Vehmanen Leena, Elomaa Inkeri, Blomqvist Carl, Saarto Tiina
Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland.
J Clin Oncol. 2006 Feb 1;24(4):675-80. doi: 10.1200/JCO.2005.02.3515.
Adjuvant chemotherapy followed by tamoxifen is a standard treatment option for women with intermediate or high-risk hormone receptor-positive breast cancer. Premenopausal women treated with chemotherapy often develop early menopause and thus, enter a period of accelerated bone loss. We conducted a prospective study of the effect of sequential adjuvant therapy with chemotherapy followed by tamoxifen on bone mineral density (BMD) in premenopausal patients.
One hundred eleven premenopausal women with early breast cancer were treated with adjuvant chemotherapy. Patients with hormone receptor-positive tumors went on to tamoxifen 6 months after the beginning of the chemotherapy (tamoxifen group), while those with hormone receptor-negative tumors received no further therapy (control group). The effect of tamoxifen and menstrual status on BMD was studied.
Tamoxifen treatment and menopausal status correlated significantly with the changes in lumbar spine BMD (P < .0001). A significant bone loss was noted in those tamoxifen-treated patients who continued to menstruate after chemotherapy. At 3 years of follow-up, menstruating patients on tamoxifen had lost -4.6% of their baseline BMD values, while a modest gain of +0.6% was noted in the control group. In contrast, bone loss was reduced among tamoxifen-treated women as compared with controls in patients who developed chemotherapy-induced early menopause. In amenorrheic patients, the lumbar spine BMD values decreased -6.8% in tamoxifen users and -9.5% in the controls, respectively.
We conclude that tamoxifen usage was associated with bone loss in patients who continued to menstruate after adjuvant chemotherapy. On the contrary, tamoxifen decreased bone loss in those women who developed chemotherapy-induced amenorrhea.
辅助化疗后使用他莫昔芬是激素受体阳性的中高危乳腺癌女性的标准治疗方案。接受化疗的绝经前女性常出现过早绝经，从而进入骨量加速流失期。我们开展了一项前瞻性研究，以探讨序贯辅助化疗后使用他莫昔芬对绝经前患者骨密度（BMD）的影响。
111例绝经前早期乳腺癌女性接受辅助化疗。激素受体阳性肿瘤患者在化疗开始6个月后继续使用他莫昔芬（他莫昔芬组），而激素受体阴性肿瘤患者不再接受进一步治疗（对照组）。研究了他莫昔芬和月经状态对骨密度的影响。
他莫昔芬治疗和绝经状态与腰椎骨密度变化显著相关（P <.0001）。在化疗后仍继续月经的他莫昔芬治疗患者中观察到显著的骨量流失。在3年随访时，使用他莫昔芬的月经患者骨密度较基线值下降了4.6%，而对照组有适度增加，为0.6%。相比之下，与对照组相比，化疗导致过早绝经的他莫昔芬治疗女性骨量流失减少。在闭经患者中，使用他莫昔芬的患者腰椎骨密度值分别下降了6.8%，对照组下降了9.5%。
我们得出结论，辅助化疗后仍继续月经的患者使用他莫昔芬与骨量流失有关。相反，他莫昔芬减少了化疗导致闭经的女性的骨量流失。
