Department of Breast Surgery, The Affiliated Tumor Hospital of Harbin Medical University, 150 Haping Road, Harbin 150040, China.
Breast Cancer Res Treat. 2012 Nov;136(2):495-502. doi: 10.1007/s10549-012-2286-z. Epub 2012 Oct 12.
Recent studies have revealed that many, perhaps most women with hormone-responsive breast cancer have low adherence to tamoxifen adjuvant hormonal therapy. However, limited data are available on tamoxifen adherence in male breast cancer (MBC) patients. The goal of this study was to assess tamoxifen adherence and its relationship to mortality in MBC patients. A cohort of 116 men who were diagnosed with receptor-positive breast cancer between June 1987 and July 2012 was recruited for the study using the cancer prevention and treatment system database of Heilongjiang Province. From the 116 patients who received a five-year tamoxifen prescription, only 64.6 % were still taking their medication 1 year later, and this percentage decreased to 46.4 and 28.7 % after 2 and 3 years, respectively, to 25.8 % after 4 years, and to 17.7 % in the last year. After multivariate adjustment, factors that significantly decreased tamoxifen adherence were low social support [Hazard ratio (HR) = 2.45, 95 % CI 1.32-4.55], age (HR = 1.10, 95 % CI 1.01-1.21), and adverse effects (HR = 2.19, 95 % CI 1.57-3.04). The primary endpoints in the adherence or low-adherence groups from this study were overall survival (OS) and disease-free survival (DFS) of the MBC patients. The five- and ten-year OS of the patients was 97.9 and 79.6 %, respectively, in the adherence group, and 84.7 and 50.4 %, respectively, in the low-adherence group (p = 0.008). The five- and ten-year DFS of the patients was 95.4 and 72.8 %, respectively, in the adherence group, and 72.6 and 42.3 %, respectively, in the low-adherence group (p = 0.007). The consequences of low treatment adherence in men, who have a potentially long life expectancy, may be significant. In light of these findings, there is an urgent need to acknowledge and tackle the issue of tamoxifen adherence in this patient group.
最近的研究表明，许多（也许是大多数）激素反应性乳腺癌女性对他莫昔芬辅助激素治疗的依从性较低。然而，关于男性乳腺癌（MBC）患者他莫昔芬依从性的数据有限。本研究的目的是评估 MBC 患者他莫昔芬的依从性及其与死亡率的关系。
通过黑龙江省癌症预防和治疗系统数据库，招募了 1987 年 6 月至 2012 年 7 月期间诊断为受体阳性乳腺癌的 116 名男性患者进行研究。在接受五年他莫昔芬处方的 116 名患者中，仅有 64.6%的患者在 1 年后仍在服药，这一比例在 2 年和 3 年后分别下降至 46.4%和 28.7%，在 4 年后降至 25.8%，在最后一年降至 17.7%。
经过多变量调整，显著降低他莫昔芬依从性的因素包括低社会支持（风险比[HR] = 2.45，95%置信区间[CI] 1.32-4.55）、年龄（HR = 1.10，95%CI 1.01-1.21）和不良反应（HR = 2.19，95%CI 1.57-3.04）。
本研究中，在依从性或低依从性组中，MBC 患者的主要终点是总生存（OS）和无病生存（DFS）。在依从性组中，患者的 5 年和 10 年 OS 分别为 97.9%和 79.6%，而在低依从性组中分别为 84.7%和 50.4%（p = 0.008）。在依从性组中，患者的 5 年和 10 年 DFS 分别为 95.4%和 72.8%，而在低依从性组中分别为 72.6%和 42.3%（p = 0.007）。
在预期寿命较长的男性中，治疗依从性低的后果可能是重大的。鉴于这些发现，迫切需要承认并解决这一患者群体中他莫昔芬依从性的问题。
