医周一句 024 来自丁香园 00:00 03:45
这里是丁香园「医周一句 · Clinical Pearls」栏目的第 24 期,今天我们要讨论的是乳腺癌患者怀孕的安全性问题。
乳腺癌一直是女性癌症的头号杀手,近些年来乳腺癌患者日趋年轻化,甚至把魔爪伸向了许多未孕的年轻女性。
有调查研究显示,约有 50% 以上的乳腺癌年轻女性有怀孕的意愿,但最终只有 4%~7% 的患者会付诸行动,这是为什么呢?原来,比起当妈妈,她们更担心怀孕会使她们的乳腺癌复发或者转移。
为了解决这一困惑,肿瘤权威杂志 Journal of Clinical Oncology(IF:24.008)就发表过一篇文章,说怀孕不仅不会增加乳腺癌复发或转移风险,甚至还起到对机体一定的保护作用。
让我们来看看原文是如何描述的:
In
this study, we addressed for the first time the prognostic impact of
subsequent pregnancy in women with a history of an endocrine- sensitive
breast cancer(BC).
The
main analysis indicated that pregnancy did not seem to be protective
against BC recurrence in patients with an endocrine- sensitive disease.
The DFS(Disease-free survival)analysis in the ER-positive population indicated that subsequent pregnancy is not detrimental. In addition, the pregnant group had a better OS (Overall survival) independent of ER status.
These
findings point out that pregnancy after BC diagnosis could be considered
safe in women with history of an ER-positive disease.
这项纳入 1,207 人的多中心回顾性研究表明,在乳腺癌治疗后,怀孕是安全可行的,甚至怀孕还可以提高乳腺癌患者的总生存期,也不会增加雌激素受体阳性的乳腺癌患者(乳腺癌的一种类别)复发转移的风险。
然而,这项发表于 2013 年的研究报道,由于对于妊娠的乳腺癌患者随访时间较短,且对雌激素受体阴性的乳腺癌患者怀孕风险未进行阐明,为了让这一结果更具说服力,该团队在 2017 年做了后续补充报道:
There
was no OS difference between the 2 cohorts in pts with ER BC, but a
significant improved OS was observed in the pregnant cohort for ER-pts
yielding a significant overall estimate. Long-term follow-up confirms that pregnancy is safe and should not be discouraged irrespective of ER status.
也就是说,通过长期随访观察,不管是雌激素受体阳性还是阴性,怀孕均不会影响乳腺癌患者的生存率,且对于雌激素受体阴性的乳腺癌患者来说,怀孕可以改善他们的总生存率。
因此,乳腺癌患者只要接受正规综合治疗,妊娠是安全可行的,只要患者有生育需求和意愿,均应给予鼓励。(责任编辑:shamouer)

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