膽結石與使用Tamoxifen之間的關係


2003 年5月2 日-一項發表於4月號World Journal of Surgery的回顧性群組研究顯示,膽結石與使用Tamoxifen之間有顯著的關係。
  
  土耳其伊斯坦堡Gulhane 軍事醫療學院的Mehmet L. Akin博士表示,儘管tamoxifen 是抗雌激素藥物,它在不同組織有類似雌性激素的活性,雌性激素和膽結石生成之間的關係已為人所知。
  
  在1990和1997年之間,在4家醫院進行蔓延性乳癌治療的3,165名患者,其中的2,462名患者因為追蹤狀況不佳、更年期之前的狀態和其他因素,而從這項研究中排除,703位受試者參與了這項研究,457名患者接受輔助藥物治療,包括tamoxifen,而246名患者並未接受其他治療。
  
  兩個小組的乳癌診斷年齡相似、更年期年齡相似、更年期開始時間和診斷出乳癌、出現糖尿病的時間,以及身體質量指數也相似。平均追蹤時間為4.6年(範圍為1-7年),在這段時間內,患者接受每年的胃腸超音波檢查。
  
  在五年之後,tamoxifen組的膽結石形成發生率為37.4%,未以tamoxifen治療的患者之膽結石發生率為2.0% (P < .0001)。在171 名tamoxifen治療的患者中,累計的膽結石發生率,在第一到第五年分別為0.4%、3.7%、24.4%、33.1%和37.4%。
  
  輔助藥物tamoxifen 療法會導致更年期後的乳癌患者形成膽結石,尤其是在治療3年後。膽結石形成的風險增加與使用較長時間使用激素有關,在第3年結束時,膽結石形成的比例明顯地增加,因此建議患者至少需要3年來監控tamoxifen的影響。

Gallstones Linked to Tamoxifen

By Laurie Barclay, MD
Medscape Medical News

May 2, 2003 — A retrospective cohort study reported in the April issue of the World Journal of Surgery showed a significant association between gallstones and the use of tamoxifen.

"Despite tamoxifen being an antiestrogen drug, it has estrogen-like activity in various tissues of some species," write Mehmet L. Akin, MD, from Gulhane Military Medical Academy in Istanbul, Turkey, and colleagues. "The relation between estrogen exposure and gallstone formation has been well known for a long time."

Of 3,165 patients treated for invasive breast cancer between 1990 and 1997 at four university hospitals, 2,462 were excluded from the study because of improper follow-up, premenopausal status, and other reasons. Of 703 subjects included in the study, 457 had received adjuvant therapy including tamoxifen and 246 had not.

Both groups were similar in terms of age at breast cancer diagnosis, age at menopause, interval between onset of menopause and diagnosis of breast cancer, presence of diabetes, and body mass index. Mean follow-up period was 4.6 years (range, 1-7 years), during which patients received annual abdominal ultrasonography.

After five years, the incidence of gallstone formation was 37.4% in tamoxifen-treated patients compared with 2.0% in patients who did not receive tamoxifen ( P < .0001). In 171 tamoxifen-treated patients, the cumulative incidence of gallstones was 0.4%, 3.7%, 24.4%, 33.1%, and 37.4% during the first, second, third, fourth, and fifth years, respectively.

"Adjuvant tamoxifen therapy leads to gallstone formation in postmenopausal breast cancer patients and is most apparent after 3 years of treatment," the authors write. "The risk of gallstone formation increased with longer duration of hormone use for current postmenopausal patients and with higher doses of estrogen used [in another study]. The apparent increase in gallstone formation at the end of the third year of tamoxifen use underlines the fact that a minimum of 3 years is needed to see the estrogenic effects of tamoxifen."

World J Surg. 2003;27:395-399

Reviewed by Gary D. Vogin, MD

    
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