Assikis V J, Jordan V C
Robert H. Lurie Cancer Center, Northwestern University Medical School, Chicago, IL, USA.
Int J Gynaecol Obstet. 1995 Jun;49(3):241-57. doi: 10.1016/0020-7292(95)02387-r.
Tamoxifen has been used as an adjuvant therapy for breast cancer for nearly two decades. The benefits of adjuvant tamoxifen therapy in prolonging disease-free and overall survival have been shown in randomized clinical trials. Despite this, some developing evidence suggests that tamoxifen causes a 2- to 3-fold increase in endometrial cancer. This paper reviews the reports of endometrial carcinoma in tamoxifen-treated patients. Two hundred fifty cases of endometrial carcinoma are reported, but only one case is identified in a premenopausal woman. When documented, 77% (n=127) of the cases are good-grade (grade 1 or 2) and 80% (n=125) are stage-I disease. Since the distribution of good grade (79%) and stage I (74%) from the Surveillance, Epidemiology and End Results (SEER) data are comparable, concerns about more aggressive or late-stage disease appear to be unwarranted. The modest increase in the incidence of early-stage, good-grade endometrial carcinoma described during tamoxifen therapy suggests that it would be unreasonable to institute an aggressive detection strategy of endometrial biopsies. This approach would only lead to further detection bias and would not be cost-effective. Physicians should ensure that patients do not have pre-existing endometrial cancer prior to adjuvant tamoxifen therapy for breast cancer and, furthermore, they should educate patients about signs and symptoms of early endometrial carcinoma and when reported these should be followed up with a gynecologic examination.
他莫昔芬作为乳腺癌的辅助治疗药物已使用了近二十年。随机临床试验已证实辅助性他莫昔芬治疗在延长无病生存期和总生存期方面具有益处。尽管如此，一些新出现的证据表明，他莫昔芬会使子宫内膜癌的发病率增加2至3倍。本文回顾了接受他莫昔芬治疗患者的子宫内膜癌报告。共报告了250例子宫内膜癌病例，但仅1例发生在绝经前女性。有记录显示，77%（n = 127）的病例为高分化（1级或2级），80%（n = 125）为I期疾病。鉴于监测、流行病学和最终结果（SEER）数据中高分化（79%）和I期（74%）的分布情况相当，对更具侵袭性或晚期疾病的担忧似乎没有依据。他莫昔芬治疗期间所描述的早期、高分化子宫内膜癌发病率的适度增加表明，采取积极的子宫内膜活检检测策略是不合理的。这种方法只会导致进一步的检测偏倚，且不具有成本效益。医生应确保患者在接受乳腺癌辅助性他莫昔芬治疗之前不存在预先存在的子宫内膜癌，此外，他们应告知患者早期子宫内膜癌的体征和症状，一旦报告这些症状，应随后进行妇科检查。
