Androgens and musculoskeletal symptoms among breast cancer patients on aromatase inhibitor therapy
Androgens and musculoskeletal symptoms among breast cancer patients on aromatase inhibitor therapy
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DOI：
10.1007/s10549-011-1611-2
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发表时间：
2011-11-01
影响因子：
3.8
通讯作者：
Helzlsouer, Kathy J.
中科院分区：
文献类型：
--
作者：
Gallicchio, Lisa;MacDonald, Ryan;Helzlsouer, Kathy J.
芳香酶抑制剂（AI）是绝经后雌激素受体阳性乳腺癌的首选辅助激素治疗，与肌肉骨骼症状的风险增加有关。这些症状的根本原因通常是雌激素耗尽，但所有接受 AI 治疗的女性雌激素水平都很低，只有一小部分人会出现症状。循环雄激素的浓度可能是导致这些副作用的中介因素。本研究的目的是检查开始 AI 治疗的女性雄激素浓度的变化，并确定雄激素浓度是否与肌肉骨骼症状相关。数据分析来自一项对 74 名计划接受 AI 治疗的乳腺癌患者进行的队列研究。在 AI 治疗前（基线）收集症状问卷数据并抽血，然后在基线后 3 个月和 6 个月再次抽血。检测血液中的睾酮、雄烯二酮、硫酸脱氢表雄酮 (DHEAS) 和性激素结合球蛋白 (SHBG)。使用睾酮和性激素结合球蛋白 (SHBG) 测量值计算游离睾酮指数 (FTI) 值。结果显示，所有雄激素的浓度在研究期间均有所增加，与 3 个月和 6 个月时的 FTI 以及 6 个月时的 DHEAS 观察到的基线浓度相比，存在统计学显着差异。此外，与在研究期间所有时间点都没有疼痛或疼痛没有恶化的患者相比，在研究期间新发疼痛或疼痛恶化的乳腺癌患者，从基线到 3 个月的平均 DHEAS 浓度变化显着较小（P = 0.04），从基线到 6 个月的平均 DHEAS 浓度变化也略有较小（P = 0.1）。研究期间睾酮、雄烯二酮和 FTI 的变化与疼痛的发作或恶化无关。这项研究的结果表明，较高的 DHEAS 浓度与较少的 AI 相关疼痛有关，应该进一步研究。
Aromatase inhibitors (AIs), the adjuvant hormonal treatment of choice for postmenopausal estrogen receptor-positive breast cancer, are associated with an increased risk of musculoskeletal symptoms. The underlying cause of the symptoms is often attributed to estrogen depletion, yet all women treated with AIs have low estrogen levels and only a subset develop symptoms. Concentrations of circulating androgens may be mediating factors contributing to these side effects. The purpose of this study was to examine changes in androgen concentrations among women initiating AI therapy and to determine if concentrations are associated with musculoskeletal symptoms. Data were analyzed from a cohort study of 74 breast cancer patients for whom AI therapy was planned. Questionnaire data on symptoms were collected and blood was drawn prior to AI therapy (baseline) and then again at 3 and 6 months after baseline. Blood was assayed for testosterone, androstenedione, dehydroepiandrosterone-sulfate (DHEAS), and sex hormone-binding globulin (SHBG). Free testosterone index (FTI) values were calculated using testosterone and SHBG measurements. The results showed that concentrations of all of the androgens increased over the study period, with statistically significant differences from baseline concentrations observed for the FTI at 3 and 6 months and for DHEAS at 6 months. Additionally, breast cancer patients with new onset or worsening of pain over the study period had a significantly smaller change in mean DHEAS concentration from baseline to 3 months (P = 0.04) and a marginally significant smaller change in mean DHEAS concentration from baseline to 6 months (P = 0.1) compared to those who reported no pain at all time points or no worsening of pain across the study period. Changes in testosterone, androstenedione, and the FTI were not associated with the onset or worsening of pain during the study period. Findings from this study suggest that higher DHEAS concentrations are associated with less AI-associated pain and should be further investigated.