对于早期乳腺癌中，近年来已经出现了内分泌治疗升级和化疗降级的趋势。不过，内分泌治疗和化疗对于早期乳腺癌患者生存质量的影响尚不明确。
2019年10月8日，欧洲肿瘤内科学会《肿瘤学报》在线发表法国全国癌症中心联盟、巴黎第十一大学（南巴黎大学）古斯塔夫鲁西研究所、卡昂弗朗索瓦·巴克莱塞中心、乔治弗朗索瓦勒克莱尔中心、居里研究所、斯特拉斯堡大学保罗斯特拉斯癌症中心、图卢兹大学癌症研究所、克劳迪乌斯雷戈德研究所、蒙彼利埃癌症研究所、阿维尼翁圣凯瑟琳医院、法国高等教育与研究部、葡萄牙里斯本尚帕利莫基金会临床中心、意大利热那亚大学圣马蒂诺综合医院、美国洛杉矶加利福尼亚大学罗纳德里根医疗中心、哈佛大学达纳法伯癌症研究所的研究报告，前瞻分析了早期乳腺癌诊断后2年内分泌疗法和化疗分别对患者自评结局的不同影响。
CANTO: A Cohort to Quantify and to Predict Treatment Related Chronic Toxicities in Patients With Non-metastatic Breast Cancer (NCT01993498)
该研究利用欧洲癌症研究与治疗组织（EORTC）生存质量问卷（QLQ）核心30项和乳腺癌23项，前瞻收集了4262例符合条件患者（绝经前占37.2%、绝经后占62.8%，内分泌治疗占81.9%、化疗占52.8%）自评结局。主要结局为乳腺癌诊断两年后的核心30项汇总评分。
结果，乳腺癌诊断两年后，整个队列多项功能和症状的生存质量评分恶化，除了情绪功能评分和未来展望评分随着时间推移而改善。
内分泌治疗（P=0.004）而非化疗（P=0.924）对于核心30项汇总评分具有显著的持续不利影响。此外，内分泌治疗对于角色功能和社会功能、疼痛、失眠、全身治疗不良反应、乳房症状以及情绪功能和未来展望评分的恢复具有不利影响。
虽然化疗对于乳腺癌诊断两年后的核心30项汇总评分无影响，但是与生理功能和认知功能、呼吸困难、经济困难、身体意象和乳房症状的恶化相关。
绝经状态对于治疗的影响不同：
对于绝经前患者，虽然核心30项汇总评分恶化趋势不显著（P=0.100），但是化疗与内分泌治疗相比，生存质量指标恶化比例显著较高
对于绝经后患者，内分泌治疗与化疗相比，根据核心30项汇总评分，生存质量指标恶化比例显著较高（P=0.004）
因此，该研究结果表明，乳腺癌诊断两年后的生存质量随着接受治疗方案不同而持续恶化。内分泌疗法（而非化疗）对于核心30项汇总评分具有重要不利影响，尤其对于绝经后女性，故有必要选择合适的患者进行术后内分泌辅助治疗升级。
Ann Oncol. 2019 Oct 8. [Epub ahead of print]
Differential impact of endocrine therapy and chemotherapy on quality of life of breast cancer survivors: a prospective patient-reported outcomes analysis.
Ferreira AR, Di Meglio A, Pistilli B, Gbenou AS, El-Mouhebb M, Dauchy S, Charles C, Joly F, Everhard S, Lambertini M, Coutant C, Cottu P, Lerebours F, Petit T, Dalenc F, Rouanet P, Arnaud A, Martin A, Berille J, Ganz PA, Partridge AH, Delaloge S, Michiels S, Andre F, Vaz-Luis I.
Gustave Roussy, University Paris-Sud, University Paris-Saclay, Villejuif; Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal; Centre Francois Baclesse Caen, Caen; Unicancer, Paris, France; IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy; Centre Georges-Francois Leclerc, Dijon; Institut Curie, Hopital René Huguenin, Saint-Cloud; Paul Strauss Cancer Center, University of Strasbourg, Strasbourg; Institut Claudius Regaud, Institut Universitaire du Cancer - Oncopole, Toulouse; C.R.L.C Val d'Aurelle, Montpellier; Clinique Sainte Catherine Avignon, Avignon; Ministry of Higher Education and Research, Ministere de l'Enseignement Superieur et de la Recherche, Paris, France; Ronald Reagan UCLA Medical Center, Los Angeles; Dana-Farber Cancer Institute, Boston, USA.
BACKGROUND: In early breast cancer (BC), there has been a trend to escalate endocrine therapy (ET) and to de-escalate chemotherapy (CT). However, the impact of ET versus CT on the quality of life (QoL) of early BC patients is unknown. Here, we characterize the independent contribution of ET and CT on patient-reported outcomes (PROs) at 2 years after diagnosis.
PATIENTS AND METHODS: We prospectively collected PROs in 4262 eligible patients using the European Organization for Research and Treatment of Cancer QLQ-C30/BR23 questionnaires inside CANTO trial (NCT01993498). The primary outcome was the C30 summary score (C30-SumSc) at 2 years after diagnosis.
RESULTS: From eligible patients, 37.2% were premenopausal and 62.8% postmenopausal; 81.9% received ET and 52.8% CT. In the overall cohort, QoL worsened by 2 years after diagnosis in multiple functions and symptoms; exceptions included emotional function and future perspective, which improved over time. ET (Pint = 0.004), but not CT (Pint = 0.924), had a persistent negative impact on the C30-SumSc. In addition, ET negatively impacted role and social function, pain, insomnia, systemic therapy side-effects, breast symptoms and further limited emotional function and future perspective recovery. Although CT had no impact on the C30-SumSc at 2-years it was associated with deteriorated physical and cognitive function, dyspnea, financial difficulties, body image and breast symptoms. We found a differential effect of treatment by menopausal status; in premenopausal patients, CT, despite only a non-significant trend for deteriorated C30-SumSc (Pint = 0.100), was more frequently associated with QoL domains deterioration than ET, whereas in postmenopausal patients, ET was more frequently associated with QoL deterioration, namely using the C30-SumSc (Pint = 0.004).
CONCLUSION(S): QoL deterioration persisted at 2 years after diagnosis with different trajectories by treatment received. ET, but not CT, had a major detrimental impact on C30-SumSc, especially in postmenopausal women. These findings highlight the need to properly select patients for adjuvant ET escalation.
KEYWORDS: early breast cancer, quality of life, endocrine therapy, chemotherapy, patient-reported outcome
DOI: 10.1093/annonc/mdz298
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