中国早期乳腺癌卵巢功能抑制临床应用专家共识(2024年版)  

Expert consensus on clinical applications of ovarian function suppression for Chinese women with early breast cancer(2024 edition)

作　　者：中国抗癌协会乳腺癌专业委员会 胡夕春 吴炅 任国胜[4] 江泽飞[5] 张瑾 张剑 Committee of Breast Cancer Society,China Anti-Cancer Association;HU Xichun;WU Jiong

机构地区：[1]不详 [2]复旦大学附属肿瘤医院肿瘤内科 [3]复旦大学附属肿瘤医院乳腺外科 [4]重庆医科大学附属第一医院乳腺甲状腺外科 [5]中国人民解放军总医院肿瘤医学部肿瘤内科 [6]天津医科大学肿瘤医院乳腺外科

出　　处：《中国癌症杂志》2024年第3期316-334,共19页China Oncology

摘　　要：中国乳腺癌患者发病年龄较轻,60%的女性患者在诊断时为绝经前。与绝经后相比,未绝经女性卵巢功能旺盛,可持续大量分泌雌激素、促进乳腺癌细胞增殖。卵巢功能抑制(ovarian function suppression,OFS)已用于乳腺癌临床治疗数十年,大量循证证据表明,单用OFS和加用OFS均可降低未绝经女性乳腺癌的复发风险并改善生存。部分OFS研究的长期随访数据(SOFT/TEXT研究12和13年随访、STO-5研究20年随访、亚裔人群的ASTRRA研究8年随访)近期陆续公布,进一步证实对于早期乳腺癌患者加用OFS可显著降低10年以上的复发风险,提高治愈可能。monarchE和NATALEE研究显示,部分CDK4/6抑制剂叠加在绝经前早期乳腺癌患者含有药物去势[促性腺激素释放激素类似物(gonadotropin releasing hormone analog,GnRHa)]的辅助内分泌治疗方案时仍可进一步增加生存获益。中国抗癌协会乳腺癌专业委员会召集了国内乳腺癌治疗领域的临床专家,在2021年版的基础上共同商讨编制了《中国早期乳腺癌卵巢功能抑制临床应用专家共识(2024年版)》。本共识建议,GnRHa仍作为绝经前激素受体阳性早期乳腺癌OFS方式的首选。GnRHa联合内分泌治疗基础上添加特定CDK4/6抑制剂的激素受体阳性绝经前乳腺癌获益人群包括:淋巴结阳性,淋巴结阴性且满足任一条件[G3,G2伴Ki-67增殖指数≥20%,G2伴多基因检测(21基因评分、Prosigna PAM50、MammaPrint、EndoPredict)高危]。本共识也认可将2023年St.Gallen共识中有化疗指征的风险因素作为OFS适用判定标准之一。GnRHa用药推荐根据激素受体阳性乳腺癌患者化疗前的卵巢功能状态进行决策。如果考虑卵巢保护,推荐GnRHa同步化疗,不影响患者生存获益;如果不考虑卵巢保护,GnRHa同步化疗和GnRHa在化疗结束后序贯使用均被认可,后者更为推荐。围绝经期患者的内分泌治疗建议参照绝经前方案。GnRHa辅助内分泌治疗�In China,60%of breast cancer patients were premenopausal women at the time of diagnosis.Compared with postmenopausal women,premenopausal women have strong ovarian function and secrete estrogen to promote breast cancer growth.Ovarian function suppression(OFS)has been used in the treatment of breast cancer for decades,and a large body of evidencebased medical research confirmed that the application of OFS alone or combination therapy can reduce the recurrence risk and improve survival in premenopausal women with breast cancer.The long-term follow-up data of OFS studies have been published successively.SOFT and TEXT study reported the follow-up results of 12 and 13 years,the STO-5 study reported the follow-up data of 20 years,and the ASTRRA study based on Asian populations reported the follow-up data of 8 years.It is further confirmed that the application of OFS for patients with early breast cancer could significantly reduce the recurrence risk over ten years and improve the possibility of cure.MonarchE study and NATALEE study demonstrated that the application of CDK4/6 inhibitors in combination with endocrine therapy and gonadotropin releasing hormone analog(GnRHa)in premenopausal patients with early breast cancer has further improved the survival benefits.Committee of Breast Cancer Society,China Anti-Cancer Association in the field of breast cancer treatment in China jointly discussed and formulated the“Expert consensus on clinical applications of ovarian function suppression for Chinese women with early breast cancer(2024 edition)”based on the“Expert consensus on clinical applications of ovarian function suppression for Chinese women with early breast cancer(2021 edition)”.The consensus recommends that medical castration with GnRHa is the first choice for OFS in premenopausal hormone receptor-positive early breast cancer.CDK4/6 inhibitors in combination with endocrine therapy and GnRHa benefit the premenopausal hormone receptor-positive breast cancer population,including patients with node-positive breas

关 键 词：乳腺癌 卵巢功能抑制 专家共识 

分 类 号：R737.9[医药卫生—肿瘤]