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关于女性乳腺癌患者绝经状态判断两个关键问题的临床思考
Clinical consideration of two key questions in assessing menopausal status of female breast cancer patients
- 中国癌症杂志 2024年34卷第7期 页码：619-627
- 作者机构：
复旦大学附属肿瘤医院肿瘤内科，复旦大学附属肿瘤医院Ⅰ期临床试验病房，复旦大学上海医学院肿瘤学系，上海 200032
- 作者简介：
[ "张剑，肿瘤内科主任医师，博士研究生导师，负责复旦大学附属肿瘤医院Ⅰ期临床研究，同时担任复旦大学附属肿瘤医院福建医院临床研究中心主任/肿瘤内科常务副主任。现任中国医药教育协会肿瘤药物临床研究专业委员会主任委员，中国老年保健协会肿瘤防治与临床研究专业委员会主任委员，长江学术带乳腺联盟主任委员，上海市抗癌协会肿瘤药物临床研究专业委员会候任主任委员，中国抗癌协会乳腺癌专业委员会常委，中国抗癌协会乳腺癌专业委员会青委会副召集人，中国临床肿瘤学会乳腺癌专家委员会委员，中国抗癌协会肿瘤临床研究管理学专业委员会委员。上海“医苑新星”杰青人才获得者，曾担任国家药品监督管理局药品审评中心临床兼职审评员。获2023十大医学先锋专家、2023“人民好医生”杰出贡献奖。以第一作者、共同第一作者或通信作者在The Lancet Oncology、Annals of Oncology、Nature Communications、Clinical Cancer Research、Journal of Hematology & Oncology等SCI收录期刊上发表论文80篇。" ]
- 基金信息：
DOI：10.19401/j.cnki.1007-3639.2024.07.001
中图分类号： R737.9收稿：2024-05-22，
修回：2024-07-03，
纸质出版：2024-07-30
- 稿件说明：
移动端阅览
张剑. 关于女性乳腺癌患者绝经状态判断两个关键问题的临床思考[J]. 中国癌症杂志, 2024,34(7):619-627.
Jian ZHANG. Clinical consideration of two key questions in assessing menopausal status of female breast cancer patients[J]. China Oncology, 2024, 34(7): 619-627.
张剑. 关于女性乳腺癌患者绝经状态判断两个关键问题的临床思考[J]. 中国癌症杂志, 2024,34(7):619-627. DOI： 10.19401/j.cnki.1007-3639.2024.07.001.
Jian ZHANG. Clinical consideration of two key questions in assessing menopausal status of female breast cancer patients[J]. China Oncology, 2024, 34(7): 619-627. DOI： 10.19401/j.cnki.1007-3639.2024.07.001.
摘要
内分泌治疗在激素受体阳性乳腺癌中扮演着至关重要的角色，并与患者的绝经状态密切相关。本文旨在深入探讨关于乳腺癌患者绝经状态判断的两个关键问题。第一，针对绝经前患者添加卵巢功能抑制（ovarian function suppression，OFS）治疗后，雌二醇（estradiol，E2）数值仍超标，可能存在“真性”超标和“假性”超标两种情况，氟维司群、阿贝西利、依西美坦及他莫昔芬等内分泌治疗药物可能干扰E2测定结果，需要警惕检测性“假性”超标的可能性。第二，在判断OFS治疗下患者是否已进入生理性绝经状态时，需考虑化疗对绝经状态的影响、围绝经期内分泌变化的复杂性等因素。建议根据患者年龄及内分泌治疗方案，考虑转换治疗并定期监测血清E2和卵泡刺激素（follicle-stimulating hormone，FSH）水平，针对疑难情况可综合抗缪勒管激素（anti-Mullerian hormone，AMH）、抑制素B（inhibin B，INHB）和雄激素等指标进行评估。
Abstract
Endocrine therapy plays a crucial role in hormone receptor-positive breast cancer and is closely related to the patient’s menopausal status. This manuscript aimed to explore two key questions in assessing menopausal status of breast cancer patients. Firstly
for premenopausal patients receiving ovarian function suppression (OFS) therapy
persistently elevated estradiol (E2) levels post-treatment may be attributed to either “true” or “pseudo” elevation
with caution needed due to potential interference from endocrine therapy drugs such as fulvestrant
abemaciclib
exemestane and tamoxifen. Secondly
when determining whether patients under OFS therapy have reached physiological menopause
factors such as the impact of chemotherapy on menopausal status and the complexity of hormone levels around menopause need to be considered. It is recommended to consider switching treatments based on the patient’s age and original endocrine therapy
and to regularly monitor levels of estradiol and follicle-stimulating hormone (FSH). In challenging cases
a comprehensive evaluation can be conducted by incorporating markers such as anti-Mullerian hormone (AMH)
inhibin B (INHB) and androgen.
关键词
Keywords
references
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