2016年4月20日，欧洲癌症研究与治疗组织（EORTC）、欧洲癌症组织（ECCO）、欧洲癌症研究学会（EACR）、欧洲乳腺癌专家学会（EUSOMA）官方期刊《欧洲癌症杂志》（EJC）在线发表了美国（国际乳腺癌研究基金会、俄亥俄州立大学）、中国（山东大学齐鲁医院、复旦大学附属肿瘤医院、河北医科大学第四医院暨河北省肿瘤医院、中国医学科学院北京协和医学院肿瘤医院、北京大学人民医院、首都医科大学附属北京朝阳医院、国立台湾大学医学院附设医院）、孟加拉国（库尔纳医学院附属医院、达卡医学院附属医院、国家癌症研究所附属医院、邦格班杜·谢赫·穆吉布医科大学研究生医院、阿马德·格兰乳腺癌中心）、菲律宾（菲律宾总医院、维森特·索托纪念医院、黎刹医学中心、圣托马斯大学医院）、尼日利亚（伊巴丹大学学院医院）、印度尼西亚（印尼大学总医院）、马来西亚（马来亚大学医学中心）的随机对照研究，发现：
卵巢切除术＋他莫昔芬对于条件受限患者是有效的治疗方法
卵泡期长的月经周期史不准确
卵泡期长的患者卵巢切除术生存较差
某些患者存在围手术期不良反应
根据月经周期史决定卵巢切除术时机不影响转移性患者结局
Eur J Cancer. 2016;60:107-116.
Luteal versus follicular phase surgical oophorectomy plus tamoxifen in premenopausal women with metastatic hormone receptor-positive breast cancer.
Love RR, Hossain SM, Hussain MM, Mostafa MG, Laudico AV, Siguan SS, Adebamowo C, Sun JZ, Fei F, Shao ZM, Liu Y, Akram Hussain SM, Zhang B, Cheng L, Panigaro S, Walta F, Chuan JH, Mirasol-Lumague MR, Yip CH, Navarro NS Jr, Huang CS, Lu YS, Ferdousy T, Salim R, Akhter C, Nahar S, Uy G, Young GS, Hade EM, Jarjoura D.
The International Breast Cancer Research Foundation, USA.
Khulna Medical College and Hospital, Khulna, Bangladesh.
Dhaka Medical College and Hospital, Dhaka, Bangladesh.
National Cancer Research Institute and Hospital, Dhaka, Bangladesh.
Philippines General Hospital, Manila, Philippines.
Vicente Sotto Memorial Hospital, Cebu, Philippines.
University College Hospital, Ibadan, Nigeria.
Qilu Hospital, Jinan, China.
Cancer Institute, Fudan University, Shanghai, China.
4th Hospital, Hebei, China.
BSMMU Postgraduate Hospital, Dhaka, Bangladesh.
Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
People's Hospital, Beijing, China.
University of Indonesia General Hospital, Jakarta, Indonesia.
Chao Yang Hospital, Beijing, China.
Rizal Medical Center, Pasig City, Philippines.
University of Malaya Medical Center, Kuala Lumpur, Malaysia.
Santo Thomas University Hospital, Manila, Philippines.
National Taiwan University Hospital, Taipei, Taiwan.
Amader Gram, Khulna, Bangladesh.
The Ohio State University Center for Biostatistics, Columbus, Ohio, USA.
Highlights
Surgical oophorectomy + tamoxifen is good therapy in patients with limited resources.
Menstrual cycle histories are inaccurate because of long follicular phases.
Patients with long follicular phases tend to have poorer survival with oophorectomy.
With other data, this study suggests peri-operative adverse effects in some patients.
PURPOSE: In premenopausal women with metastatic hormone receptor-positive breast cancer, hormonal therapy is the first-line therapy. Gonadotropin-releasing hormone analogue + tamoxifen therapies have been found to be more effective. The pattern of recurrence risk over time after primary surgery suggests that peri-operative factors impact recurrence. Secondary analyses of an adjuvant trial suggested that the luteal phase timing of surgical oophorectomy in the menstrual cycle simultaneous with primary breast surgery favourably influenced long-term outcomes.
METHODS: Two hundred forty-nine premenopausal women with incurable or metastatic hormone receptor-positive breast cancer entered a trial in which they were randomised to historical mid-luteal or mid-follicular phase surgical oophorectomy followed by oral tamoxifen treatment. Kaplan-Meier methods, the log-rank test, and multivariable Cox regression models were used to assess overall and progression-free survival (PFS) in the two randomised groups and by hormone-confirmed menstrual cycle phase.
RESULTS: Overall survival (OS) and PFS were not demonstrated to be different in the two randomised groups. In a secondary analysis, OS appeared worse in luteal phase surgery patients with progesterone levels <2 ng/ml (anovulatory patients; adjusted hazard ratio 1.46, 95% confidence interval [CI]: 0.89-2.41, p = 0.14) compared with those in luteal phase with progesterone level of 2 ng/ml or higher. Median OS was 2 years (95% CI: 1.7-2.3) and OS at 4 years was 26%.
CONCLUSIONS: The history-based timing of surgical oophorectomy in the menstrual cycle did not influence outcomes in this trial of metastatic patients. ClinicalTrials.gov number NCT00293540.
KEYWORDS: Acute effects; Anovulatory; Metastatic; Oophorectomy
PMID: 27107325
DOI: 10.1016/j.ejca.2016.03.011
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