Department of Medicine and Oncology, Southern Älvsborg Hospital, 50182, Borås, Sweden; Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden.
Regional Cancer Center Southeast Sweden and Department of Biomedical and Clinical Medicine, Linköping University, Linköping, Sweden.
Breast. 2023 Oct;71:63-68. doi: 10.1016/j.breast.2023.07.010. Epub 2023 Jul 25.
Tamoxifen is an established treatment for breast cancer, but its long-term effects on survival and on secondary cancers are not fully evaluated.
We studied 30 years outcome of 4124 postmenopausal patients who were randomized to receive (totally) two or five years of adjuvant tamoxifen.
After 5 years of follow-up, when tamoxifen treatment was finished in both groups, until 15 years of follow-up, overall mortality (HR 0.80, 95% CI 0.72-0.90, p < 0.001), breast cancer mortality for all patients (HR 0.80, 95% CI 0.68-0.94, p = 0.006) and breast cancer mortality for patients with estrogen receptor positive disease (HR 0.67, 95% CI 0.55-0.83, p < 0.001) were significantly reduced in the five-year group as compared to the two-year group. After 15 years, the difference remained but did not further increase. In the five-year group, the incidence of contralateral breast cancer was gradually reduced during the entire period of observation. The incidence of lung cancer was also reduced in the five-year group. In contrast there was an increased endometrial cancer incidence in the five-year group and for those receiving 40 mg of tamoxifen this incidence was further increased.
Three more years of tamoxifen therapy reduced the risk of breast cancer mortality. The difference was established during the first 15 years after randomization. Moreover, the incidence of contralateral breast cancer gradually decreased for 30 years. The incidence of lung cancer was reduced in the five-year group. In contrast the incidence of endometrial cancer was increased.
他莫昔芬是一种已被确立的乳腺癌治疗药物，但它对生存和继发性癌症的长期影响尚未完全评估。
我们研究了 4124 例绝经后患者的 30 年结局，这些患者被随机分配接受（总）两年或五年的辅助他莫昔芬治疗。
在两组均结束 5 年的随访后（即停止他莫昔芬治疗），直至随访 15 年，全因死亡率（HR 0.80，95%CI 0.72-0.90，p<0.001）、所有患者的乳腺癌死亡率（HR 0.80，95%CI 0.68-0.94，p=0.006）和雌激素受体阳性疾病患者的乳腺癌死亡率（HR 0.67，95%CI 0.55-0.83，p<0.001）在五年组均显著低于两年组。随访 15 年后，这种差异仍然存在，但并未进一步增加。在五年组中，对侧乳腺癌的发生率在整个观察期间逐渐降低。五年组的肺癌发生率也降低了。相反，五年组子宫内膜癌的发生率增加，而接受 40mg 他莫昔芬治疗的患者其子宫内膜癌的发生率进一步增加。
再接受三年的他莫昔芬治疗可降低乳腺癌死亡率的风险。这种差异在随机分组后的头 15 年就已经确立。此外，对侧乳腺癌的发生率在 30 年内逐渐下降。五年组的肺癌发生率降低。相反，子宫内膜癌的发生率增加。
