接受他莫昔芬治疗的年轻乳腺癌患者罹患子宫内膜癌的风险也较高,使用芳香化酶抑制剂可降低这一风险:一项基于台湾人口的研究。

Ci ji yi xue za zhi = Tzu-chi medical journal Pub Date : 2019-07-23 eCollection Date: 2020-04-01 DOI:10.4103/tcmj.tcmj_17_19
Sung-Chao Chu, Chia-Jung Hsieh, Tso-Fu Wang, Mun-Kun Hong, Tang-Yuan Chu
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引用次数: 0

摘要

研究目的以往的西方研究报告显示,接受他莫昔芬治疗的老年(≥50岁)乳腺癌幸存者罹患子宫内膜癌的风险较高。本研究旨在揭示年轻乳腺癌幸存者(材料与方法:研究人员从台湾国民健康保险数据库中收集了 1999 年至 2012 年期间 39,216 名新确诊的乳腺癌患者。通过 Cox 回归分析比较了未使用他莫昔芬者(14588 人)、仅使用他莫昔芬者(19302 人)和人工授精测序者(5326 人)罹患子宫内膜癌的风险,并对年龄、糖尿病、高血压和化疗进行了调整:结果:在 14 年的研究期间,有 133 名患者被诊断出罹患子宫内膜癌。与不使用他莫昔芬的患者相比,仅使用他莫昔芬的患者罹患子宫内膜癌的风险更高(14 年发病率为 1.7% 对 0.3%;调整后危险比 [HR] 3.90;95% 置信区间 [CI],2.37-6.42)。在老年组(≥50 岁)和年轻组(40-50 岁)中都观察到了这种情况。后者的调整 HR(95% CI)为 3.74(1.65-8.48)。停止使用他莫昔芬后,这一风险依然存在。与仅使用他莫昔芬的患者相比,测序人工授精患者罹患子宫内膜癌的风险较低(调整HR为0.43;95% CI为0.25-0.72):结论:在这一全国性队列中,不仅是年龄≥50岁的患者,接受他莫昔芬治疗的年轻患者(40-49岁)罹患子宫内膜癌的风险也较高。我们建议,不仅在积极用药期间,在随访阶段也要定期进行妇科监测。有序使用人工合成药物可降低接受他莫昔芬治疗的乳腺癌患者罹患子宫内膜癌的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Younger tamoxifen-treated breast cancer patients also had higher risk of endometrial cancer and the risk could be reduced by sequenced aromatase inhibitor use: A population-based study in Taiwan.

Objective: Previous Western studies reported that older (≥50 years) breast cancer survivors with tamoxifen treatment had higher risk of endometrial cancer. This study aims to disclose whether younger (<50 years) tamoxifen-treated breast cancer patients also had higher risk of endometrial cancer and to examine whether sequenced aromatase inhibitor (AI) use could reduce the risk.

Materials and methods: A population-based cohort of 39,216 newly diagnosed breast cancer patients was identified from Taiwan National Health Insurance Database from 1999 to 2012. The risk of endometrial cancer in nonusers (n = 14,588), tamoxifen-only (n = 19,302), and sequenced AI (n = 5326) users was compared with Cox regression analysis and was adjusted with age, diabetes, hypertension, and chemotherapy.

Results: During the 14-year study period, 133 patients were diagnosed with subsequent endometrial cancers. Compared with nonusers, tamoxifen-only users had higher risk of endometrial cancer (14-year incidence 1.7% vs. 0.3%; adjusted hazard ratio [HR] 3.90; 95% confidence interval [CI], 2.37-6.42). This was observed in both older (≥50 years) and younger (40-50 years) age groups. Adjusted HR (95% CI) for the latter was 3.74 (1.65-8.48). This risk persisted after cessation of tamoxifen use. The risk of endometrial cancer was lower in sequenced AI when compared with tamoxifen-only users (adjusted HR 0.43; 95% CI, 0.25-0.72).

Conclusions: Not only patients ≥50 years but also younger (40-49 years) patients with tamoxifen treatment had higher risk of subsequent endometrial cancer in this nation-wide cohort. We suggest regular gynecologic monitoring not only during active use but also during follow-up phase. Sequenced AI use may reduce the risk of endometrial cancer in tamoxifen-treated breast cancer patients.

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