Effects on survival of menstrual cycle phase of adjuvant surgical oophorectomy in premenopausal women with breast cancer
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Richard R. Love Gregory S. Young Erinn M. Hade David Jarjoura
- چاپ و سال / کشور: 2011
Description
Adjuvant surgical oophorectomy is an effective and remarkably cost effective treatment for premenopausal women with hormone receptor positive operable breast cancer. Previously published secondary analyses indicated a survival benefit for patients whose surgery was performed in the luteal phase of the menstrual cycle as opposed to the follicular. This study utilizes additional follow-up and more fully examines this hypothesis and the general implications of long-term follow-up on trial design. Beginning in 1993 we recruited women to a multicenter randomized clinical trial of adjuvant surgical oophorectomy and tamoxifen for 5 years. We recorded the reported day 1 of the patients’ last menstrual cycle on the day of their adjuvant surgery. We conducted secondary analyses of the association of history-estimated luteal or follicular phase oophorectomy surgery with disease-free and overall survival. In multivariable Cox analyses, disease-free survival (DFS) exhibited a positive trend and overall survival (OS) showed a significant improvement in patients whose surgery was estimated to have occurred in the luteal phase of the menstrual cycle compared to the follicular (HR for DFS: 0.66, 95% CI: 0.37–1.16; HR for OS: 0.49, 95% CI: 0.27–0.88). From the hazard function plots, it appears that the luteal phase surgery effect on DFS diminishes after 6 years of follow-up. In conclusion, adjuvant surgical oophorectomy during the luteal phase of the menstrual cycle resulted in a reduced hazard of recurrence as compared to oophorectomy in the follicular phase during the first 5.5 years of follow-up. The practical and biological implications of these findings deserve rigorous evaluation in clinical trials.
Breast Cancer Res Treat (2011) 126:479–485 DOI 10.1007/s10549-011-1370-0 Received: 22 July 2010 / Accepted: 23 January 2011 / Published online: 4 February 2011 Springer Science+Business Media, LLC. 2011
