From the Department of Radiation Oncology, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.
Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
QJM. 2016 Feb;109(2):103-9. doi: 10.1093/qjmed/hcv072. Epub 2015 Apr 7.
To assess the possible association between tamoxifen treatment and the subsequent risk of dementia in patients with breast cancer, a population-based cohort study was conducted using the Taiwanese National Health Insurance Research Database.
The study cohort contained 24 197 patients diagnosed with breast cancer between 1 January 2000 and 31 December 2004. Among them, 16 556 cases received tamoxifen treatment and 7641 did not. Four women without breast cancer were frequency matched to each case by age and index-year as the cancer-free group. The outcome of the analysis of is dementia. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariate Cox proportional hazards regression models.
Patients with breast cancer exhibited a similar risk of developing dementia (adjusted HR = 0.95, 95% CI = 0.86-1.04) compared with the cancer-free group. In addition, among women diagnosed with breast cancer, tamoxifen users exhibited a significant 17% lower risk of dementia compared with those not using tamoxifen (adjusted HR = 0.83, 95% CI = 0.69-0.98), but the significant difference was limited to 5 years or more use (adjusted HR = 0.47, 95% CI = 0.32-0.69). Both tamoxifen and aromatase inhibitor use had a joint effect, with a significantly lower risk of dementia among patients.
The results of this population-based cohort study suggest that long-term use of tamoxifen in patients with breast cancer is associated with a lower risk of dementia.
为了评估他莫昔芬治疗与乳腺癌患者随后发生痴呆风险之间的可能关联，采用台湾全民健康保险研究数据库进行了一项基于人群的队列研究。
研究队列包含 24197 例于 2000 年 1 月 1 日至 2004 年 12 月 31 日期间诊断患有乳腺癌的患者。其中，16556 例接受了他莫昔芬治疗，7641 例未接受。为每个病例按年龄和索引年与无癌症的女性进行频数匹配，共匹配了 4 名女性作为对照组。分析的结局为痴呆。使用多变量 Cox 比例风险回归模型估计风险比（HR）和 95%置信区间（CI）。
与无癌症组相比，患有乳腺癌的患者发生痴呆的风险相似（调整后的 HR=0.95，95%CI=0.86-1.04）。此外，在诊断患有乳腺癌的女性中，与未使用他莫昔芬的患者相比，使用他莫昔芬的患者痴呆风险显著降低 17%（调整后的 HR=0.83，95%CI=0.69-0.98），但这种显著差异仅限于使用 5 年或更长时间（调整后的 HR=0.47，95%CI=0.32-0.69）。他莫昔芬和芳香化酶抑制剂的使用均具有联合效应，患者的痴呆风险显著降低。
这项基于人群的队列研究结果表明，长期使用他莫昔芬治疗乳腺癌患者与痴呆风险降低相关。
