Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Department of Oncology Surgey, Wenzhou People's Hospital, Wenzhou, Zhejiang, China.
BMC Cancer. 2021 Jul 10;21(1):798. doi: 10.1186/s12885-021-08538-5.
Tamoxifen (TAM) and Toremifene (TOR), two kinds of selective estrogen receptor modulators (SERMs), have equal efficacy in breast cancer patients. However, TAM has been proved to affect serum lipid profiles and cause fatty liver disease. The study aimed to compare the effects of TAM and TOR on fatty liver development and lipid profiles.
This study performed a retrospective analysis of 308 SERMs-treated early breast cancer patients who were matched 1:1 based on propensity scores. The follow-up period was 3 years. The primary outcomes were fatty liver detected by ultrasonography or computed tomography (CT), variation in fibrosis indexes, and serum lipid profiles change.
The cumulative incidence rate of new-onset fatty liver was higher in the TAM group than in the TOR group (113.2 vs. 67.2 per 1000 person-years, p < 0.001), and more severe fatty livers occurred in the TAM group (25.5 vs. 7.5 per 1000 person-years, p = 0.003). According to the Kaplan-Meier curves, TAM significantly increased the risk of new-onset fatty liver (25.97% vs. 17.53%, p = 0.0243) and the severe fatty liver (5.84% vs. 1.95%, p = 0.0429). TOR decreased the risk of new-onset fatty liver by 45% (hazard ratio = 0.55, p = 0.020) and showed lower fibrotic burden, independent of obesity, lipid, and liver enzyme levels. TOR increased triglycerides less than TAM, and TOR increased high-density lipoprotein cholesterol, while TAM did the opposite. No significant differences in total cholesterol and low-density lipoprotein cholesterol are observed between the two groups.
TAM treatment is significantly associated with more severe fatty liver disease and liver fibrosis, while TOR is associated with an overall improvement in lipid profiles, which supports continuous monitoring of liver imaging and serum lipid levels during SERM treatment.
他莫昔芬（TAM）和托瑞米芬（TOR）是两种选择性雌激素受体调节剂（SERMs），在乳腺癌患者中的疗效相当。然而，TAM 已被证明会影响血清脂质谱并导致脂肪肝疾病。本研究旨在比较 TAM 和 TOR 对脂肪肝发展和脂质谱的影响。
本研究对 308 例接受 SERMs 治疗的早期乳腺癌患者进行了回顾性分析，这些患者基于倾向评分进行了 1:1 匹配。随访时间为 3 年。主要结局是通过超声或计算机断层扫描（CT）检测到的脂肪肝、纤维化指标的变化以及血清脂质谱的变化。
TAM 组新发脂肪肝的累积发生率高于 TOR 组（113.2 比 67.2 例/1000 人年，p<0.001），且 TAM 组更易发生严重脂肪肝（25.5 比 7.5 例/1000 人年，p=0.003）。根据 Kaplan-Meier 曲线，TAM 显著增加了新发脂肪肝的风险（25.97%比 17.53%，p=0.0243）和严重脂肪肝的风险（5.84%比 1.95%，p=0.0429）。TOR 使新发脂肪肝的风险降低了 45%（风险比=0.55，p=0.020），且与肥胖、脂质和肝酶水平无关，表现出较低的纤维化负担。与 TAM 相比，TOR 降低了甘油三酯，增加了高密度脂蛋白胆固醇，而 TAM 则相反。两组间总胆固醇和低密度脂蛋白胆固醇无显著差异。
TAM 治疗与更严重的脂肪肝疾病和肝纤维化显著相关，而 TOR 与整体脂质谱改善相关，这支持在 SERM 治疗期间持续监测肝脏成像和血清脂质水平。
