摘要
目的探讨促性腺激素释放激素激动剂(GnRHa)联合内分泌治疗期间乳腺癌患者卵巢去势(OS)的效果。方法回顾性分析北京大学肿瘤医院乳腺肿瘤内科接受含GnRHa内分泌治疗的绝经前乳腺癌患者的临床特点,比较戈舍瑞林缓释植入剂3.6 mg(戈舍瑞林组)、注射用醋酸亮丙瑞林微球3.75 mg(亮丙瑞林1M组)及注射用醋酸亮丙瑞林微球11.25 mg(亮丙瑞林3M组)用药后1年期间血清雌二醇(E2)和卵泡刺激素(FSH)浓度水平以及去势逃逸情况。研究中去势逃逸定义为至少出现1次外周血E2≥30 pg/ml。结果共纳入102例患者,其中戈舍瑞林组、亮丙瑞林1M型组及亮丙瑞林3M型组分别纳入32例、32例及38例,平均年龄分别为42.37(33~55)岁、42.53(28~57)岁和40.90(28~54)岁,平均体质指数(BMI)分别为24.33(15~31)、24.77(15~36)和24.28(18~37),各组中分别有87.5%、90.4%和92.1%患者曾接受过化疗,单因素分析组间均无统计学差异(均P>0.05)。发生至少1次去势逃逸的概率分别为6.25%、9.38%和5.26%,全体患者为6.86%,3组间结果无统计学差异(P=0.888)。在对全体患者进行的多因素分析中,年龄是去势逃逸的独立影响因素,年轻患者更易发生去势逃逸(OR=0.869,95%CI(0.756~0.999),P=0.049)。结论含GnRHa内分泌治疗过程中存在去势逃逸情况,临床实践中3种常用GnRHa卵巢去势效果相当。年轻患者去势逃逸风险更高,定期监测该人群激素水平具有一定的临床意义,值得进一步研究探讨。
Objective To evaluate the ovarian suppression(OS)efficacy of endocrine therapy combined with gonadotropin releasing hormone agonists(GnRHa)among breast cancer patients.Methods The clinical characteristics of premenopausal breast cancer patients who had received endocrine therapy with GnRHa for 12 months were studied retrospectively.The patients were divided into the goserelin group(goserelin 3.6 mg per month),leuprorelin 1M group(leuprorelin3.75 mg per month)and leuprorelin 3M group(leuprorelin 11.25 mg every 3 months)according to the dosage.Estradiol(E2)and follicle stimulating hormone(FSH)levels were compared between the three groups.In addition,ovarian escape(OE)events,defined as at least one occurrence of E2≥30 pg/ml,were compared between these groups.Results Of the102 patients enrolled in this study,32 were in the goserelin group,32 in the leuprorelin 1M group and 38 in the leuprorelin 3M group,with an average age of 42.37(33-55),42.53(28-57),and 40.90(28-54)years old,and an average body mass index(BMI)of 24.33(15-31),24.77(15-36),and 24.28(18-37),respectively.87.5%,90.4% and 92.1% of the patients in the three groups received chemotherapy,and there was no statistically significant difference based on single factor analysis(P>0.05).The probability of OE was 6.25%,9.38% and 5.26% respectively,and 6.86% in all patients.There was no statistically significant difference between the three groups(P=0.888).According to the multivariate analysis of the patients,age was the only factor that affected OE probability,and younger patients were more likely to develop OE[OR=0.869,95%CI(0.756-0.999),P=0.049].Conclusion During endocrine therapy with GnRHa,patients may develop OE.The ovarian suppression efficacy of the three commonly used GnRHas appears to be similar.As younger patients are at higher risk of OE,regular hormone monitoring in this population is of clinical significance and worthy of more study.
作者
陈祎霏
严颖
姜晗昉
邸立军
宋国红
李惠平
CHEN Yi-fei;YAN Ying;JIANG Han-fang;DLi-jun;SONG Guo-hong;LI Hui-ping(Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing),Department of Breast Oncology,Peking University Cancer Hospital&Institute,Beijing 100142,China)
出处
《军事医学》
CAS
2021年第5期373-379,共7页
Military Medical Sciences
关键词
乳腺癌
促性腺激素释放激素激动剂
卵巢功能抑制
内分泌治疗
雌二醇
去势逃逸
breast cancer
gonadotropin releasing hormone agonists(GnRHa)
ovarian function suppression
endocrine therapy
estradiol
ovarian escape
