Prognostic Significance of Mammographic Density Change After Initiation of Tamoxifen for ER-Positive Breast Cancer
Prognostic Significance of Mammographic Density Change After Initiation of Tamoxifen for ER-Positive Breast Cancer
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DOI：
10.1093/jnci/dju425
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发表时间：
2015-03-01
影响因子：
10.3
通讯作者：
Gierach, Gretchen L.
中科院分区：
文献类型：
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作者：
Nyante, Sarah J.;Sherman, Mark E.;Gierach, Gretchen L.
背景资料：先前对绝经后乳腺癌患者的分析表明，开始他莫昔芬治疗后乳腺摄影密度（MD）下降与生存率提高有关，但排除了绝经前妇女，因为他莫昔芬是主要的抗内分泌治疗。因此，我们评估了他莫昔芬治疗后MD的变化和32 - 87岁患者乳腺癌死亡率。方法：本病例对照研究包括349例在Kaiser Permanente Northwest接受他莫昔芬治疗的雌激素受体（ER）阳性乳腺癌患者（1990-2008）：97例死于乳腺癌（病例患者），252例未死于乳腺癌（对照患者），在诊断和疾病阶段的年龄和年份上匹配。在基线（他莫昔芬开始治疗前平均6个月）和随访（开始治疗后平均12个月）时测量未受影响乳房的MD百分比。结果：MD下降最高三分位数的患者与最低三分位数的女性相比，其乳腺癌死亡风险较低（比值比[OR] = 0.44，95%置信区间[CI] = 0.22至0.88）;校正基线MD后结果相似（OR = 0.49，95%CI = 0.23 - 1.02）。仅在基线MD的中间和上部三分位数的患者中观察到死亡减少。协会没有不同的年龄，他莫昔芬使用持续时间，雌激素和/或residestin使用，体重指数，或接受化疗或radiotherapy.Conclusion：这些数据表明，年轻和老年ER阳性乳腺癌患者经历大幅度减少MD以下他莫昔芬启动有改善预后。
Background: A prior analysis of postmenopausal breast cancer patients linked a decline in mammographic density (MD) following the initiation of tamoxifen treatment with improved survival, but excluded premenopausal women, for whom tamoxifen is the primary anti-endocrine therapy. Therefore, we evaluated change in MD after tamoxifen and breast cancer death among patients age 32 to 87 years.Methods: This case-control study included 349 estrogen receptor (ER)-positive breast cancer patients who were treated with tamoxifen at Kaiser Permanente Northwest (1990-2008): 97 who died from breast cancer (case patients) and 252 who did not (control patients), matched on age and year at diagnosis and disease stage. Percent MD in the unaffected breast was measured at baseline (mean six months before tamoxifen initiation) and follow-up (mean 12 months after initiation). Associations between change in MD and breast cancer death were estimated using conditional logistic regression.Results: Patients in the highest tertile of MD decline had a lower risk of breast cancer death when compared with women in the lowest tertile (odds ratio [OR] = 0.44, 95% confidence interval [CI] = 0.22 to 0.88); results were similar after adjustment for baseline MD (OR = 0.49, 95% CI = 0.23 to 1.02). Reductions in death were observed only among patients in the middle and upper tertiles of baseline MD. Associations did not differ by age, tamoxifen use duration, estrogen and/or progestin use, body mass index, or receipt of chemotherapy or radiotherapy.Conclusion: These data suggest that younger and older ER-positive breast cancer patients who experience large reductions in MD following tamoxifen initiation have an improved prognosis.