Al-Azemi M, Labib N S, Motawy M M M, Temmim L, Moussa M A A, Omu A E
Department of Obstetrics and Gynecology, Faculty of Medicine, Kuwait University, Kuwait.
Med Princ Pract. 2004 Jan-Feb;13(1):30-4. doi: 10.1159/000074048.
To determine the prevalence of pathologic changes in the endometrium of tamoxifen-treated asymptomatic postmenopausal patients with breast cancer.
Fifty postmenopausal asymptomatic breast cancer patients with positive estrogen receptor status were treated with 20 mg of tamoxifen daily for a period of 5-60 months. The control group consisted of 30 asymptomatic postmenopausal breast cancer patients who were negative for estrogen receptor and therefore did not receive tamoxifen. Endometrial biopsies were performed using Pipelle endometrial suction curette at least 5 months after the study began. The endometrium was classified as atrophic (negative finding) and proliferative or hyperplastic (positive findings). The study and control groups were compared for demographic characteristics, risk factors for endometrial cancer, histological findings and the duration of tamoxifen treatment.
A significantly greater prevalence of endometrial abnormalities existed among the tamoxifen-treated than control patients (76 vs. 33%, p < 0.001). The abnormal endometrial changes were further demarcated in both groups into proliferative (54 vs. 26.7%, p = 0.02) and hyperplastic (22 vs. 6.6%, p = NS). In the study group, 63.6% of hyperplastic endometrium was simple hyperplasia and 36.4% was complex/no atypia hyperplasia, while in the control group all the cases were simple hyperplasia. No endometrial cancer was detected in either group. In addition, there was a positive association between the duration of tamoxifen exposure (<1 year vs. >/=1 year) and the endometrial abnormalities (46.6 vs. 88.6%, p = 0.003; proliferative 57.1 vs. 74.1%, p = 0.015; hyperplastic 42.8 vs. 25.8%, p = NS).
The adjuvant use of tamoxifen is associated with significant time-dependent abnormal endometrial changes among patients with cancer of the breast.
确定他莫昔芬治疗的无症状绝经后乳腺癌患者子宫内膜病理改变的发生率。
50例雌激素受体阳性的绝经后无症状乳腺癌患者，每日服用20mg他莫昔芬，持续5 - 60个月。对照组由30例雌激素受体阴性的无症状绝经后乳腺癌患者组成，因此未接受他莫昔芬治疗。在研究开始至少5个月后，使用Pipelle子宫内膜抽吸刮宫器进行子宫内膜活检。子宫内膜分为萎缩性（阴性结果）和增生性或增生过长性（阳性结果）。比较研究组和对照组的人口统计学特征、子宫内膜癌危险因素、组织学结果以及他莫昔芬治疗时间。
他莫昔芬治疗组的子宫内膜异常发生率显著高于对照组（76%对33%，p < 0.001）。两组的子宫内膜异常变化进一步分为增生性（54%对26.7%，p = 0.02）和增生过长性（22%对6.6%，p = 无显著性差异）。在研究组中，63.6%的增生过长性子宫内膜为单纯性增生，36.4%为复杂性/无异型性增生，而对照组所有病例均为单纯性增生。两组均未检测到子宫内膜癌。此外，他莫昔芬暴露时间（<1年对≥1年）与子宫内膜异常之间存在正相关（46.6%对88.6%，p = 0.003；增生性57.1%对74.1%，p = 0.015；增生过长性42.8%对25.8%，p = 无显著性差异）。
他莫昔芬的辅助使用与乳腺癌患者显著的时间依赖性子宫内膜异常变化有关。
