本文選題：化療致閉經(jīng) + 乳腺癌��； 參考：《昆明醫(yī)科大學》2017年碩士論文

【摘要】：[目的]CIA (chemotherapy-induced amenorrhea)定義為從化療開始后6個月內(nèi)出現(xiàn)閉經(jīng),閉經(jīng)至少持續(xù)12個月。研究CIA在絕經(jīng)前乳腺癌患者化療后的發(fā)生率及其影響因素,以及CIA在絕經(jīng)前乳腺癌患者中臨床意義。[方法]回顧收集了 2012年9月至2013年9月云南省腫瘤醫(yī)院收治的新發(fā)絕經(jīng)前乳腺癌患者,從病歷資料中收集患者信息,包括初治時的年齡、身高、體重、BMI、化療方案、化療周期、初潮年齡、生育史、手術方式、腫瘤臨床病理特點、內(nèi)分泌治療、曲妥珠單抗的使用、放療與否�；熀笤陆�(jīng)狀況的情況及預后通過電話隨訪獲得。所有統(tǒng)計學資料采用SPSS24.0處理。各組構成比的比較采用卡方檢驗進行比較,采用ROC曲線探索年齡與BMI對CIA的預測界值。不同年齡組CIA時間的比較采用Kruskal-Wallis H檢驗進行多組比較;生存分析采用Kaplan-Meier法,log-rank檢驗比較組間差異。連續(xù)資料的相關性分析采用spearman相關進行分析,分類變量的相關性分析采用交叉表的列聯(lián)系數(shù)進行觀察[結(jié)果]中位隨訪時間為46個月(12-54月)�；颊吣挲g分布在28-53歲,中位初診年齡43歲。大部分為淋巴結(jié)陰性、激素受體陽性、HER2陰性、腫瘤直徑小于等于2cm的早期乳腺癌患者。共有62例發(fā)生CIA, 46例未發(fā)生CIA。共56例患者化療后在隨訪期間恢復月經(jīng),其中13例未停經(jīng)。初診年齡是絕經(jīng)前乳腺癌化療致閉經(jīng)具有預測意義及影響其恢復的重要因素。大于42歲患者CIA風險增高,44歲以下患者更容易恢復月經(jīng)。BMI值與CIA存在一定關聯(lián),BMI大于等于23.0的患者中發(fā)生CIA的比例更高。閉經(jīng)距首次化療時間越早,越有可能發(fā)展為CIA。未發(fā)現(xiàn)不同化療方案、他莫昔芬和曲妥珠單抗對CIA的發(fā)生有影響。月經(jīng)恢復時間與DFS、激素受體及化療方案均無明顯相關性。CIA對乳癌患者無病生存可能有潛在的獲益。[結(jié)論]初診年齡是絕經(jīng)前乳腺癌化療致閉經(jīng)具有預測意義及影響其恢復的重要因素。大于42歲患者CIA風險增高,44歲以下患者更容易恢復月經(jīng)。BMI值、閉經(jīng)距首次化療時間與CIA的發(fā)生存在一定關聯(lián)。CIA對乳癌患者無病生存可能有潛在的獲益。當患者化療后符合絕經(jīng)判斷標準但小于44歲,給患者使用芳香化酶抑制劑前后仍需要規(guī)律監(jiān)測雌激素、FSH。
[Abstract]:[objective] CIA chemotherapy-induced amenorrhea was defined as amenorrhea within 6 months after the onset of chemotherapy, and amenorrhea lasted for at least 12 months. To study the incidence and influencing factors of CIA after chemotherapy in premenopausal breast cancer and the clinical significance of CIA in premenopausal breast cancer. [methods] the data of newly diagnosed premenopausal breast cancer patients admitted to Yunnan Cancer Hospital from September 2012 to September 2013 were retrospectively collected, including age, height, weight and chemotherapy regimen. Chemotherapy cycle, menarche age, birth history, surgical method, clinicopathological features of tumor, endocrine therapy, use of trotozumab, radiotherapy or not. The status and prognosis of menstruation after chemotherapy were obtained by telephone follow-up. All statistical data were treated with SPSS24.0. The comparison of constitution ratio of each group was made by chi-square test. The ROC curve was used to explore the age and BMI's prediction bound of CIA. CIA time of different age groups was compared by Kruskal-Wallis H test and survival analysis by Kaplan-Meier method and log-rank test. The correlation analysis of continuous data was carried out by spearman correlation analysis, and the correlation analysis of classified variables was conducted by using the column association number of crossover tables. [results] the median follow-up time was 46 months (12-54 months). The age of the patients ranged from 28 to 53 years old, with a median age of 43 years. Most of them were lymph node negative, hormone receptor positive or HER2 negative, tumor diameter less than equal to 2cm in early breast cancer patients. There were 62 cases with CIAs, 46 cases without CIAs. A total of 56 patients recovered their menstruation after chemotherapy, 13 of them were unmenopausal. Age at first diagnosis is an important factor affecting the recovery of premenopausal breast cancer due to chemotherapy-induced amenorrhea. Patients over 42 years of age with increased risk of CIA and patients under 44 years of age were more likely to recover menstruation. There was a certain correlation between the value of menorrhagia and CIA. There was a higher incidence of CIA in those patients whose CIA was greater than or equal to 23.0. The earlier the amenorrhea is before the first chemotherapy, the more likely it is to develop into CIA. No different chemotherapy protocols were found, tamoxifen and tritozumab had an effect on the occurrence of CIA. There was no significant correlation between menstrual recovery time and DFS, hormone receptor and chemotherapy regimen. The CIA may have potential benefits for disease-free survival of breast cancer patients. [conclusion] the age of first diagnosis is a predictor of chemotherapy-induced amenorrhea in premenopausal breast cancer and an important factor affecting the recovery of premenopausal breast cancer. Patients over 42 years of age with increased risk of CIA and patients under 44 years of age are more likely to recover menstruation. The time of first chemotherapy in amenorrhea and the occurrence of CIA may have potential benefits for the disease-free survival of breast cancer patients. When the patient meets the criteria of menopause after chemotherapy but is less than 44 years old, it is necessary to monitor estrogen FSH regularly before and after the treatment of aromatase inhibitor.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.9

【參考文獻】

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1 Winnie Yeo;Hang-Mei Lee;Amy Chan;Emily YY Chan;Miranda CM Chan;Keeng-Wai Chan;Sharon WW Chan;Foon-Yiu Cheung;Polly SY Cheung;Peter HK Choi;Josette SY Chor;William WL Foo;Wing-Hong Kwan;Stephen CK Law;Lawrence PK Li;Janice WH Tsang;Yuk Tung;Lorna LS Wong;Ting-Ting Wong;Chun-Chung Yau;Tsz-Kok Yau;Benny CY Zee;;Risk factors and natural history of breast cancer in younger Chinese women[J];World Journal of Clinical Oncology;2014年05期

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本文編號：1870981