Adjuvant tamoxifen-induced mammographic breast density reduction as a predictor for recurrence in estrogen receptor-positive premenopausal breast cancer patients
Adjuvant tamoxifen-induced mammographic breast density reduction as a predictor for recurrence in estrogen receptor-positive premenopausal breast cancer patients
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DOI：
10.1007/s10549-013-2726-4
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发表时间：
2013-12-01
影响因子：
3.8
通讯作者：
Lee, Eun Sook
中科院分区：
文献类型：
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作者：
Ko, Kyung Lan;Shin, In Suk;Lee, Eun Sook
众所周知，他莫昔芬可以降低高危女性患乳腺癌的风险，并在预防性环境中降低乳房 X 光检查乳腺密度 (MD)。我们研究了 MD 减少 (MDR) 在辅助治疗中预测雌激素受体 (ER) 阳性患者复发的功效。 2003 年 1 月至 2008 年 12 月期间，共有 1,066 名 ER 阳性乳腺癌患者在我们的机构接受了治愈性手术并接受了他莫昔芬辅助治疗至少 2 年。一名放射科医生使用计算机系统审查了所有乳房 X 光检查，并根据乳房成像报告和数据系统对 MD 模式进行了分类。使用手术前（preMD）拍摄的基线乳房X光照片和开始辅助他莫昔芬后拍摄的后续乳房X光照片（postMD）评估MDR。 MDR阳性被定义为MD后等级的降级，以MD前等级作为参考。将患者分为MDR阳性和MDR阴性2组进行统计分析。在平均 19 个月的他莫昔芬辅助治疗后出现 MDR 的患者，其复发风险比未出现 MDR 的患者低 65%。此外，根据 MDR 的显着风险降低对任何类型的复发模式都有预测能力，包括 ER 阳性乳腺癌患者的局部区域复发（减少 87%）和全身复发（减少 52%），特别是对于 50 岁以下的女性。在我们的研究中，只有 4 名患者 (0.4%) 在平均 61 个月的随访期内出现对侧乳房复发，并且没有一人经历过 MDR。总之，他莫昔芬辅助治疗期间的 MDR 与 ER 阳性乳腺癌患者（尤其是年轻女性）较低的全身和局部区域复发风险独立相关。对于经过大约 1.5 年他莫昔芬治疗后未出现 MDR 的患者，应更加谨慎，并需要采取其他治疗策略。
Tamoxifen is known to reduce the risk of breast cancer in women at high risk and also reduces mammographic breast density (MD) in a preventive setting. We investigated the efficacy of MD reduction (MDR) for predicting recurrence in estrogen receptor (ER)-positive patients in an adjuvant setting. A total of 1,066 ER-positive breast cancer patients who were enrolled in this study underwent curative surgery and received adjuvant tamoxifen for at least 2 years at our institution between January 2003 and December 2008. Using a computerized system, a single radiologist reviewed all mammograms and classified MD patterns on the basis of the Breast Imaging Reporting and Data System. MDR was assessed using the baseline mammogram taken before surgery (preMD) and the follow-up mammogram taken after the start of adjuvant tamoxifen (postMD). MDR positivity was defined as downgrading of the postMD grade, with the preMD grade as a reference. Patients were divided into 2 groups, MDR-positive and MDR-negative, for statistical analysis. Patients who showed MDR after an average of 19 months of adjuvant tamoxifen treatment had a 65 % lower risk of recurrence than patients who did not show MDR. Furthermore, significant risk reduction according to MDR had a predictive power for any type of recurrence pattern including loco-regional recurrence (87 % reduction) and systemic recurrence (52 % reduction) in ER-positive breast cancer patients, especially in women a parts per thousand currency sign50 years. In our study, only 4 patients (0.4 %) showed contralateral breast recurrence during the mean 61-month follow-up period and none of them experienced MDR. In conclusion, MDR during adjuvant tamoxifen therapy was independently associated with a lower risk of systemic and loco-regional recurrence in ER-positive breast cancer patients, especially in young women. For patients who do not experience MDR after approximately 1.5 years of tamoxifen therapy, more caution should be taken and other treatment strategies are warranted.