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卵巢切除术后激素替代治疗不增加乳腺癌风险

2011-07-03 MedSci原创 MedSci原创

乳腺癌激素替代
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 宾夕法尼亚大学Abramson癌症中心的Susan M. Domchek博士在美国临床肿瘤学会(ASCO)年会上公布的一项观察性队列研究显示，有BRCA突变并接受了预防性卵巢切除术的女性仍可通过激素替代治疗(HRT)控制围绝经期症状，至少短期治疗不增加乳腺癌风险。 这项名为“外科终点的预防和观察(PROSE)”的研究从美国和欧洲20个中心招募了1,299例存在BRCA1突变(61%)

 宾夕法尼亚大学Abramson癌症中心的Susan M. Domchek博士在美国临床肿瘤学会(ASCO)年会上公布的一项观察性队列研究显示，有BRCA突变并接受了预防性卵巢切除术的女性仍可通过激素替代治疗(HRT)控制围绝经期症状，至少短期治疗不增加乳腺癌风险。

这项名为“外科终点的预防和观察(PROSE)”的研究从美国和欧洲20个中心招募了1,299例存在BRCA1突变(61%)或BRCA2突变(39%)的女性患者，其中25%接受了预防性输卵管-卵巢切除术，后者中45%术后接受HRT。对未曾接受卵巢切除术和HRT的女性平均随访5.1年，对接受手术但未曾接受HRT者平均随访3.6年，对接受手术和HRT者平均随访5.4年。

结果显示，共有22%的受试者被诊断为乳腺癌，而在接受了卵巢切除术的亚组中这一比例仅为13%。分析表明，术后HRT并未导致乳腺癌风险增加，反而呈风险下降的趋势：与术后未接受HRT者相比，风险比(HR)为0.78；与未接受手术和HRT者相比，HR为0.43。上述结果不受BRCA突变亚型或具体HRT用药种类的影响。

此外，在未接受卵巢切除术的女性中，曾在自然绝经后使用过HRT药物者的乳腺癌风险也倾向于降低(HR，0.52)。

但梅奥医院的肿瘤学家Lynn Hartmann博士评论指出，需警惕这项观察性研究中的潜在偏倚：家人中BRCA突变所致癌症的类型可能影响女性对卵巢切除术的选择，乳腺病史(如不典型增生)可能影响术后对HRT的选择，等等。她建议开展大规模、多中心注册研究，以得出更确切的结论。

更多阅读
HRT Post Oophorectomy Adds No Breast Cancer Risk.internal medicine news 2011.06.28

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    2011-12-24 doctorzheng

    #切除术#

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    2011-08-07 gaoxiaoe

    #乳腺癌风险#

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    2011-07-31 wfang555

    #替代治疗#

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    2011-12-10 sjq027

    #癌风险#

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    2011-12-05 ms5822920152752585

    #卵巢切除术#

    0

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HER2阳性乳腺癌新辅助治疗探讨

　　　 病史及体检 　　患者女性，51岁，已绝经。2月前偶然触及右乳肿物，无痛及发热，未予相关检查和治疗，右乳肿块逐渐增大，于2010年1月14日入院治疗。　 　　双乳无乳头凹陷及乳头溢液，右乳约11点可见局部皮肤凹陷征，并可触及大小约3×2 cm质硬肿物，边界欠清，活动度差，与周围皮肤轻度粘连，右腋下可触及数个肿大淋巴结，有融合，最大3×2 cm，活动度差。　辅助检查　 　　入院后彩超检

女性同时患皮脂腺癌、甲状腺乳头状癌和乳腺癌：病例报告

引言          单一个体或多个家族成员出现多种不同的肿瘤应怀疑内患者遗传易感性病变[1,2]。肿瘤抑制基因（如Cowden综合征的PTEN基因和乳腺癌的 BRCA1/2基因）通过引发细胞凋亡和G1周期停滞发挥作用。然而，表达和组织特异性剪接可能导致剪接变异体（SVs）和随后下游信号结果的差异性表达。由于癌症相关基因的剪接修饰改变

乳腺癌总生存改善添新证

　　ASCO 2011报道：Kieback的一项研究报告提示，乳腺癌患者在他莫昔芬或依西美坦治疗期间出现绝经症状或关节痛/肌痛与总生存改善相关。 　　研究者对TEAM研究德国队列进行了回顾性分析，评估在依西美坦或他莫昔芬辅助治疗期间，有和无绝经症状或关节痛/肌痛患者的无进展生存和总生存。 　　结果显示，共1502例患者被纳入分析，739例患者接受他莫昔芬，763例接受依美西坦。在他莫昔芬或依西