• Contact us
  • E-Submission

Ewha Med J : The Ewha Medical Journal

OPEN ACCESS
mobile search button mobile menu button
Search
Advanced Search
ABOUT
BROWSE ARTICLES
JOURNAL POLICIES
FOR CONTRIBUTORS

Articles

Page Path

Review Article
Special Issues for Breast Cancer

Endocrine Therapy for Breast Cancer

Joohyun Woo, Woosung Lim
The Ewha Medical Journal 2014;37(2):83-91. Published online: September 30, 2014

Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea.

Corresponding author: Woosung Lim. Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, 1071 Anyancheon-ro, Yangcheon-gu, Seoul 158-710, Korea. Tel: 82-10-2570-8980, Fax: 82-2-2644-7984, limw@ewha.ac.kr
• Received: August 1, 2014   • Accepted: August 29, 2014

Copyright © 2014. Ewha Womans University School of Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

  • 68 Views
  • 0 Download
  • 2 Crossref
prev next

Full Article

Download PDF Download PDF
  • Breast cancer is the second most common cancer in Korean women and its mortality rate has increased steadily. Although breast cancer is heterogeneous tumor, hormone receptor-positive tumors comprise about 75 percent of all breast cancers. Therefore endocrine therapy that works by targeting estrogen receptor is a pivotal treatment for breast cancers. There are selective estrogen receptor modulators, such as tamoxifen and raloxifene, aromatase inhibitors, such as anastrozole, letrozole and exemestane, fulvestrant and luteinizing hormone-releasing hormone agonists used in endocrine therapy. Endocrine therapy is effective in treating early breast cancer as an adjuvant therapy and metastatic breast cancer as a palliative therapy. Also in women who are at high risk for breast cancer, tamoxifen or raloxifene can prevent breast cancer. Studies for neoadjuvant endocrine therapy are emerging. Considering side effects of each drug and overcoming drug resistance are needed to maximize effectiveness of treatment and advance endocrine therapy.
  • Keywords: Breast neoplasms; Drug therapy; Antineoplastic agents, hormonal
  • 1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin 2009;59:225-249.
  • 2. The Korean Breast Cancer Society.The breast; Seoul: Koonja; 2013.
  • 3. Powles TJ, Ashley S, Tidy A, Smith IE, Dowsett M. Twenty-year follow-up of theRoyal Marsden randomized, double-blinded tamoxifen breast cancer prevention trial. J Natl Cancer Inst 2007;99:283-290.
  • 4. Lumachi F, Luisetto G, Basso SM, Basso U, Brunello A, Camozzi V. Endocrine therapy of breast cancer. Curr Med Chem 2011;18:513-522.
  • 5. Addo S, Yates RA, Laight A. A phase I trial to assess the pharmacology of the new oestrogen receptor antagonist fulvestrant on the endometrium in healthy postmenopausal volunteers. Br J Cancer 2002;87:1354-1359.
  • 6. Wakeling AE. Similarities and distinctions in the mode of action of different classes of antioestrogens. Endocr Relat Cancer 2000;7:17-28.
  • 7. Puhalla S, Brufsky A, Davidson N. Adjuvant endocrine therapy for premenopausal women with breast cancer. Breast 2009;18:Suppl 3. S122-S130.
  • 8. Smith IE, Dowsett M. Aromatase inhibitors in breast cancer. N Engl J Med 2003;348:2431-2442.
  • 9. Goel S, Sharma R, Hamilton A, Beith J. LHRH agonists for adjuvant therapy of early breast cancer in premenopausal women. Cochrane Database Syst Rev 2009;CD004562.
  • 10. Donegan WL, Spratt JS. Cancer of the breast; Philadephia: Saunders; 2002.
  • 11. Osborne CK, Boldt DH, Clark GM, Trent JM. Effects of tamoxifen on human breast cancer cell cycle kinetics: accumulation of cells in early G1 phase. Cancer Res 1983;43:3583-3585.
  • 12. Early Breast Cancer Trialists' Collaborative Group (EBCTCG)Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005;365:1687-1717.
  • 13. Delozier T, Switsers O, Genot JY, Ollivier JM, Hery M, Namer M, et al. Delayed adjuvant tamoxifen: ten-year results of a collaborative randomized controlled trial in early breast cancer (TAM-02 trial). Ann Oncol 2000;11:515-519.
  • 14. Fisher B, Dignam J, Bryant J, Wolmark N. Five versus more than five years of tamoxifen for lymph node-negative breast cancer: updated findings from the National Surgical Adjuvant Breast and Bowel Project B-14 randomized trial. J Natl Cancer Inst 2001;93:684-690.
  • 15. Davies C, Pan H, Godwin J, Gray R, Arriagada R, Raina V, Abraham M, et al. Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet 2013;381:805-816.
  • 16. Ramaswamy B, Shapiro CL. Osteopenia and osteoporosis in women with breast cancer. Semin Oncol 2003;30:763-775.
  • 17. Love RR, Mazess RB, Barden HS, Epstein S, Newcomb PA, Jordan VC, et al. Effects of tamoxifen on bone mineral density in postmenopausal women with breast cancer. N Engl J Med 1992;326:852-856.
  • 18. Ward RL, Morgan G, Dalley D, Kelly PJ. Tamoxifen reduces bone turnover and prevents lumbar spine and proximal femoral bone loss in early postmenopausal women. Bone Miner 1993;22:87-94.
  • 19. Saarto T, Blomqvist C, Valimaki M, Makela P, Sarna S, Elomaa I. Clodronate improves bone mineral density in post-menopausal breast cancer patients treated with adjuvant antioestrogens. Br J Cancer 1997;75:602-605.
  • 20. Marttunen MB, Hietanen P, Tiitinen A, Ylikorkala O. Comparison of effects of tamoxifen and toremifene on bone biochemistry and bone mineral density in postmenopausal breast cancer patients. J Clin Endocrinol Metab 1998;83:1158-1162.
  • 21. Grey AB, Stapleton JP, Evans MC, Tatnell MA, Ames RW, Reid IR. The effect of the antiestrogen tamoxifen on bone mineral density in normal late postmenopausal women. Am J Med 1995;99:636-641.
  • 22. Vehmanen L, Elomaa I, Blomqvist C, Saarto T. Tamoxifen treatment after adjuvant chemotherapy has opposite effects on bone mineral density in premenopausal patients depending on menstrual status. J Clin Oncol 2006;24:675-680.
  • 23. Ellmen J, Hakulinen P, Partanen A, Hayes DF. Estrogenic effects of toremifene and tamoxifen in postmenopausal breast cancer patients. Breast Cancer Res Treat 2003;82:103-111.
  • 24. Powles TJ, Hickish T, Kanis JA, Tidy A, Ashley S. Effect of tamoxifen on bone mineral density measured by dual-energy x-ray absorptiometry in healthy premenopausal and postmenopausal women. J Clin Oncol 1996;14:78-84.
  • 25. Jonat W, Kaufmann M, Sauerbrei W, Blamey R, Cuzick J, Namer M, et al. Goserelin versus cyclophosphamide, methotrexate, and fluorouracil as adjuvant therapy in premenopausal patients with node-positive breast cancer: The Zoladex Early Breast Cancer Research Association Study. J Clin Oncol 2002;20:4628-4635.
  • 26. Cuzick J, Sestak I, Baum M, Buzdar A, Howell A, Dowsett M, et al. Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 10-year analysis of the ATAC trial. Lancet Oncol 2010;11:1135-1141.
  • 27. Dowsett M, Cuzick J, Ingle J, Coates A, Forbes J, Bliss J, et al. Meta-analysis of breast cancer outcomes in adjuvant trials of aromatase inhibitors versus tamoxifen. J Clin Oncol 2010;28:509-518.
  • 28. BIG 1-98 Collaborative GroupMouridsen H, Giobbie-Hurder A, Goldhirsch A, Thurlimann B, Paridaens R, et al. Letrozole therapy alone or in sequence with tamoxifen in women with breast cancer. N Engl J Med 2009;361:766-776.
  • 29. Jin H, Tu D, Zhao N, Shepherd LE, Goss PE. Longer-term outcomes of letrozole versus placebo after 5 years of tamoxifen in the NCIC CTG MA.17 trial: analyses adjusting for treatment crossover. J Clin Oncol 2012;30:718-721.
  • 30. Lonning PE, Geisler J. Indications and limitations of third-generation aromatase inhibitors. Expert Opin Investig Drugs 2008;17:723-739.
  • 31. Coombes RC, Hall E, Gibson LJ, Paridaens R, Jassem J, Delozier T, et al. A randomized trial of exemestane after two to three years of tamoxifen therapy in postmenopausal women with primary breast cancer. N Engl J Med 2004;350:1081-1092.
  • 32. McCloskey E. Effects of third-generation aromatase inhibitors on bone. Eur J Cancer 2006;42:1044-1051.
  • 33. Hadji P, Ziller M, Albert US, Kalder M. Assessment of fracture risk in women with breast cancer using current vs emerging guidelines. Br J Cancer 2010;102:645-650.
  • 34. Gibson L, Lawrence D, Dawson C, Bliss J. Aromatase inhibitors for treatment of advanced breast cancer in postmenopausal women. Cochrane Database Syst Rev 2009;CD003370.
  • 35. Lonning PE. Lack of complete cross-resistance between different aromatase inhibitors; a real finding in search for an explanation? Eur J Cancer 2009;45:527-535.
  • 36. Chia S, Gradishar W, Mauriac L, Bines J, Amant F, Federico M, et al. Double-blind, randomized placebo controlled trial of fulvestrant compared with exemestane after prior nonsteroidal aromatase inhibitor therapy in postmenopausal women with hormone receptor-positive, advanced breast cancer: results from EFECT. J Clin Oncol 2008;26:1664-1670.
  • 37. Robertson JF, Llombart-Cussac A, Rolski J, Feltl D, Dewar J, Macpherson E, et al. Activity of fulvestrant 500 mg versus anastrozole 1 mg as first-line treatment for advanced breast cancer: results from the FIRST study. J Clin Oncol 2009;27:4530-4535.
  • 38. Charehbili A, Fontein DB, Kroep JR, Liefers GJ, Mieog JS, Nortier JW, et al. Neoadjuvant hormonal therapy for endocrine sensitive breast cancer: a systematic review. Cancer Treat Rev 2014;40:86-92.
  • 39. Mieog JS, van der Hage JA, van de Velde CJ. Neoadjuvant chemotherapy for operable breast cancer. Br J Surg 2007;94:1189-1200.
  • 40. Mauri D, Pavlidis N, Ioannidis JP. Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis. J Natl Cancer Inst 2005;97:188-194.
  • 41. Alba E, Calvo L, Albanell J, De la Haba JR, Arcusa Lanza A, Chacon JI, et al. Chemotherapy (CT) and hormonotherapy (HT) as neoadjuvant treatment in luminal breast cancer patients: results from the GEICAM/2006-03, a multicenter, randomized, phase-II study. Ann Oncol 2012;23:3069-3074.
  • 42. Semiglazov VF, Semiglazov VV, Dashyan GA, Ziltsova EK, Ivanov VG, Bozhok AA, et al. Phase 2 randomized trial of primary endocrine therapy versus chemotherapy in postmenopausal patients with estrogen receptor-positive breast cancer. Cancer 2007;110:244-254.
  • 43. Cataliotti L, Buzdar AU, Noguchi S, Bines J, Takatsuka Y, Petrakova K, et al. Comparison of anastrozole versus tamoxifen as preoperative therapy in postmenopausal women with hormone receptor-positive breast cancer: the Pre-Operative "Arimidex" Compared to Tamoxifen (PROACT) trial. Cancer 2006;106:2095-2103.
  • 44. Eiermann W, Paepke S, Appfelstaedt J, Llombart-Cussac A, Eremin J, Vinholes J, et al. Preoperative treatment of postmenopausal breast cancer patients with letrozole: a randomized double-blind multicenter study. Ann Oncol 2001;12:1527-1532.
  • 45. Masuda N, Sagara Y, Kinoshita T, Iwata H, Nakamura S, Yanagita Y, et al. Neoadjuvant anastrozole versus tamoxifen in patients receiving goserelin for premenopausal breast cancer (STAGE): a double-blind, randomised phase 3 trial. Lancet Oncol 2012;13:345-352.
  • 46. Smith IE, Dowsett M, Ebbs SR, Dixon JM, Skene A, Blohmer JU, et al. Neoadjuvant treatment of postmenopausal breast cancer with anastrozole, tamoxifen, or both in combination: the Immediate Preoperative Anastrozole, Tamoxifen, or Combined with Tamoxifen (IMPACT) multicenter double-blind randomized trial. J Clin Oncol 2005;23:5108-5116.
  • 47. Ellis MJ, Suman VJ, Hoog J, Lin L, Snider J, Prat A, et al. Randomized phase II neoadjuvant comparison between letrozole, anastrozole, and exemestane for postmenopausal women with estrogen receptor-rich stage 2 to 3 breast cancer: clinical and biomarker outcomes and predictive value of the baseline PAM50-based intrinsic subtype--ACOSOG Z1031. J Clin Oncol 2011;29:2342-2349.
  • 48. Hind D, Wyld L, Beverley CB, Reed MW. Surgery versus primary endocrine therapy for operable primary breast cancer in elderly women (70 years plus). Cochrane Database Syst Rev 2006;CD004272.
  • 49. Kataja V, Castiglione M. ESMO Guidelines Working GroupPrimary breast cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 2009;20:Suppl 4. 10-14.
  • 50. Gnant M, Mlineritsch B, Schippinger W, Luschin-Ebengreuth G, Postlberger S, Menzel C, et al. Endocrine therapy plus zoledronic acid in premenopausal breast cancer. N Engl J Med 2009;360:679-691.
  • 51. O'Shaughnessy JA, Kelloff GJ, Gordon GB, Dannenberg AJ, Hong WK, Fabian CJ, et al. Treatment and prevention of intraepithelial neoplasia: an important target for accelerated new agent development. Clin Cancer Res 2002;8:314-346.
  • 52. Lumachi F, Ermani M, Basso SM, Lonardi S, Tosoni A, Brandes AA. Breast cancer risk in symptomatic women spontaneously undergoing clinical breast examination. Anticancer Res 2003;23:3565-3568.
  • 53. Thomsen A, Kolesar JM. Chemoprevention of breast cancer. Am J Health Syst Pharm 2008;65:2221-2228.
  • 54. Lumachi F, Basso SM, Orlando R. Cytokines, thyroid diseases and thyroid cancer. Cytokine 2010;50:229-233.
  • 55. Tomita S, Zhang Z, Nakano M, Ibusuki M, Kawazoe T, Yamamoto Y, et al. Estrogen receptor alpha gene ESR1 amplification may predict endocrine therapy responsiveness in breast cancer patients. Cancer Sci 2009;100:1012-1017.
  • 56. Fisher B, Costantino JP, Wickerham DL, Cecchini RS, Cronin WM, Robidoux A, et al. Tamoxifen for the prevention of breast cancer: current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study. J Natl Cancer Inst 2005;97:1652-1662.
  • 57. Cuzick J, Forbes J, Edwards R, Baum M, Cawthorn S, Coates A, et al. First results from the International Breast Cancer Intervention Study (IBIS-I): a randomised prevention trial. Lancet 2002;360:817-824.
  • 58. Dunn BK, Ryan A. Phase 3 trials of aromatase inhibitors for breast cancer prevention: following in the path of the selective estrogen receptor modulators. Ann N Y Acad Sci 2009;1155:141-161.
  • 59. O'Regan RM, Jordan VC. The evolution of tamoxifen therapy in breast cancer: selective oestrogen-receptor modulators and downregulators. Lancet Oncol 2002;3:207-214.
  • 60. Love RR, Wiebe DA, Newcomb PA, Cameron L, Leventhal H, Jordan VC, et al. Effects of tamoxifen on cardiovascular risk factors in postmenopausal women. Ann Intern Med 1991;115:860-864.
  • 61. Cuzick J, Powles T, Veronesi U, Forbes J, Edwards R, Ashley S, et al. Overview of the main outcomes in breast-cancer prevention trials. Lancet 2003;361:296-300.
  • 62. Vogel VG, Costantino JP, Wickerham DL, Cronin WM, Cecchini RS, Atkins JN, et al. Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA 2006;295:2727-2741.
  • 63. Larionov AA, Miller WR. Challenges in defining predictive markers for response to endocrine therapy in breast cancer. Future Oncol 2009;5:1415-1428.
  • 64. Basso U, Fratino L, Brunello A, Lumachi F, De Salvo GL, Lonardi S, et al. Which benefit from adding gemcitabine to vinorelbine in elderly (>or=70 years) women with metastatic breast cancer? Early interruption of a phase II study. Ann Oncol 2007;18:58-63.
  • 65. Coates AS, Keshaviah A, Thurlimann B, Mouridsen H, Mauriac L, Forbes JF, et al. Five years of letrozole compared with tamoxifen as initial adjuvant therapy for postmenopausal women with endocrine-responsive early breast cancer: update of study BIG 1-98. J Clin Oncol 2007;25:486-492.
Fig. 1
(A) Pre- and (B) posttreatment breast magnetic resonance imaging (MRI) in a patient who received neoadjuvant endocrine therapy. A 72-year-old woman was diagnosed with breast cancer on April, 2013. A left subareolar mass was confirmed as invasive ductal carcinoma by core needle biopsy and immunohistochemistry revealed that the tumor was estrogen receptor- and progesterone receptor-positive, and C-erbB2-negative breast cancer. She was treated with letrozole for 6 months. MRI shows the clinical response of neoadjuvant endocrine therapy. The size of primary tumor partially decreased from 4.2 cm to 3.0 cm on MRI after neoadjuvant endocrine therapy for 6 months (arrows). Also metastatic lymph node in left axilla disappeared (not shown).
emj-37-83-g001.jpg
Table 1
A summary of research studies on adjuvant tamoxifen

NSABP, National Surgical Adjuvant Breast and Bowel Project; ER, estrogen receptor; EBCTCG, Early Breast Cancer Trialists' Collaborative Group; ATLAS, Adjuvant Tamoxifen Longer Against Shorter; aTTom, adjuvant Tamoxifen Treatment offers more.

emj-37-83-i001.jpg
Table 2
A summary of research studies on adjuvant aromatase inhibitor

IBCSG, International Breast Cancer Study Group; BIG, Breast International Group; ER, estrogen receptor; ATAC, arimidex, tamoxifen, alone or in combination; PR, progesterone receptor; EBCTCG, Early Breast Cancer Trialists' Collaborative Group; AI, aromatase inhibitor.

emj-37-83-i002.jpg
Table 3
A summary of research studies on neoadjuvant endocrine therapy

ER, estrogen receptor; PR, progesterone receptor; IMPACT, immediate preoperative anastrozole, tamoxifen, or combined with tamoxifen; PROACT, pre-operative "arimidex" compared to tamoxifen; ACOSOG, American college of surgeons oncology group; PEPI, Preoperative endocrine prognostic index.

emj-37-83-i003.jpg

Figure & Data

References

    Citations

    Citations to this article as recorded by  
    • Predictive Factors for Medication Adherence in Patients with Breast Cancer on Hormone Therapy
      Hee-jung Jung, Su-Jin Lim
      Asian Oncology Nursing.2023; 23(4): 216.     CrossRef
    • Analysis and Identification of Active Compounds from Gami-Soyosan Toxic to MCF-7 Human Breast Adenocarcinoma Cells
      Mi-Yeon Jung, Chang-Seob Seo, Seon-Eun Baek, Jaemin Lee, Myoung-Sook Shin, Ki Sung Kang, Sullim Lee, Jeong-Eun Yoo
      Biomolecules.2019; 9(7): 272.     CrossRef

    Download Citation

    Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

    Format:

    Include:

    Endocrine Therapy for Breast Cancer
    Ewha Med J. 2014;37(2):83-91.   Published online September 30, 2014
    DOI: https://doi.org/10.12771/emj.2014.37.2.83
    Download Citation
    Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.
    Format:
    • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
    • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
    Include:
    • Citation for the content below
    Endocrine Therapy for Breast Cancer
    Ewha Med J. 2014;37(2):83-91.   Published online September 30, 2014
    DOI: https://doi.org/10.12771/emj.2014.37.2.83
    Close

    Figure

    • 0
    Endocrine Therapy for Breast Cancer
    Image
    Fig. 1 (A) Pre- and (B) posttreatment breast magnetic resonance imaging (MRI) in a patient who received neoadjuvant endocrine therapy. A 72-year-old woman was diagnosed with breast cancer on April, 2013. A left subareolar mass was confirmed as invasive ductal carcinoma by core needle biopsy and immunohistochemistry revealed that the tumor was estrogen receptor- and progesterone receptor-positive, and C-erbB2-negative breast cancer. She was treated with letrozole for 6 months. MRI shows the clinical response of neoadjuvant endocrine therapy. The size of primary tumor partially decreased from 4.2 cm to 3.0 cm on MRI after neoadjuvant endocrine therapy for 6 months (arrows). Also metastatic lymph node in left axilla disappeared (not shown).

    Fig. 1

    Endocrine Therapy for Breast Cancer

    A summary of research studies on adjuvant tamoxifen

    NSABP, National Surgical Adjuvant Breast and Bowel Project; ER, estrogen receptor; EBCTCG, Early Breast Cancer Trialists' Collaborative Group; ATLAS, Adjuvant Tamoxifen Longer Against Shorter; aTTom, adjuvant Tamoxifen Treatment offers more.

    A summary of research studies on adjuvant aromatase inhibitor

    IBCSG, International Breast Cancer Study Group; BIG, Breast International Group; ER, estrogen receptor; ATAC, arimidex, tamoxifen, alone or in combination; PR, progesterone receptor; EBCTCG, Early Breast Cancer Trialists' Collaborative Group; AI, aromatase inhibitor.

    A summary of research studies on neoadjuvant endocrine therapy

    ER, estrogen receptor; PR, progesterone receptor; IMPACT, immediate preoperative anastrozole, tamoxifen, or combined with tamoxifen; PROACT, pre-operative "arimidex" compared to tamoxifen; ACOSOG, American college of surgeons oncology group; PEPI, Preoperative endocrine prognostic index.
    Table 1 A summary of research studies on adjuvant tamoxifen

    NSABP, National Surgical Adjuvant Breast and Bowel Project; ER, estrogen receptor; EBCTCG, Early Breast Cancer Trialists' Collaborative Group; ATLAS, Adjuvant Tamoxifen Longer Against Shorter; aTTom, adjuvant Tamoxifen Treatment offers more.

    Table 2 A summary of research studies on adjuvant aromatase inhibitor

    IBCSG, International Breast Cancer Study Group; BIG, Breast International Group; ER, estrogen receptor; ATAC, arimidex, tamoxifen, alone or in combination; PR, progesterone receptor; EBCTCG, Early Breast Cancer Trialists' Collaborative Group; AI, aromatase inhibitor.

    Table 3 A summary of research studies on neoadjuvant endocrine therapy

    ER, estrogen receptor; PR, progesterone receptor; IMPACT, immediate preoperative anastrozole, tamoxifen, or combined with tamoxifen; PROACT, pre-operative "arimidex" compared to tamoxifen; ACOSOG, American college of surgeons oncology group; PEPI, Preoperative endocrine prognostic index.

    Table 1

    Table 2

    Table 3

    Ewha Med J : The Ewha Medical Journal

    ABOUT

    BROWSE ARTICLES 

    JOURNAL POLICIES

    FOR CONTRIBUTORS 

    © Ewha Womans University College of Medicine.
    TOP