乳腺癌:少吃油,多活命
创作:JM 审核:萝卜医生 2017年05月14日
  • 目的:探索降胆固醇药物(CLM)联合内分泌治疗是否能改善乳腺癌预后;
  • 方法:BIG 1-98为随机、双盲、III期临床试验,从1998年到2003年纳入8010名绝经后、激素受体阳性的早期侵袭性乳腺癌患者;
  • 结果:内分泌治疗过程中开始使用CLM与预后改善相关,无病生存期、无乳腺癌间期、无远处复发间期延长;
  • 结论:对于激素受体阳性的早期乳腺癌患者,内分泌治疗同时辅以CLM可能预防复发。
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Cholesterol, Cholesterol-Lowering Medication Use, and Breast Cancer Outcome in the BIG 1-98 Study

BIG 1-98研究中胆固醇、降胆固醇药物的使用和乳腺癌预后

10.1200/JCO.2016.70.3116

2017-04-10, Report

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Purpose Cholesterol-lowering medication (CLM) has been reported to have a role in preventing breast cancer recurrence. CLM may attenuate signaling through the estrogen receptor by reducing levels of the estrogenic cholesterol metabolite 27-hydroxycholesterol. The impact of endocrine treatment on cholesterol levels and hypercholesterolemia per se may counteract the intended effect of aromatase inhibitors. Patients and Methods The Breast International Group (BIG) conducted a randomized, phase III, double-blind trial, BIG 1-98, which enrolled 8,010 postmenopausal women with early-stage, hormone receptor-positive invasive breast cancer from 1998 to 2003. Systemic levels of total cholesterol and use of CLM were measured at study entry and every 6 months up to 5.5 years. Cumulative incidence functions were used to describe the initiation of CLM in the presence of competing risks. Marginal structural Cox proportional hazards modeling investigated the relationships between initiation of CLM during endocrine therapy and outcome. Three time-to-event end points were considered: disease-free-survival, breast cancer-free interval, and distant recurrence-free interval. Results Cholesterol levels were reduced during tamoxifen therapy. Of 789 patients who initiated CLM during endocrine therapy, the majority came from the letrozole monotherapy arm (n = 318), followed by sequential tamoxifen-letrozole (n = 189), letrozole-tamoxifen (n = 176), and tamoxifen monotherapy (n = 106). Initiation of CLM during endocrine therapy was related to improved disease-free-survival (hazard ratio [HR], 0.79; 95% CI, 0.66 to 0.95; P = .01), breast cancer-free interval (HR, 0.76; 95% CI, 0.60 to 0.97; P = .02), and distant recurrence-free interval (HR, 0.74; 95% CI, 0.56 to 0.97; P = .03). Conclusion Cholesterol-lowering medication during adjuvant endocrine therapy may have a role in preventing breast cancer recurrence in hormone receptor-positive early-stage breast cancer. We recommend that these observational results be addressed in prospective randomized trials.

First Authors:
Signe Borgquist

Correspondence Authors:
Signe Borgquist

All Authors:
Signe Borgquist,Anita Giobbie-Hurder,Thomas P Ahern,Judy E Garber,Marco Colleoni,István Láng,Marc Debled,Bent Ejlertsen,Roger von Moos,Ian Smith,Alan S Coates,Aron Goldhirsch,Manuela Rabaglio,Karen N Price,Richard D Gelber,Meredith M Regan,Beat Thürlimann

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