来曲唑在绝经后受体阳性乳腺癌新辅助内分泌治疗中的应用

Application of Letrozole in Neoadjuvant Endocrine Therapy for Postmenopausal Breast Cancer with Receptor Positive

关键词:  来曲唑  绝经后乳腺癌  新辅助内分泌治疗  受体阳性

Key words:  letrozole  postmenopausal breast cancer  neoadjuvant endorine therapy  hormone receptor positive

摘要:

目的 评估来曲唑在绝经后雌激素和/或孕激素受体(ER/PR)阳性乳腺癌新辅助内分泌治疗中临床应用价值、耐受性及与临床病理因素的相关性。方法 38例绝经后中晚期乳腺癌，给予来曲唑治疗3~12个月，平均4个月，并观察疗效，手术前后肿瘤标本进行ER，PR，Her-2，Ki-67检测，术后继续服用来曲唑，并随访1~3年。结果 临床客观缓解68.4%，超声客观缓解55.3%，3例进展(7.9%)后改为化疗。病理评价(33例手术)完全缓解1例(2.6%)，部分缓解26例(78.8%)，稳定6例(18.2%)。治疗后33例(86.8%)病人行手术治疗，其中保乳手术7例(21.2%)，改良根治术26例(78.8%)。组织学分级低的肿瘤有效率高(P<0.05)。疗效与HER-2表达情况无关，Ki-67在治疗后下降，治疗前后相比差异显著(P<0.05)。治疗中6例病人出现Ⅰ级不良反应(15.8%)。部分病人治疗后雌或孕激素受体表达消失。结论 绝经后受体阳性乳腺癌采用来曲唑新辅助内分泌治疗安全、有效、耐受性好，治疗后保乳率高，特别对年老体弱者是一良好选择。

Abstract:

OBJECTIVE To assess clinical application value, survivability, and the correlation to clinicopathologic factors of neoadjuvant endocrine therapy for postmenopausal breast cancer patients with ER(+) and/or PR(+). METHODS A total of 38 elderly patients with breast cancer were given letrozole for 3-12 months, 4 months in average，ER，PR，Her-2 and Ki-67 were detected before and after surgery, all patients were followed up for one to three years. RESULTS Clinical objective response is 68.4%. Sonography objective response is 55.3%. Complete remission achieved in 1 case (2.6%), partial remission in 26 cases(78.8%), no change in 6 cases(18.2%), the disease in 3 cases(7.9%) was progressed and changed into chemotherapy later. 33 cases(86.8%) were performed operation after treatment, 7 cases(21.2%) treated with BCS and 26 cases(78.8%)with mastectomy. There are no correlation found between response and the expression of HER-2. The expression of Ki-67 is remarkable decreased after treatment with letrozole (P<0.05). Several patients lose their ER or PR expressions after treatment. CONCLUSION Neoadjuvant endocrine therapy with letrozole for postmenopausal patients with receptor-positive breast cancer could effectively decrease or delay the advancement of tumor, the method is effective and safe, especially for elderly women whom are sickish and ineligible for radical mastectomy.