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目的分析绝经前乳腺癌患者接受新辅助化疗后闭经的相关影响因素,了解新辅助化疗相关的闭经(NCRA)与新辅助化疗后肿瘤降期的关系。方法回顾性随访观察我院2006年3月至2011年3月期间224例绝经前乳腺癌患者接受新辅助化疗后月经状态的改变及新辅助化疗后彩超下乳房肿瘤的变化情况,分析新辅助化疗时患者年龄、化疗方案、肿瘤病理组织学特征(ER/PR和Her-2)、术后服用他莫昔芬(tamoxifen,TAM)与NCRA及其随后月经恢复的关系,以及新辅助化疗后肿瘤的变化与NCRA的关系。结果 224例患者中有166例(74.11%)患者出现NCRA,其中有15例停经但雌激素水平增高而行卵巢切除或接受戈舍瑞林治疗,余151例NCRA患者中有40例(26.49%)出现月经恢复。单因素及多因素分析结果显示,NCRA的发生及随后的月经恢复均与患者的年龄有关(P<0.001,P=0.001);不同化疗方案对NCRA的发生无明显影响(P>0.05),但是对NCRA后月经恢复有重要影响(P<0.001);肿瘤的ER/PR和Her-2表达和是否服用TAM对NCRA发生及其随后的月经恢复均无明显影响(P>0.05)。发生NCRA时的化疗周期数随患者年龄的增长而减少,与NCRA后月经的恢复无关(P>0.05)。NCRA的发生与新辅助化疗后肿瘤的降期无关(P>0.05)。结论大多数绝经前乳腺癌患者接受新辅助化疗后会出现闭经,年龄越大的患者越容易发生NCRA,而且发生NCRA时接受化疗的周期数更少;年龄和化疗方案都会影响NCRA后月经的恢复;NCRA的发生未影响新辅助化疗的近期疗效。
Objective To analyze the influencing factors of amenorrhea after neoadjuvant chemotherapy in premenopausal women with breast cancer and to understand the relationship between neoadjuvant chemotherapy-related amenorrhea (NCRA) and tumor progression after neoadjuvant chemotherapy. Methods A retrospective follow-up observation of our hospital from March 2006 to March 2011 224 cases of premenopausal women with breast cancer after receiving neoadjuvant chemotherapy to change the status of menstruation and neoadjuvant chemotherapy after color Doppler ultrasound of breast cancer changes, analysis of neoadjuvant chemotherapy The patient’s age, chemotherapy regimen, tumor histopathological features (ER / PR and Her-2), postoperative tamoxifen (TAM) and NCRA and its subsequent menstrual recovery, as well as neoadjuvant chemotherapy The relationship between changes and NCRA. Results NCRA occurred in 166 of 224 patients (74.11%). Among them, 15 patients had menopause but estrogen levels were elevated and ovariectomized or treated with goserelin. Out of 151 patients with NCRA, 40 (26.49% Menstruation appears. Univariate and multivariate analysis showed that the occurrence of NCRA and the subsequent menstrual recovery were related to the age of the patients (P <0.001, P = 0.001). The different chemotherapy regimens had no significant effect on the occurrence of NCRA (P> 0.05) (P <0.001). The expression of ER / PR and Her-2 in tumor and whether taking TAM had no significant effect on the occurrence of NCRA and subsequent menstrual recovery (P> 0.05). The number of cycles of chemotherapy with NCRA decreased with age, but not with postmenopausal menstruation (P> 0.05). The occurrence of NCRA was not related to the tumor down-stage after neoadjuvant chemotherapy (P> 0.05). Conclusion Most patients with premenopausal breast cancer undergo amenorrhea after receiving neoadjuvant chemotherapy. Patients with older age are more likely to develop NCRA and have fewer cycles of chemotherapy when NCRA is present. Both age and chemotherapy regimen will affect postmenopausal recovery after NCRA The occurrence of NCRA did not affect the recent efficacy of neoadjuvant chemotherapy.