Borner M M, Bacchi M, Castiglione M
Institute of Medical Oncology, Inselspital, Bern, Switzerland.
Eur J Cancer. 1996 Nov;32A(12):2173-6. doi: 10.1016/s0959-8049(96)00227-4.
Tamoxifen (TAM) treatment following isolated locoregional recurrence of breast cancer significantly increases 5-year disease-free survival rates compared with observation alone in potentially hormone-responsive patients [J Clin Oncol 1994, 12, 2071-2077]. The treatment outcome was re-analysed by menopausal status (stratification factor) in 35 premenopausal and in 132 postmenopausal patients. Disease progression was highly reduced by tamoxifen in the postmenopausal group and was similar to control in the premenopausal group. However, the 5-year cumulative incidence analysis of the type of first failure showed TAM to be associated with increased incidence of distant metastases (P = 0.01) in premenopausal patients. TAM reduced local progression (P = 0.40) in premenopausal and both types of failure (P = 0.16 and P = 0.001, respectively) in postmenopausal patients. Administration of TAM was associated with a decrease of 5-year overall survival from 90 +/- 7% to 60 +/- 14% in premenopausal patients. Although cautious interpretation of these results is highly recommended due to the small patient numbers and the retrospective subset analyses, these findings might be worthy of further investigation in larger trials. Prospective randomised studies to test hormonal treatment outcome by menopausal status should be encouraged in breast cancer.
在潜在激素反应性患者中，乳腺癌局部区域复发后使用他莫昔芬（TAM）治疗与单纯观察相比，可显著提高5年无病生存率[《临床肿瘤学杂志》1994年，12卷，2071 - 2077页]。对35例绝经前患者和132例绝经后患者按绝经状态（分层因素）重新分析了治疗结果。他莫昔芬在绝经后组中显著降低了疾病进展，在绝经前组中与对照组相似。然而，对首次失败类型的5年累积发病率分析显示，绝经前患者中TAM与远处转移发生率增加相关（P = 0.01）。TAM降低了绝经前患者的局部进展（P = 0.40）以及绝经后患者两种类型的失败（分别为P = 0.16和P = 0.001）。在绝经前患者中，使用TAM与5年总生存率从90±7%降至60±14%相关。尽管由于患者数量少和回顾性子集分析，强烈建议谨慎解读这些结果，但这些发现可能值得在更大规模的试验中进一步研究。应鼓励开展前瞻性随机研究，以按绝经状态测试乳腺癌的激素治疗效果。
