Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles, 2nd Floor, Pasadena, CA, 91101, USA.
City of Hope, 1500 E. Duarte Rd., Duarte, CA, 91010, USA.
Breast Cancer Res Treat. 2019 Apr;174(3):785-794. doi: 10.1007/s10549-018-05086-8. Epub 2019 Jan 18.
Venous thromboembolism (VTE) is the second most common cause of death in hospitalized patients with cancer, and cancer treatments may exacerbate VTE risk. Patients with hormone-receptor-positive breast cancer usually receive adjuvant endocrine therapy for 5 years or longer. The aim of this study is to examine VTE risk following long-term use of aromatase inhibitor (AI) compared with tamoxifen use among breast cancer survivors.
A prospective cohort of 12,904 postmenopausal women who were diagnosed with a first primary hormone-receptor-positive breast cancer and free from previous cardiovascular disease or VTE from 1991 to 2010 were followed through December 2011. Data elements were captured from the comprehensive electronic health records of a large California health plan, Kaiser Permanente. Women who developed deep vein thrombosis (DVT) or pulmonary embolism (PE) were identified as having VTE. We calculated person-year rates of VTE by endocrine therapy groups. Multivariable Cox proportional hazards models were applied to assess the association between time-dependent endocrine therapy and VTE risk.
We identified 623 VTE events during a median follow-up of 5.4 years. The crude rates were 4.6 and 2.8 per 1000 person-years for DVT and PE, respectively. Compared with tamoxifen use, AI use was associated with at least 41% lower VTE risk (adjusted HR 0.59, 95% CI 0.43, 0.81). Greater risk reductions in AI users were seen in women who also underwent adjuvant chemotherapy.
These findings supplement existing evidence to inform treatment decisions that balance cancer control and cardiovascular toxic outcomes.
静脉血栓栓塞症（VTE）是住院癌症患者的第二大常见死因，癌症治疗可能会加剧 VTE 风险。激素受体阳性乳腺癌患者通常需要接受辅助内分泌治疗 5 年或更长时间。本研究旨在比较长期使用芳香化酶抑制剂（AI）与乳腺癌幸存者使用他莫昔芬后 VTE 的风险。
对 1991 年至 2010 年间诊断出的首发性激素受体阳性乳腺癌且无既往心血管疾病或 VTE 的 12904 名绝经后妇女进行前瞻性队列研究，随访至 2011 年 12 月。数据元素来自加利福尼亚州一家大型健康计划 Kaiser Permanente 的综合电子健康记录中获取。患有深静脉血栓形成（DVT）或肺栓塞（PE）的妇女被确定为患有 VTE。我们按内分泌治疗组计算 VTE 的人年发生率。多变量 Cox 比例风险模型用于评估时间依赖性内分泌治疗与 VTE 风险之间的关系。
在中位数为 5.4 年的随访中，我们共发现 623 例 VTE 事件。DVT 和 PE 的粗发生率分别为 4.6 和 2.8/1000 人年。与使用他莫昔芬相比，使用 AI 与至少 41%的 VTE 风险降低相关（调整后的 HR 0.59，95%CI 0.43，0.81）。在接受辅助化疗的女性中，AI 使用者的风险降低幅度更大。
这些发现补充了现有证据，为平衡癌症控制和心血管毒性结果的治疗决策提供了信息。
