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近年来,正乳腺癌是威胁女性健康的恶性肿瘤之一,其发病率呈逐年上升的趋势,已跃居女性恶性肿瘤的首位。我国的发病率已高出世界平均水平的1%~2%~[1]。在乳腺癌的综合治疗中,内分泌治疗占有重要的地位,正确把握乳腺癌的治疗策略,掌握最新的内分泌治疗药物,将有助于提高乳腺癌的治疗效果。两组激素受体阳性早期乳腺癌患者术后口服他莫昔芬治疗5年及10年的随机对照试验。口服他莫昔芬10年组患者的总死亡率、乳腺癌相关死亡率及复发率均低于口服他莫昔芬5年组。但延长他莫昔芬治疗时间可增加子宫内膜癌及血栓栓塞时间的发生率。因此,他莫昔芬治疗的价值随着时间的推移而降低。对于激素受体阳性早期(浸润性、非转移性)乳腺癌的患者,术后行内分泌治疗口服他莫昔芬5年可减低约8%的复发率,并且与未行内分泌治疗患者相比明显延长生存时间。在诊断乳腺癌15年后生存率可见明显差异~[1、2]。绝境后患者可使用芳香化酶抑制剂,可用于替代他莫昔芬或他莫昔芬后续治疗~[1]。激素受体阳性早期乳腺癌患者术后口服他莫昔芬治疗超过5年后的利害平衡该如何把握?2010年发表的2的两项临床试验提供了额外的数据。
In recent years, positive breast cancer is one of the malignant tumors that threaten women’s health. The incidence has been increasing year by year and has leapt to the top of female malignant tumors. The incidence in our country has been 1% ~ 2% higher than the world average [1]. In the comprehensive treatment of breast cancer, endocrine therapy occupies an important position, the correct grasp of breast cancer treatment strategies, to master the latest endocrine therapy drugs, will help to improve the therapeutic effect of breast cancer. Two randomized controlled trials of two groups of hormonally receptor-positive early-stage breast cancer patients treated with oral tamoxifen for 5 years and 10 years. The overall mortality, breast cancer-related mortality and relapse rates in the 10-year oral tamoxifen group were lower than those in the 5-year oral tamoxifen group. But prolonging tamoxifen treatment time can increase the incidence of endometrial cancer and thromboembolism time. Therefore, the value of tamoxifen treatment decreases over time. For patients with hormone receptor-positive early (invasive, non-metastatic) breast cancer, postoperative endocrine therapy of oral tamoxifen for 5 years reduced the relapse rate by approximately 8% and was significantly greater in patients who did not undergo endocrine therapy Extend survival time. 15 years after the diagnosis of breast cancer survival rate showed significant differences ~ [1,2]. Patients can use the aromatase inhibitor after the end of life, can be used to replace tamoxifen or tamoxifen follow-up treatment [1]. What should I do if the hormonal receptor-positive early-stage breast cancer patient receives post-operative oral tamoxifen for more than 5 years of benefit balance? Two clinical trials of 2 published in 2010 provide additional data.