 年至 2015 年间诊断为 I 期至 III 期激素受体阳性乳腺癌的绝经前女性，旨在观察 OFS 联合内分泌治疗（他莫昔芬或 AI）的应用情况和疗效。为了处理混杂因素，我们同时使用了多变量建模和倾向评分匹配。
在 1717 名合格患者中，有 17.1%的患者接受了 OFS 治疗。随着时间的推移，OFS 的应用率显著增加，尤其是 2014 年以后（2014 年以后为 16%，25%），尤其是与 AI 联合应用时（2014 年以后为 0.4%，8%）。在多变量模型中，只有年龄较小和诊断年份≥2014 与 OFS 的使用相关（均 P<0.001）。中位随访 38 个月（P25-P75，19.6-66.4 个月），接受 OFS 治疗的患者总体生存优于未接受 OFS 治疗的患者（调整后的危险比，0.44；95%置信区间，0.19-0.96；5 年绝对获益率，2.1%[95.3%比未接受 OFS 治疗的患者为 93.2%]）。使用倾向评分匹配也得到了类似的获益。
在真实环境中，2014 年后 OFS 的应用有所增加。2014 年后，四分之一的绝经前女性接受了辅助 OFS 治疗，其中 30%以上的患者与 AI 联合使用。在本研究中，辅助 OFS 的应用与总体生存获益相关。
