Levgur M.

Department of O tetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY 11219, USA. mlevgur@maimonides.org

尽管乳腺癌妇女不应接受雌激素治疗已被广泛接受，但人们对这一用药原则依然心存怀疑。最近几年，反对这个观点的呼声愈来愈高。2002年六月发表的妇女健康倡议(WHI)研究，对雌激素疗法(ET)或绝经后激素疗法(HT)的安全系数提出质疑。这种疑虑是否适用于乳腺癌生存者并不清楚，因为该研究没有涉及到这些妇女。为了解决研究提出的质疑，特别是关于乳腺癌患者的争论，我们回顾了2003年3月前发表的文章。相关信息来自过去10年间所进行的10项非对照研究、11项病例对照研究、8项回顾性研究和3项前瞻性研究。这些研究包括了1558例接受ET或HT 治疗的乳腺癌生存者。总体上，非对照研究的复发率是7.3%(53 of 728)。在11项病例对照研究的治疗组患者中，平均复发率是10.7% (99 /830) (2.6-15.4%)，而非治疗组为20.3% (739 / 3,640) (2.3-29.5%)。本综述表明：在激素治疗患者中，疾病的复发率没有增加。但这并不是结论性的观点，因为某些研究存在偏倚和混淆因素。在综述所涉及的研究中，仅有两项研究是前瞻性、随机、病例对照研究。考虑到这一实事，以及WHI提出的问题，我们认为还需要开展更多的相关研究来解决上述有争议的问题。

PMID: 15305822 [PubMed - in proce ]

Hormone therapy for women after breast cancer: a review.

Levgur M.

Department of O tetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY 11219, USA. mlevgur@maimonides.org

Even though it is accepted that women with breast cancer should not receive estrogen therapy, doubts have been expre ed as to the validity of this policy. In recent years o osition to this practice has been voiced more adamantly. The results of the Women\'s Health Initiative (WHI) study, published in July 2002, question the safety margin of estrogen therapy (ET) or hormone therapy (HT) in menopause. Whether this concern is a licable to breast cancer survivors is unclear as these women were not addre ed by the study. In light of the uncertainties raised by the study and particularly the ongoing controversy about breast cancer patients, a review of the literature published prior to March 2003 was undertaken. The information gathered on the topic comes from 10 uncontrolled studies and 11 case-controlled studies, 8 retro ective and 3 pro ective, carried out over the past decade. The experience encompa es 1,558 breast cancer survivors treated with ET or HT. Overall, the recurrence rate accrued from the uncontrolled studies is 7.3% (53 of 728). The average rate culminating from 11 case-controlled studies is 10.7% (99 of 830) (2.6-15.4%) in treated patients vs. 20.3% (739 of 3,640) (2.3-29.5%) in their untreated counterparts. This review revealed no increase in recurrent disease among treated patients but is not conclusive as some studies that have been flawed by biases and confounders. The fact that only 2 studies were case controlled and pro ective as well as randomized, and co idering concer raised by the WHI study, it seems that many more such trials will be nece ary before this controversial i ue will be settled.