绝经后受体阳性乳腺癌患者高危人群的内分泌治疗.ppt

* Treat：化疗 Annals of Oncology 18: 1293–1306, 2007 * * 尽管受体阳性患者整体预后较好，但仍有一部分高危患者出现复发转移 Anderson et al. J Clin Oncol. 2001;19:18. While about 10% of ER-positive tumours reveal HER-2 overexpression，HR阳性HER2阳性与HER2阴性患者RFS不同 HER-2–positive patients showed a shorter TTR for both tamoxifen- and anastrozole-treated patients (P.0018 and.0001, respectively) at 5 years (Fig 4). For tamoxifen, the recurrence rate at 5 years was 9.0% for HER-2–negative patients and 18.8% for HER-2– positive patients; for anastrozole, it was 5.9% for HER-2–negative and 19.8% for HER-2–positive patients. Thus, there was no indication of a greater differential benefit of anastrozole over tamoxifen in the HER- 2–positive patients. However, there were only 44 events in the HER- 2–positive group, so the CIs are wide. * Pathol Oncol Res.?2014 Aug 6. [Epub ahead of print] Prognostic Value of?Ki-67?in?Breast?Carcinoma: Tissue Microarray Method Versus Whole Section Analysis- Potentials and Pitfalls. Dedi? Plaveti? N1,?Jaki?-Razumovi? J,?Kuli? A,?Sirotkovi?-Skerlev M,?Bari? M,?Vrbanec D. * Albain, K.S., Barlow, W.E., Shak, S., Hortobagyi, G.N., Livingston, R.B., Yeh, I.T. et al. (2010) Prognostic and predictive value of the 21-gene recurrence score assay in postmenopausal women with node-positive, oestrogen-receptor-positive breast cancer on chemotherapy: a retrospective analysis of a randomised trial. Lancet Oncol 11: 55–65. * ATAC试验的亚组分析显示,阿那曲唑在淋巴结阴性患者中优势较他莫昔芬更为明显，而对于淋巴结阳性患则无显著优势。BIG1-98试验亚组分析结果则与之相反。是否绝经后激素受体阳性乳腺癌患者高风险人群更能从AI辅助治疗中获益，亚组分析结果仅可作为参考性数据，并不能以此指导临床实践。 * ALLRED评分通过和TAM治疗后患者的远期生存，更加确实的证明了这一点。Allred同时评价ER阳性细胞的比例和染色强度，我们发现Allred3分以上的患者均能从中受益。 经常有人会问，ER（+）的cutoff值是1%，依据是什么,就是从这篇文章中来的。同时我们也看到，分值越高，对内分泌治疗的反应越好。 * * 中位随访8年，两个序贯组与来曲唑单药组相比，DFS和OS均无统计学差异。两个序贯组间DFS和OS也无统计学差异 TEAM试验和BIG1-98试验中均未显示出他莫昔芬2-3年更换AI至5年与初始AI治疗5年疗效上的差别，但BIG1-98中他莫昔芬序贯来曲唑组前两年的复发率明显高于初始来曲唑组（4.4%对比3.1%），尤其是转移淋巴结数目大于4个、肿瘤大于2cm和有脉管癌栓的患者更为明显（P<0.05），而对于复发风险较低的患者来说，初始治疗选择他莫昔芬或AI则区别不大。 * MA17试验中虽然来曲唑强化治疗组整体并无OS改善（HR=0.8，P=0.3），但淋巴结阳