Tai Yi-Jou, Lee Chung-Chen, Chen Yong-Chen, You San-Lin, Chiang Ying-Cheng
Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan.
Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.
Gynecol Oncol Rep. 2025 Apr 5;59:101732. doi: 10.1016/j.gore.2025.101732. eCollection 2025 Jun.
This study aimed to explore the risk factors for metachronous uterine cancer, including age at diagnosis, stage, body mass index (BMI), medical history and tamoxifen treatment in women with breast cancer to enable tailored risk-based gynecological surveillance.
A nationwide population-based cohort study was conducted. Data were retrieved from the Taiwan National Health Insurance Research Database and Taiwan Cancer Registry from 2011 to 2019. The risk of metachronous uterine cancer was analyzed by Cox regression model.
There were 307 patients identified with uterine cancer among 114,906 patients with breast cancer. The incidence was 37.46 cases per 100,000 person-years among tamoxifen non-users (69 cases per 184,207 person-years). Among tamoxifen users (n = 58,227), the incidence rates were 105.52 cases (79 cases per 74,869 person-years) for <1 year of use, 111.62 cases (111 cases per 99,444 person-years) for 1-3 years, 58.19 cases (31 cases per 53,276 person-years) for 3-5 years, and 62.12 cases (17 cases per 27,366 person-years) for ≥5 years. The hazard ratio (HR) for uterine cancer was 3.06 (95 % confidence interval [CI] 2.14-4.39), 3.03 (95 % CI 2.15-4.28), 1.61 (95 % CI 1.01-2.57), and 1.77 (95 % CI 1.00-3.13) for patients on tamoxifen for <1, 1-3, 3-5, and ≥5 years. High BMI (≥25 kg/m) was associated with an increased risk (HR 2.46, 95 % CI 1.07-5.64). Abnormal uterine bleeding was a significant predictor regardless of the clinical or sonographic diagnosis of endometrial lesions.
Routine ultrasound is not recommended for the detection of metachronous uterine cancer, and gynecologic investigations should focus on breast cancer patients with high BMI, tamoxifen use, and abnormal uterine bleeding.
本研究旨在探讨异时性子宫癌的危险因素，包括确诊年龄、分期、体重指数（BMI）、病史以及乳腺癌患者的他莫昔芬治疗情况，以便进行基于风险的个性化妇科监测。
开展了一项全国性的基于人群的队列研究。数据取自2011年至2019年的台湾全民健康保险研究数据库和台湾癌症登记处。采用Cox回归模型分析异时性子宫癌的风险。
在114,906例乳腺癌患者中，有307例被确诊患有子宫癌。在未使用他莫昔芬的患者中，发病率为每100,000人年37.46例（每184,207人年69例）。在使用他莫昔芬的患者中（n = 58,227），使用时间<1年的发病率为105.52例（每74,869人年79例），1 - 3年的发病率为111.62例（每99,444人年111例），3 - 5年的发病率为58.19例（每53,276人年31例），≥5年的发病率为62.12例（每27,366人年17例）。使用他莫昔芬<1年、1 - 3年、3 - 5年和≥5年的患者患子宫癌的风险比（HR）分别为3.06（95%置信区间[CI] 2.14 - 4.39）、3.03（95% CI 2.15 - 4.28）、1.61（95% CI 1.01 - 2.57）和1.77（95% CI 1.00 - 3.13）。高BMI（≥25 kg/m²）与风险增加相关（HR 2.46，95% CI 1.07 - 5.64）。无论子宫内膜病变的临床诊断或超声诊断如何，异常子宫出血都是一个重要的预测指标。
不建议采用常规超声检测异时性子宫癌，妇科检查应关注BMI高、使用他莫昔芬以及有异常子宫出血的乳腺癌患者。
