Incidence and Time Course of Bleeding After Long-Term Amenorrhea After Breast Cancer Treatment A Prospective Study
Incidence and Time Course of Bleeding After Long-Term Amenorrhea After Breast Cancer Treatment A Prospective Study
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DOI：
10.1002/cncr.25106
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发表时间：
2010-07-01
期刊：
影响因子：
6.2
通讯作者：
Naughton, Michelle J.
中科院分区：
文献类型：
--
作者：
Sukumvanich, Paniti;Case, L. Doug;Naughton, Michelle J.
背景：对接受现行标准化疗方案治疗的绝经前乳腺癌患者化疗引起的闭经（CIA）的发生率和随后月经出血的时间进行了检查。方法：1998 年 1 月至 2002 年 7 月期间，招募了 466 名诊断为 I 至 III 期乳腺癌时年龄为 20 至 45 岁的女性。患者从研究招募时起每月填写出血日历。每 6 个月获得一次更新的病史数据。结果：大多数女性接受阿霉素和环磷酰胺 (AC) 治疗；阿霉素、环磷酰胺和紫杉醇 (ACT)；或环磷酰胺、甲氨蝶呤和 5-氟尿嘧啶 (CMF)。大约 41% 的女性经历了最初 6 个月的 CIA，另外 29% 的女性经历了至少 1 年的 CIA。大约一半患有 CIA 6 个月的女性和 29% 患有 CIA 1 年的女性在随后的 3 年内（通常是闭经后的一年）恢复出血。 CIA 6 个月后，不同治疗方案的出血恢复情况存在显着差异（P=0.002；AC 为 68%，ACT 为 57%，CMF 为 23%），但 CIA 1 年后则没有显着差异（P=.5）。在 23% 经历过最初 2 年 CIA 期的女性中，10% 在闭经发作后的 3 年内恢复出血，但没有人有规律的月经。结论：相当一部分接受化疗的女性会经历 CIA 期，但许多人会恢复出血。与 CMF 相比，ACT 等较新的治疗方案似乎具有更高的出血恢复率。这一发现可能对抗雌激素治疗的选择以及未来潜在的怀孕/生育具有影响。癌症 2010；116：3102-11。 (C) 2010 年美国癌症协会。
BACKGROUND: The incidence of chemotherapy-induced amenorrhea (CIA) and the time to subsequent menstrual bleeding in premenopausal breast cancer patients treated with current standard chemotherapy regimens was examined. METHODS: Four hundred sixty-six women ages 20 to 45 years at the time of diagnosis of a stage I to III breast cancer were recruited between January 1998 and July 2002. Patients completed monthly bleeding calendars from the time of study recruitment. Updated medical history data were obtained at 6-month intervals. RESULTS: Most women received doxorubicin and cyclophosphamide (AC); doxorubicin, cyclophosphamide, and paclitaxel (ACT); or cyclophosphamide, methotrexate, and 5-fluorouracil (CMF). Approximately 41% of women experienced an initial 6 months of CIA, and an additional 29% had at least 1 year of CIA. Approximately half of the women with 6 months of CIA and 29% of those with 1 year of CIA resumed bleeding within the subsequent 3 years, usually in the year after their amenorrheic episode. Resumption of bleeding differed significantly by treatment regimen after 6 months of CIA (P=.002; 68% with AC, 57% with ACT, and 23% with CMF), but not after 1 year of CIA (P=.5). Of the 23% of women who experienced an initial 2-year period of CIA, 10% resumed bleeding within the ensuing 3 years after their amenorrheic episode, but none had regular menses. CONCLUSIONS: A considerable proportion of women treated with chemotherapy will experience periods of CIA, but many will resume bleeding. Newer treatment regimens such as ACT appear to have a higher resumption of bleeding compared with CMF. This finding may have implications for choice of anti-estrogen treatment and for future potential pregnancies/fertility. Cancer 2010;116:3102-11. (C) 2010 American Cancer Society.