约50%服用芳香化酶抑制剂的乳腺癌患者报告出现肌肉骨骼痛或症状加重,18%~30%报告出现疲劳。这些都是女性提高终止治疗的重要原因。 2012年ASCO年会上公布了VITAL研究结果,VITAL研究是一项III期随机、安慰剂对照的双盲试验,纳入了147名乳腺癌女性,发现来曲唑治疗时,添加维生素D3(30000IU/周)可减少骨骼肌肉痛。 本研究纳入了147名I~III期乳腺癌患者,都接受来曲唑治疗+维生素D(600IU/d)+钙(1200mg/d)治疗。被随机分配接受额外的30000IU/周的维生素D3或安慰剂,分别在基线水平、12周和24周检测维生素D水平和进行症状调查。安慰剂组有三个病人,由于骨骼肌肉痛在早期终止治疗。维生素D组,基线、12周和24周的维生素D水平分别为22、53、57ng/mL,安慰剂组分别为25、32、31ng/mL。维生素D组和安慰剂组出现骨骼肌肉痛事件的比例分别为51%和37%(p=0.069)。研究还评估了不良生活质量事件的发生率,安慰剂组明显较高(72% vs 42%,p<0.001)。 研究结果表明,使用芳香酶抑制剂辅助治疗的患者,补充维生素D可减少肌肉骨骼痛和疲劳。
美国研究人员在线发表于《临床肿瘤学杂志》(JCO)上一项大型、前瞻性观察性研究显示,早期乳腺癌完成治疗的妇女定期服用阿司匹林可降低死亡危险50%。研究人员称,这是首次发现阿司匹林可显著降低乳腺癌复发和死亡风险。 美国哈佛大学医学院米歇尔·霍姆斯及其团队从1976年起对参加“护士健康研究”项目的4164例(30~55岁)女护士(诊断为I、II、III期乳腺癌)到2006年6月,进行长达30年的随访研究。 结果显示,400例妇女发生癌细胞扩散,341例护士死于乳腺癌。乳腺癌患者如每周服用阿司匹林2-5天,体内癌细胞扩散和死于乳腺癌的危险分别降低60%和71%。那些每周服用阿司匹林6-7天的乳腺癌患者癌细胞扩散危险降低43%,死于乳腺癌危险降低64%。接受早期乳腺癌治疗的患者服用阿司匹林后,癌细胞扩散和死于乳腺癌的风险均降低50%。 霍姆斯说,“如果这些研究结果被其他的临床试验所验证,服用阿司匹林可能成为又一种简单、低成本和相对安全的工具,帮助乳腺癌妇女延长寿命和生活得更健康。” 研究人员指出,对于阿司匹林同类的其他非类固醇类抗炎药是否也可以帮助降低乳腺癌,对此尚不确定其以何种方式对肿瘤施以影响,但这类药可以减少炎症。以往其他的研究也显示,阿司匹林和非类固醇类抗炎药可降低患结肠癌危险。 但研究者强调,乳腺癌患者不应在接受放射治疗或化疗期间服用阿司匹林。因为可能出现副作用。原文摘要:Aspirin Intake and Survival After Breast Cancer Michelle D. Holmes,* Wendy Y. Chen, Lisa Li, Ellen Hertzmark, Donna Spiegelman, and Susan E. Hankinson From the Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Department of Medical Oncology, Dana-Farber Cancer Institute; and Departments of Epidemiology and Biostatistics, Harvard School of Public Health, Boston, MA.Purpose: Animal and in vitro studies suggest that aspirin may inhibit breast cancer metastasis. We studied whether aspirin use among women with breast cancer decreased their risk of death from breast cancer.Methods: This was a prospective observational study based on responses from 4,164 female registered nurses in the Nurses' Health Study who were diagnosed with stages I, II, or III breast cancer between 1976 and 2002 and were observed until death or June 2006, whichever came first. The main outcome was breast cancer mortality risk according to number of days per week of aspirin use (0, 1, 2 to 5, or 6 to 7 days) first assessed at least 12 months after diagnosis and updated.Results: There were 341 breast cancer deaths. Aspirin use was associated with a decreased risk of breast cancer death. The adjusted relative risks (RRs) for 1, 2 to 5, and 6 to 7 days of aspirin use per week compared with no use were 1.07 (95% CI, 0.70 to 1.63), 0.29 (95% CI, 0.16 to 0.52), and 0.36 (95% CI, 0.24 to 0.54), respectively (test for linear trend, P < .001). This association did not differ appreciably by stage, menopausal status, body mass index, or estrogen receptor status. Results were similar for distant recurrence. The adjusted RRs were 0.91 (95% CI, 0.62 to 1.33), 0.40 (95% CI, 0.24 to 0.65), and 0.57 (95% CI, 0.39 to 0.82; test for trend, P = .03) for 1, 2 to 5, and 6 to 7 days of aspirin use, respectively.Conclusion: Among women living at least 1 year after a breast cancer diagnosis, aspirin use was associated with a decreased risk of distant recurrence and breast cancer death
适应症: 临床I期、II期,肿块最大径小于3cm 肿块大于3cm或III期患者,经术前化疗降期后——慎重考虑 肿块与乳房体积比——乳房有适当体积,术后能够保持外观效果绝对禁忌症: 不能接受放疗者 两个或以上象限的多中心病灶 不能保证病理切缘阴性相对禁忌症: 肿瘤位于乳房中央区(乳晕及乳晕旁2cm),包括乳头Paget’s病 直径>3cm 钼靶X线显示弥散的恶性或可疑恶性的钙化灶保乳治疗的局部治疗方法: 原发灶切除范围应包括肿瘤、肿瘤周围1-2cm的组织以及肿瘤深部的胸大肌筋膜 腋窝淋巴结清扫,或者前哨淋巴结活检 全乳放疗保乳治疗的全身治疗方法: 同全乳切除加淋巴结清扫手术的全身治疗
意大利De Laurentiis等进行了一项荟萃分析,比较在蒽环类药物为基础的化疗方案中加入紫杉类药物是否可以延长高危早期乳腺癌患者的无病生存期(DFS)及总生存期(OS)。该论文发表在 J Clin Oncol 2008,26: 44 分析者检索了PubMed数据库和San Antonio乳腺癌大会、ASCO年会的会议记录,从中纳入13项相关随机对照临床研究数据进行分析。这些研究共包含随机入选的22452例女性患者,其中5829例复发,3329例已经死亡。对各项研究DFS和OS的风险比(HR)及其95%可信区间(CI)数据进行汇总评估。 结果显示,对于高复发危险早期乳腺癌患者,在蒽环类药物为基础的化疗方案中加入紫杉类药物,可以显著降低其复发和死亡危险,其中复发危险约降低17%,死亡危险约降低15%。分析表明,DFS的HR为0.83(95% CI为0.79~0.87,P<0.00001),OS的HR为0.85(95% CI为0.79~0.91,P<0.00001)。这一结果具有临床意义,即与早期乳腺癌术后辅助化疗金标准蒽环类药物治疗相比,在以蒽环类药物为基础的方案中加入紫杉类药物可使5年复发危险降低5%,死亡危险降低3%。 另外,对不同亚组患者分析显示,复发或死亡危险的降低不受紫杉类药物种类、雌激素受体(ER)表达、腋窝淋巴结转移数目(1~3枚或≥4枚)、患者年龄(<50岁或≥50岁)及绝经状态的影响。 原文摘要如下:Taxane-Based Combinations As Adjuvant Chemotherapy of Early Breast Cancer: A Meta-Analysis of Randomized TrialsPurpose We conducted a meta-analysis of randomized trials that evaluated the efficacy of incorporating taxanes into anthracycline-based regimens for early breast cancer (EBC). We aimed to determine whether this approach improves disease-free survival (DFS) and overall survival (OS) and whether benefits are maintained across relevant patient subgroups. Methods Studies were retrieved by searching the PubMed database and the proceedings of major conferences. We extracted hazard ratios (HR) and 95% CIs for DFS and OS from each trial and obtained pooled estimates using an inverse-variance model. Results Thirteen studies were included in the meta-analysis (N = 22,903 patients). The pooled HR estimate was 0.83 (95% CI, 0.79 to 0.87; P < .00001) for DFS and 0.85 (95% CI, 0.79 to 0.91; P < .00001) for OS. Risk reduction was not influenced by the type of taxane, by estrogen receptor (ER) expression, by the number of axillary metastases (N1 to 3 v N4+), or by the patient's age/menopausal status. Sensitivity analysis showed that taxanes given in combination with anthracyclines, unlike sequential administration, did not significantly improve OS. However, the test for interaction showed that HR did not differ between the two schedules (P = .54). Taxane administration resulted in an absolute 5-year risk reduction of 5% for DFS and 3% for OS. Conclusion The addition of a taxane to an anthracycline-based regimen improves the DFS and OS of high-risk EBC patients. The DFS benefit was independent of ER expression, degree of nodal involvement, type of taxane, age/menopausal status of patient, and administration schedule.
绝经前乳腺癌的辅助内分泌治疗:1. TAM 5年。2. TAM治疗2~3年进入绝经后可以改用AI治疗共5年;TAM治疗5年进入绝经后改用AI强化治疗2~5年。3. 有高危复发因素的年轻患者可以考虑卵巢功能抑制加TAM或AI治疗。4. 对部分不适合TAM治疗者,可以考虑在卵巢功能抑制加AI治疗。绝经后乳腺癌的辅助内分泌治疗:1. TAM治疗2~3年后换用AI 3~2年。2. 对于高危或HER2阳性患者,起始使用AI 5年。3. 对已经完成5年TAM治疗的患者,淋巴结阳性者应再接受AI 2~5年。
JAMA 2009年302卷22期报告了美国Vanderbilt大学和中国上海预防医学研究所合作开展的研究结果。该研究纳入了5042例20~75岁的女性乳腺癌患者,中位随访期3.9年。比较大豆摄入量最高和最低四分位数的两组乳腺癌患者的死亡率和复发率。结果表明,大豆的摄入量与乳腺癌患者的死亡率和复发率呈负相关,大豆摄入量最高和最低四分位数两组4年的死亡率分别是7.4%和10.3%,复发率分别是8%和11.2%。在雌激素受体阳性或阴性的乳腺癌患者中,这种负相关的关系均存在,而且在服用或不服用他莫昔芬患者中都存在这种关系。研究还发现,在大豆摄取量达到每日11克之前,大豆食品摄取与死亡率和复发率之间似乎遵循着一种线性的剂量-反应模式,但摄取更多的大豆食品并未获得额外的在死亡率和复发率上的益处。因此,该研究提示,适度地摄取大豆食品可能对罹患乳腺癌的妇女有益。原文摘要如下:Soy Food Intake and Breast Cancer Survival Xiao Ou Shu, MD, PhD; Ying Zheng, MD, MSc; Hui Cai, MD, PhD; Kai Gu, MD; Zhi Chen, MD, PhD; Wei Zheng, MD, PhD; Wei Lu, MD, PhD JAMA.2009;302(22):2437-2443. Context Soy foods are rich in isoflavones, a major group of phytoestrogens that have been hypothesized to reduce the risk of breast cancer. However, the estrogen-like effect of isoflavones and the potential interaction between isoflavones and tamoxifen have led to concern about soy food consumption among breast cancer patients. Objective To evaluate the association of soy food intake after diagnosis of breast cancer with total mortality and cancer recurrence. Design, Setting, and Participants The Shanghai Breast Cancer Survival Study, a large, population-based cohort study of 5042 female breast cancer survivors in China. Women aged 20 to 75 years with diagnoses between March 2002 and April 2006 were recruited and followed up through June 2009. Information on cancer diagnosis and treatment, lifestyle exposures after cancer diagnosis, and disease progression was collected at approximately 6 months after cancer diagnosis and was reassessed at 3 follow-up interviews conducted at 18, 36, and 60 months after diagnosis. Annual record linkage with the Shanghai Vital Statistics Registry database was carried out to obtain survival information for participants who were lost to follow-up. Medical charts were reviewed to verify disease and treatment information. Main Outcome Measures Total mortality and breast cancer recurrence or breast cancer–related deaths. Cox regression analysis was carried out with adjustment for known clinical predictors and other lifestyle factors. Soy food intake was treated as a time-dependent variable. Results During the median follow-up of 3.9 years (range, 0.5-6.2 years), 444 deaths and 534 recurrences or breast cancer–related deaths were documented in 5033 surgically treated breast cancer patients. Soy food intake, as measured by either soy protein or soy isoflavone intake, was inversely associated with mortality and recurrence. The hazard ratio associated with the highest quartile of soy protein intake was 0.71 (95% confidence interval [CI], 0.54-0.92) for total mortality and 0.68 (95% CI, 0.54-0.87) for recurrence compared with the lowest quartile of intake. The multivariate-adjusted 4-year mortality rates were 10.3% and 7.4%, and the 4-year recurrence rates were 11.2% and 8.0%, respectively, for women in the lowest and highest quartiles of soy protein intake. The inverse association was evident among women with either estrogen receptor–positive or –negative breast cancer and was present in both users and nonusers of tamoxifen. Conclusion Among women with breast cancer, soy food consumption was significantly associated with decreased risk of death and recurrence.
乳腺增生症是女性常见的乳房疾病,多发病之一,本质上是一种生理增生与复旧不全造成的乳腺正常结构的紊乱。本病常见25~40岁的妇女。一般认为发生与卵巢功能失调有关。 常见症状: (1)乳房疼痛:重者影响工作和生活,疼痛的特点是具有周期性,常于月经前期发生或加重。 (2)乳房肿块:常为多发性乳房内散在的颗粒样结节,可见于一侧,也可见于双侧。 (3)乳头溢液:见于少数病人,溢液可呈黄绿色、棕色,偶为无色浆液。 治疗建议:(1).中成药或方剂治疗:属肝气郁结型的:逍遥散、小金丸、乳癖消等。肝肾阴虚型:六味地黄丸、二至丸,同时合用小金丸。冲任失调型的:小金丸、乳核散结片等。 (2)西药:他莫昔芬片、碘剂、疼痛严重者可试用甲基睾丸素。 日常保健: (1)改变饮食,少吃动物脂肪,甜食及过多进补食品,要多吃蔬菜和水果类,多吃粗粮。 (2)生活要有规律、不熬夜。 (3)和谐的性生活有助于调节内分泌平衡,减少乳腺增生的发生。 (4)少生气,保持情绪稳定,活泼开朗心情。 (5)定期规律的体育锻炼,可控制体重,减少激素分泌紊乱及提高免疫力。 (6)不滥用含雌激素美容用品、含雌激素的保健品等。 (7)产妇坚持哺乳。
孙正魁博士以“乳腺癌治疗与康复的误区”为题,讲述了乳腺癌患者在治疗与康复过程中存在的一些错误认识,并详细讲解了正确防治乳腺癌及乳腺癌术后康复知识,告知患者乳腺癌可防可治,规范的治疗已经有了很好的治愈率等。此次讲座让患者对乳腺癌的治疗和康复有了一个比较全面的认识,有利于乳腺癌患者增强信心、科学治疗、理性康复。专家深入浅出的讲解赢得了患者的一致好评,讲座结束后,乳腺癌患者们还互相进行了交流。
目的:探讨磁共振成像(magnetic resonance imaging, MRI)对评估保乳手术可行性的价值。方法:87例经临床体检和超声检查后计划进行保乳术乳腺癌患者,均行术前乳房MRI查、其中65例行钼钯X线检查,手术标本均行组织病理学检查。将MRI和钼靶X线检查结果与组织病理学结果进行对照,分析是否适宜行保乳术(breast-conserving surgery,BCS)。结果:MRI检查能够准确检测出乳腺癌灶的数目、大小和淋巴结状况,测量切除肿块/乳房体积比。通过MRI综合判断71例可行BCS、16例不可行BCS,与病理检查结果的符合率达91.6%,高于钼钯X线检查。结论:术前MRI检查能为乳腺癌BCS患者的筛选提供比较全面而准确的信息,是传统的影像学方法的有益补充。