1、绝经前乳腺 癌内 分泌治 疗策略探讨This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C5
2、1 microcontroller and DS18B20 temperature sensor.内容l 绝经前乳腺癌流行病学l TAM辅助治疗l 卵巢功能抑制辅助治疗和治疗指南与专家共识解读l LHRHa化疗 对于年轻激素受体阳性绝经前乳腺癌患者的价值l 内分泌治疗在晚期乳腺癌治疗中的地位This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by
3、 using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.绝经前乳腺癌流行病学This paper mainly introduces the design of an intelligent temperature control system which realizes the function
4、of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.中国乳腺癌 1999-2008年流行病学特点绝经状态N=4211绝经后 N=1329绝经前 N=2486Li J, et al. BMC Cancer 2011;
5、11:364.This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcont
6、roller and DS18B20 temperature sensor.中国乳腺癌 1999-2008年流行病学特点绝经时的年龄N=156250岁 N=1017Li J, et al. BMC Cancer 2011; 11:364.This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital t
7、emperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.TAM辅助治疗This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and
8、 control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.2005 EBCTCG荟萃分析他莫昔芬：绝经前辅助内分泌治疗的 “金标准 ”l 他莫昔芬降低肿瘤复发和死亡风险的治疗利益已确立 1-21. EBCTCG Lancet 1998; 351: 14511467.2. EBCTC
9、G Overview, Lancet 2005; 356:1687-1717.随访时间 (年 )15年 的 获 益 211.8% (SE 1.3)Log-rank 2p0.000015年 TAM 33.2%对照组 45.0%15年 的 获 益 29.2% (SE 1.2)Log-rank 2p0.000015年 TAM 25.6%对照组 34.8%38.326.524.715.160504030201000 5 10 1560504030201000 5 10 1525.717.811.98.3随访时间 (年 )复发率(%)死亡率(%)This paper mainly introduces
10、the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature senso
11、r.2011 EBCTCG荟萃分析他莫昔芬：绝经前辅助内分泌治疗的 “金标准 ”l 他莫昔芬降低肿瘤复发和死亡风险的治疗利益已确立 1-31. EBCTCG Lancet 1998; 351: 14511467.2. EBCTCG Overview, Lancet 2005; 356:1687-1717.3. EBCTCG Lancet 2011; 378: 771-784.This paper mainly introduces the design of an intelligent temperature control system which realizes the functio
12、n of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.2011 EBCTCG荟萃分析他莫昔芬：绝经前辅助内分泌治疗的 “金标准 ”l 他莫昔芬降低肿瘤复发和死亡风险的治疗利益已确立 1-31. EBCTCG Lan
13、cet 1998; 351: 14511467.2. EBCTCG Overview, Lancet 2005; 356:1687-1717.3. EBCTCG Lancet 2011; 378: 771-784.TAM5年治疗显著降低 10年内复发风险， 10年后不再降低RR: 0.53 Yr0-4, 0.68 Yr5-9, 0.97 Yr10-14ER临界阳性（ 1019 fmol/mg）也可显著降低复发风险 RR: 0.67乳腺癌死亡风险持续 15年，约降低 1/3 RR: 0.71 Yr0-4, 0.66 Yr5-9, 0.68 Yr10-14TAM获益与 PR, 年龄 , 淋巴结状况
14、 , 肿瘤大小及化疗无关血栓及子宫内膜癌死亡风险只在大于 55岁有小的绝对增加This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of
15、the system are AT89C51 microcontroller and DS18B20 temperature sensor.卵巢功能抑制辅助治疗This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single ch
16、ip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.卵巢功能抑制显著降低复发及乳腺癌死亡风险EBCTCG荟萃分析51.6%年复发风险 17%复发风险47.3%15复发率(%)15年绝对获益 4.3%60504030201000 5 10Log-rank 2P=0.00001年事件发生率比 0.83 (SE=0.038)对照组卵巢功能抑制组时间 (年 )年乳腺癌死亡风险 13%乳腺癌死亡率(%)15乳腺癌死亡风险43.5%40.
17、3%15年绝对获益 3.2%60504030201000 5 10Log-rank 2P=0.004年事件发生率比 0.87 (SE=0.045)对照组卵巢功能抑制组时间 (年 )N=7601 N=7601Early Breast Cancer Trialists Collaboralive Group(EBCTCG). Lancet 2005; 365:1687-1717.This paper mainly introduces the design of an intelligent temperature control system which realizes the functio
18、n of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.卵巢功能抑制的方法卵巢切除术Oophorectomy放疗Radiation药物PharmacogicalMcDonald Wade S, et al. Onco
19、logy 2008; 75:192-202.This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT
20、89C51 microcontroller and DS18B20 temperature sensor.绝经前转移性乳腺癌患者，诺雷得单药去势与手术去势疗效相似，可避免手术1. Taylor CW, et al. J Clin Oncol 1998; 16:994-999. 2. McDonald Wade S, et al. Oncology 2008; 75:192-202.1008060402000 24 48 72时间 (月 )总生存概率(%)P=NSHR=0.8095% CI: 0.53-1.20诺雷得手术去势风险患者例数死亡例数6967444896以诺雷得为代表的 GnRHa是卵
21、巢抑制的首选 2：避免手术，作用可逆，保留生育能力绝经前 ER+早期乳腺癌患者中 GnRHa辅助治疗地位的荟萃分析16项临床研究， 9,022例患者LHRHa vs. 化疗LHRHa+他莫昔芬 vs. 化疗他莫昔芬联合 LHRHa的优势化疗 (他莫昔芬 )联合 LHRHa的优势中位随访时间： 7.3年入组时间： 1987 2001中位年龄： 43.6岁淋巴结阴性率： 31%T1： 51%ER阳性率： 92%Cuzick et al. Lancet 2007; 369: 1711-1723.This paper mainly introduces the design of an intelli
22、gent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.无全身治疗 LHRH0.5 0.7 1 1.
23、4复发复发后死亡不支持 LHRHa支持 LHRHa化疗 vs. LHRH+tam无全身治疗 (LHRH+tam)三苯氧胺 LHRH化疗 LHRH化疗 +三苯氧胺 LHRH(化疗 +三苯氧胺 )LHRH任何全身治疗 LHRH化疗 (LHRH+tam)化疗 vs. LHRH标准辅助治疗联合 GnRHa能降低复发风险，改善生存Cuzick et al. Lancet 2007; 369: 1711-1723.This paper mainly introduces the design of an intelligent temperature control system which realiz
24、es the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.标准辅助治疗联合 GnRHa显著降低复发风险达 12%Cuzick et al. Lancet 2007; 369: 1711-17
25、23.时间 (年 )12%化疗 他莫昔芬 +GnRHa (n=1370)化疗 他莫昔芬 (n=1371)复发率(%)0 1 2 3 4 5 6 7 8 9 1050010203040 HR=0.8895 CI 0.77-0.99P=0.04This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital
26、temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.标准辅助治疗联合 GnRHa显著降低复发后死亡风险达 15%时间 (年 )504030201000 2 3 4 5 6 7 8 9 10复发后的死亡率(%)化疗 他莫昔芬 +GnRHa (n=1370)化疗 他莫昔芬 (n=1371)HR=0.8595%CI=0.73-0.99P=0.0415%C
27、uzick et al. Lancet 2007; 369: 1711-1723.This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components o
28、f the system are AT89C51 microcontroller and DS18B20 temperature sensor.ZIPP：研究设计l 4个协作组， 2710例合格病人l 淋巴结阳性或阴性 (I期或 II期 )疾病l ER+： 68%l 标准治疗 =放射治疗 化疗诺雷得 3.6mg/28d+他莫昔芬2040mg/d，治疗 2年 他莫昔芬 2040mg/d，治疗 2年诺雷得 3.6mg/28d，治疗 2年无后续治疗 标准治疗手术 R主要终点DFS、 OS 入组时间： 1987年 8月 -1999年 3月 患者中位年龄： 44岁，含诺雷得组为22-56岁，不含诺雷得组
29、为 21-55岁 化疗方案：推荐 CMF，部分中心选择CEFHackshaw A, et al. J Natl Cancer Inst 2009; 101:341-349.Baun M, et al. Eur J Cancer 206; 42:895-904.不含诺雷得组N=1355含诺雷得组N=1351This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and con
30、trol by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.联合了诺雷得方案后，显著改善 l 无 事件生存 显著改善 - HR=0.82 95% CI 0.730.92; p=0.001l 总生存显著改善 - HR=0.83 95% CI 0.760.96; p=0.013l 复发风险显著降
31、低- HR=0.81 95% CI 0.710.92; p=0.001l 乳腺癌死亡风险显著降低- HR=0.82 95% CI 0.700.96; p=0.0318%17%19%18%Hackshaw A, et al. J Natl Cancer Inst 2009; 101:341-349.This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control
32、 by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.ZIPP全组结果：风险比l 在三苯氧胺的基础上，联用诺雷得降低了- 任何事件风险 8%- 死亡风险 10%Hackshaw A, et al. J Natl Cancer Inst 2009; 101:341-349.风险比 (95%可信区
33、间 )治疗 任何事件 死亡 乳腺癌复发 乳腺癌死亡仅三苯氧胺 1(参照 ) 1(参照 ) 1(参照 ) 1(参照 )三苯氧胺 +诺雷得0.92(0.80-1.07)0.90(0.75-1.09)0.91(0.78-1.07)0.89(0.73-1.09)-复发风险 9%-乳腺癌死亡风险 11%This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control b
34、y using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.全球各大乳腺癌治疗指南多数仍然推荐GnRHa用于绝经前激素受体阳性早期乳腺癌患者指南 NCCN NCCN ESMO St.Gallen专家共识 乳腺癌诊疗规范区域 美国 中国 欧洲 全球 中国版本 2011.v2 2011.v1 2011 20
35、11 2011推荐 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microc
36、ontroller and DS18B20 temperature sensor.2009年早期乳腺癌的主要治疗全球专家共识Goldhirsch A, et al. Ann Oncol 2009 doi:10.1093/annonc/mdp322.l 绝经前乳腺癌的内分泌治疗 他莫昔芬联合卵巢功能抑制或他莫昔芬单药是标准内分泌治疗 专家组强烈支持 LHRHa作为卵巢功能抑制的重要方法 专家组倾向于 LHRHa最合适的 使用时间是 5年u 尤其在复发高危人群和 /或 HER-2阳性患者中This paper mainly introduces the design of an intellige
37、nt temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.2011 NCCN乳腺癌临床实践指南 (美 )T
38、his paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller a
39、nd DS18B20 temperature sensor.2011 ESMO 原发乳腺癌临床实践指南l 内分泌治疗 ： 绝经前患者他莫昔芬单药(20mg/d5年 )或卵巢功能抑制联合他莫昔芬是标准治疗 ，尤其在化疗后 卵巢功能抑制和他莫昔芬至少与无进一步内分泌治疗的化疗同等有效 GnRHa能带来 足够治疗活性 的可逆性卵巢功能抑制 GnRHa应至少治疗 2年 ，尽管最佳治疗持续时间尚未确立 This paper mainly introduces the design of an intelligent temperature control system which realizes th
40、e function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.2011 St. Gallen 乳腺癌全球专家共识绝经前妇女内分泌治疗的选择l 专家团同意他莫昔芬单药或卵巢功能抑制联合他莫昔芬是合理的治疗选
41、择l 对有他莫昔芬禁忌的患者，单纯卵巢功能抑制是可接受的治疗选择，卵巢功能抑制联合芳香化酶抑制剂也是合理的This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core
42、components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.中国乳腺癌诊疗规范 (2011年版 )l 根据患者月经状态选择适当的内分泌治疗药物，一般绝经前患者优先选择三苯氧胺，亦可联合药物或手术去势 l 激素受体阳性的早期乳腺癌，对于绝经前高复发风险的患者，可联合卵巢抑制 /切除 This paper mainly introduces the design of an intelligent temperature control system which realizes the f
43、unction of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.LHRHa化疗 对于年轻激素受体阳性绝经前乳腺癌患者的价值This paper mainly introduces the design of an
44、 intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.St.Gallen 1992
45、不推荐 LHRHa注释：戈舍瑞林辅助治疗正在进行St.Gallen (1998)ASCO (1999)ASCO (1999)ZIPPABCSG5 (3.5y)INT0101 (6y)EBCC(2000)J Clin Oncol (2000)ASCO (2001)ZEBRAGROCTA02 (6.3y)Mam-1 (5y)St.Gallen 2001推荐用于中高危患者 注释： 随戈舍瑞林辅助治疗研究结果公布后出现该推荐Tumori(Abs) * (1995)GROCTA 02(3y) St.Gallen 1995推荐用于中高危患者 注释：戈舍瑞林辅助治疗正在进行紫色：会议报告；蓝色：发表文献诺雷
46、得辅助治疗研究与 St. Gallen推荐历史199220001995诺雷得研究 St.Gallen对 LHRHa推荐的变化报告来源This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomput
47、er. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.St.Gallen 2005推荐用于所有处于危险的患者J Clin Oncol (2002)ASCO (2002)J Clin Oncol (2002)Anti Cancer Res (2002)J Natl Cancer Inst (2003)Eur J Cancer (2003)ASCO (2004)ZEBRA (6y)IBCSGVIII (5.7y)ABCSG5 (5y)TABLE (2y)IBC
48、SGVIII (7y)ZEBRA (7.3y)GABG IV-A-93 (4.9y)J Clin Oncol (2005)Br J Cancer (2005)INT0101 (9.6y)Mam-1 (6y)ZIPP (5.5年 )GABG IV-A-93 (4.9y)Eur J Cancer (2006)Eur J Cancer (2006)St.Gallen 2007推荐治疗： LHRHa +TAM / TAM / LHRHaSt.Gallen 2009推荐治疗： LHRHa +TAM / TAM / LHRHa诺雷得辅助治疗研究与 St. Gallen推荐历史紫色：会议报告；蓝色：发表文献
49、200520092007诺雷得研究 St.Gallen对 LHRHa推荐的变化报告来源This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.总体结论l 对于绝经前和围绝经期 50岁以下淋巴结阳性内分泌敏感型乳腺癌，卵巢功能抑制 /诺雷得可替代细胞毒化疗l 卵巢功能抑制 /诺雷得对月经的影响是 可逆 的l 激素受体状态的评估对于治疗决策而言至关重要
