Li Y C, Deng Z X, Wang Y J, Xu T, Sun Q, Shen S J
Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences & School of Basic Medicine, Beijing 100730, China.
Zhonghua Wai Ke Za Zhi. 2023 Feb 1;61(2):107-113. doi: 10.3760/cma.j.cn112139-20220925-00405.
To compare the effect of different endocrine therapy drugs on liver function in patients with early breast cancer. A retrospective cohort study was conducted to include 4 318 patients with early breast cancer who received adjuvant endocrine therapy in Department of Breast Surgery, Peking Union Medical College Hospital from January 1, 2013 to December 31, 2021. All the patients were female, aged (51.2±11.3) years (range: 20 to 87 years), including 1 182 patients in the anastrozole group, 592 patients in the letrozole group, 332 patients in the exemestane group, and 2 212 patients in the toremifene group. The mixed effect model was used to analyze and compare the liver function levels of patients at baseline, 6, 12, 18, 24, 36, 48, 60 months of medication, and 1 year after drug withdrawal among the three aromatase inhibitors (anastrozole, letrozole, exemestane) and toremifene. ALT and AST of the 4 groups were significantly higher than the baseline level at 6 months (all <0.01), and there were no significant differences in total bilirubin, direct bilirubin and AST levels among all groups one year after drug withdrawal ( 0.538, 0.718, 0.061, respectively). There was no significant difference in the effect of all groups on AST levels (=2.474, =0.061), and in the effect of three aromatase inhibitors (anastrozole, letrozole, and exemestane) on ALT levels (anastrozole letrozole, =0.182; anastrozole exemestane, =0.535; letrozole exemestane, =0.862). Anastrozole and letrozole had significantly higher effects on ALT levels than toremifene (<0.01, =0.009). The proportion of abnormal liver function in each group increased significantly at 6 months compared with baseline, and then the proportion showed a decreasing trend over time. Three aromatase inhibitors (anastrozole, letrozole, and exemestane) and toremifene can significantly increase the level of ALT and AST in patients with breast cancer, and the levels can gradually recover to the baseline after 1 year of drug withdrawal. The effect of non-steroidal aromatase inhibitors (anastrozole, letrozole) on ALT levels is greater than toremifene.
比较不同内分泌治疗药物对早期乳腺癌患者肝功能的影响。进行一项回顾性队列研究，纳入2013年1月1日至2021年12月31日在北京协和医院乳腺外科接受辅助内分泌治疗的4318例早期乳腺癌患者。所有患者均为女性，年龄（51.2±11.3）岁（范围：20至87岁），其中阿那曲唑组1182例，来曲唑组592例，依西美坦组332例，托瑞米芬组2212例。采用混合效应模型分析和比较三种芳香化酶抑制剂（阿那曲唑、来曲唑、依西美坦）和托瑞米芬在用药基线、用药6、12、18、24、36、48、60个月及停药1年后患者的肝功能水平。4组患者的谷丙转氨酶（ALT）和谷草转氨酶（AST）在用药6个月时均显著高于基线水平（均P<0.01），停药1年后各组总胆红素、直接胆红素和AST水平差异均无统计学意义（分别为P=0.538、P=0.718、P=0.061）。各组对AST水平的影响差异无统计学意义（F=2.474，P=0.061），三种芳香化酶抑制剂（阿那曲唑、来曲唑、依西美坦）对ALT水平的影响差异也无统计学意义（阿那曲唑与来曲唑，P=0.182；阿那曲唑与依西美坦，P=0.535；来曲唑与依西美坦，P=0.862）。阿那曲唑和来曲唑对ALT水平的影响显著高于托瑞米芬（P<0.01，P=0.009）。与基线相比，各组肝功能异常比例在用药6个月时显著增加，之后随时间呈下降趋势。三种芳香化酶抑制剂（阿那曲唑、来曲唑、依西美坦）和托瑞米芬均可显著升高乳腺癌患者的ALT和AST水平，停药1年后水平可逐渐恢复至基线。非甾体类芳香化酶抑制剂（阿那曲唑、来曲唑）对ALT水平的影响大于托瑞米芬。
