乳腺癌妇女应用他莫昔芬联合或不联合促性腺激素释放激素类似物对 DXA 值的影响。
Effect of tamoxifen with or without gonadotropin-releasing hormone analog on DXA values in women with breast cancer.
机构信息
Division of Endocrinology and Metabolism, Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital and School of Medicine, Pusan National University, Busan, Republic of Korea.
出版信息
Sci Rep. 2021 Feb 9;11(1):3407. doi: 10.1038/s41598-021-82824-x.
The purpose of this study was to compare the changes in DXA values including trabecular bone score (TBS) and bone mineral density (BMD) of lumbar spine (LS) and femur according to the hormone therapies including tamoxifen (TMXF) treatment with or without gonadotropin releasing hormone analog (GnRH analog) in women with breast cancer. We enrolled 119 women with breast cancer who had undergone breast-conserving surgery or mastectomy followed by TMXF treatment for postmenopausal women (TMXF group, n = 63, 52.9%) or by combination therapy of TMXF combined with GnRH analog for premenopausal women (TMXF + GnRH group, n = 56, 47.1%) from December 2013 to December 2017. The median follow-up period was 13 months (interquartile range [IQR], 12.0-14.75) for TMXF group and 13.5 months (IQR, 12.00-16.00) for TMXF + GnRH group, respectively. Patients did not receive bone-modifying therapy. The baseline dual-energy X-ray absorptiometry (DXA) scan before breast cancer surgery and follow-up DXA during hormone therapy. Comparing the first and follow-up DXA results, BMD in LS were significantly decreased in both TMXF (P < 0.001, mean difference: - 0.06) and TMXF + GnRH (P < 0.001, mean difference: - 0.09) groups. BMD values of femoral neck (P = 0.0011, mean difference: - 0.01) and total femur (P < 0.001, mean difference: - 0.03) was significantly changed between the baseline and follow-up DXA in TMXF + RnRH group. In the TMX group, a significant changed occurred in the BMD in total femur (P < 0.001, mean difference: - 0.030) but not the BMD of femoral neck (P = 0.095, mean difference: - 0.007). Regarding TBS, no significant change was found in the TMXF (P = 0.574, mean difference: - 0.004) group, whereas there was a significant decrease in TBS in the TMXF + GnRH (P < 0.001, mean difference: - 0.02) group during follow-up. TBS is more sensitive in reflecting the bone microarchitecture changes by TMXF or GnRH agonist in breast cancer patients than BMD. This finding demonstrates that TBS can be a useful parameter to detect bone microarchitectural changes in clinical applications.
本研究旨在比较接受他莫昔芬（TMXF）治疗（绝经后女性，TMXF 组，n=63，52.9%；或联合促性腺激素释放激素类似物治疗的绝经前女性，TMXF+GnRH 组，n=56，47.1%）的乳腺癌女性中，根据激素治疗包括他莫昔芬（TMXF）治疗加或不加促性腺激素释放激素类似物（GnRH 类似物），DXA 值（包括骨小梁评分[TBS]和骨密度[BMD]）在腰椎（LS）和股骨的变化。我们招募了 2013 年 12 月至 2017 年 12 月期间接受保乳手术或乳房切除术的 119 例乳腺癌女性，接受 TMXF 治疗的绝经后女性（TMXF 组，n=63，52.9%）或 TMXF 联合 GnRH 类似物联合治疗的绝经前女性（TMXF+GnRH 组，n=56，47.1%）。TMXF 组的中位随访时间为 13 个月（四分位距 [IQR]，12.0-14.75），TMXF+GnRH 组为 13.5 个月（IQR，12.00-16.00）。患者未接受骨修饰治疗。在乳腺癌手术前进行基线双能 X 射线吸收法（DXA）扫描，并在激素治疗期间进行随访 DXA。比较第一次和随访 DXA 结果，TMXF 组（P<0.001，平均差异：-0.06）和 TMXF+GnRH 组（P<0.001，平均差异：-0.09）的 LS 骨密度均显著降低。TMXF+GnRH 组股骨颈（P=0.0011，平均差异：-0.01）和全股骨（P<0.001，平均差异：-0.03）的 BMD 值在基线和随访 DXA 之间有显著变化。在 TMX 组中，全股骨骨密度（P<0.001，平均差异：-0.030）显著变化，但股骨颈骨密度（P=0.095，平均差异：-0.007）无显著变化。关于 TBS，TMXF 组（P=0.574，平均差异：-0.004）无显著变化，而 TMXF+GnRH 组（P<0.001，平均差异：-0.02）在随访期间 TBS 显著降低。TBS 比 BMD 更能敏感地反映乳腺癌患者 TMXF 或 GnRH 激动剂对骨微结构的影响。这一发现表明，TBS 可以成为临床应用中检测骨微结构变化的有用参数。
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