Adjuvant therapy for very young women with breast cancer: need for tailored treatments.
Adjuvant therapy for very young women with breast cancer: need for tailored treatments.
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DOI：
10.1093/oxfordjournals.jncimonographs.a003459
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发表时间：
2001-12
期刊：
影响因子：
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通讯作者：
A. Goldhirsch;R. Gelber;G. Yothers;R. Gray;S. Green;J. Bryant;S. Gelber;M. Castiglione‐Gertsch;A. Coates
中科院分区：
文献类型：
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作者：
A. Goldhirsch;R. Gelber;G. Yothers;R. Gray;S. Green;J. Bryant;S. Gelber;M. Castiglione‐Gertsch;A. Coates
乳腺癌很少发生在35岁以下的女性身上。来自不同来源的数据表明，在这样的年龄诊断与可怕的预后相关，主要是因为出现更具侵略性的表现。尽管化疗对绝经前患者的效果是显著的，但最近对2233名患者的研究表明，患有内分泌反应性肿瘤的非常年轻的女性比患有此类肿瘤的老年绝经前患者的复发风险要高得多。相比之下，如果将年轻和老年绝经前患者的肿瘤归类为内分泌无反应，结果是相似的。在美国三个主要合作小组的试验中，对7631名单独接受化疗的患者进行的研究显示，年龄的影响与原发肿瘤的类固醇激素受体状态之间存在类似的相互作用。需要对非常年轻的患者进行更好的治疗，除了内分泌反应性肿瘤患者的其他内分泌药物外，还可能涉及卵巢功能抑制，以及对内分泌非反应性肿瘤患者进行更精确的化疗及其时机、持续时间和强度的研究。患有这种疾病的非常年轻的女性面临着个人、家庭、职业和生活质量问题，这进一步使治疗决策阶段复杂化。为年轻患者开发更有效的治疗方法需要量身定做的治疗调查，而不能依赖主要来自绝经前老年妇女的信息。
Breast cancer rarely occurs in women below the age of 35 years. Data from various sources indicate that diagnosis at such an age is associated with a dire prognosis mainly because of a more aggressive presentation. Although the effect of chemotherapy for premenopausal patients is substantial, recent evidence on 2233 patients suggested that very young women with endocrine-responsive tumors had a statistically significantly higher risk of relapse than older premenopausal patients with such tumors. In contrast, results for younger and older premenopausal patients were similar if their tumors were classified as endocrine nonresponsive. Information from studies on 7631 patients who were treated with chemotherapy alone in trials of three major U.S. cooperative groups showed a similar interaction between the effect of age and steroid hormone receptor status of the primary tumor. Better treatments for very young patients are required and may involve ovarian function suppression in addition to other endocrine agents in patients with endocrine responsive tumors and a more precise investigation of chemotherapy and its timing, duration, and intensity in those with endocrine nonresponsive tumors. Very young women with this disease are faced with personal, family, professional, and quality-of-life issues, which further complicate the phase of treatment decision making. The development of more effective therapies for younger patients requires tailored treatment investigations and cannot rely on information predominantly contributed from older premenopausal women.