DeMichele Angela, Troxel Andrea B, Berlin Jesse A, Weber Anita L, Bunin Greta R, Turzo Elene, Schinnar Rita, Burgh Desiree, Berlin Michelle, Rubin Stephen C, Rebbeck Timothy R, Strom Brian L
Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
J Clin Oncol. 2008 Sep 1;26(25):4151-9. doi: 10.1200/JCO.2007.14.0921.
Raloxifene reduces breast cancer risk in women with osteoporosis, and both tamoxifen and raloxifene prevent breast cancer in high-risk women. However, in vitro, raloxifene does not share the pro-estrogenic effects of tamoxifen on the endometrium. Randomized trials of these agents have provided limited information about endometrial cancer risk in the general population. We sought to compare endometrial cancer risks associated with raloxifene, tamoxifen, and nonusers of a selective estrogen receptor modulator (SERM) in the general population and characterize the endometrial tumors occurring in these groups.
We performed a case-control study of white and African American women age 50 to 79 years in the Philadelphia area. Patients were diagnosed with endometrial cancer between July 1999 and June 2002. Controls were identified through random-digit dialing.
We analyzed 547 cases and 1,410 controls. Among cases, 3.3% had taken raloxifene; 6.2% had taken tamoxifen. Among controls, 6.6% had taken raloxifene; 2.4% had taken tamoxifen. After adjustment for other risk factors, the odds of endometrial cancer among raloxifene users was 50% that of nonusers (odds ratio [OR] = 0.50; 95% CI, 0.29 to 0.85), whereas tamoxifen users had three times the odds of developing endometrial cancer compared with raloxifene users (OR = 3.0; 95% CI, 1.3 to 6.9). Endometrial tumors in raloxifene users had a more favorable histologic profile and were predominantly International Federation of Gynecology and Obstetrics stage I and low grade.
Raloxifene users had significantly lower odds of endometrial cancer compared with both tamoxifen users and SERM nonusers, suggesting a role for raloxifene in endometrial cancer prevention and individualization of SERM therapy.
雷洛昔芬可降低骨质疏松症女性患乳腺癌的风险，他莫昔芬和雷洛昔芬均可预防高危女性患乳腺癌。然而，在体外实验中，雷洛昔芬对子宫内膜没有他莫昔芬那种雌激素样作用。这些药物的随机试验提供了关于一般人群子宫内膜癌风险的有限信息。我们试图比较一般人群中雷洛昔芬、他莫昔芬以及未使用选择性雌激素受体调节剂（SERM）者的子宫内膜癌风险，并描述这些组中发生的子宫内膜肿瘤特征。
我们对费城地区50至79岁的白种人和非裔美国女性进行了一项病例对照研究。患者在1999年7月至2002年6月期间被诊断为子宫内膜癌。对照通过随机数字拨号确定。
我们分析了547例病例和1410例对照。在病例中，3.3%曾服用雷洛昔芬；6.2%曾服用他莫昔芬。在对照中，6.6%曾服用雷洛昔芬；2.4%曾服用他莫昔芬。在对其他风险因素进行调整后，雷洛昔芬使用者患子宫内膜癌的几率是未使用者的50%（比值比[OR]=0.50；95%可信区间，0.29至0.85），而他莫昔芬使用者患子宫内膜癌的几率是雷洛昔芬使用者的三倍（OR=3.0；95%可信区间，1.3至6.9）。雷洛昔芬使用者的子宫内膜肿瘤组织学特征更有利，主要为国际妇产科联盟I期且分级低。
与他莫昔芬使用者和未使用SERM者相比，雷洛昔芬使用者患子宫内膜癌的几率显著更低，这表明雷洛昔芬在预防子宫内膜癌及SERM治疗个体化方面有作用。
