Pathologic And Related Factors Analysis Of Endometrial Lesion Of 82 Cases Breast Cancer Patients After Tamoxifen Taken

Breast and endometrial cancer were considered to be hormone-dependent tumors, the incidence of endometrial cancer are currently related to high endogenous or exogenous estrogen. Tamoxifen has anti-estrogen effect, it is used for adjuvant endocrine therapy in breast cancer patients. In conditions of low estrogen, TAM have weak estrogen-like effect, led to the endometrial hyperplasia by long-term usage. Cohen, etc.[1]studies 164 cases of postmenopausal women who took TAM, 20.7% had endometrial lesions, which related to TAM taking time, when the time> 48 months, 30.8% patiens had endometrial lesions.Normal breast epithelial cells contain a variety of hormone receptor,such as estrogen receptor (ER),progesterone receptor (PR),androgen receptor(AR),etc.The growth and development of mammary gland depend on various hormones harmonious action,when breast cancer occurs,some can keep all or part of the hormone receptors,and has a certain function,its growth and development by hormone environment influence,namely for hormone-dependent tumors[2-3].As a hormone-dependent breast cancer,its treatment in addition to surgery,chemotherapy,radiation therapy,the endocrine therapy has become an indispensable part.Tamoxifen is a kind of endocrine therapy medicine of breast cancer patients since 1980s.At present,tamoxifen is still estrogen or/and progestational hormone receptor-positive breast cancer patients who underwent the endocrine therapy for the first-line treatment after 20 years of scientific research and clinical curative effect observation.The surgeon suggest that estrogen or/and progestational hormone receptor-positive breast cancer patients who underwent the prescribed tamoxifen 3-5 years,to prevent breast cancer recurrence and metastasis.TAM is a nonsteroidal selective estrogen receptor antagonist,a kind of three styrene derivatives, tamoxifen is a selective estrogen receptor modulators,which has double function,when the estrogen level rises performance for estrogen inhibition,conversely,it is behaved for weak estrogen-like effects.Because of the latter effects, some pathological changes occurred on TAM-taken patients' endometrial,cervix, vaginal,ovarian etc, especially on endometrial.Objective:To analysis the endometrium pathological changes and related factors of breast cancer patients after tamoxifen taken,analysis and evaluation the effects on endometrial,and provide a theoretical basis for endometrial cancer caused by tamoxifen.Method:82 postoperative breast cancer patients of TAM taken and were admitted to gynecologic ward of Hebei Medical University Forth Hospital from July 1, 2008 to October 31,2009 due to their pelvic problems were studied retrospectively.Establish the clinical material database,and the patients were followed up (outpatient review,telephone follow-up combining the complaint) until December 31, 2010. By the time patients start taking tamoxifen as a starting point, to patient death, or last follow-up lost time for the end of study outcomes for death. During this period, live or loss to be as censored value.Use SPSS13.0 for statistics.Measurement data using non-parameter test (Mann - Whitney U inspection),counting material using a Chi-square test (χ2 test) and Fisher exact test,and the correlation study using Logistic regression statistics method. Test results are statistically significant (p < 0.05).Results:Overall cases 82 cases, follow-up 74 cases(90.24%),lost to follow-up 4 cases (4,88%),death 4 cases (4.88%),causes of death are multiple metastases after operation. Premenopausal patients 42 cases,postmenopausal patients 32 cases of 74 patients.The cases are analyzed,and the results are as follows:1 The related endometrial pathology results after tamoxifen taken: in the premenopausal group,twenty-six (26/42,61.90%) patients had endometrial lesion such as endometrial polyps,polypoid hyperplasia,muscular tumor/adenomyoma,atypical hyperplasia and endometrioid carcinoma,while 28 cases (28/32,87.50%) in menopausal group.Both in premenopausal group and menopausal group have endometrial cancer and pre-cancerous cases,3 cases (3/42,7.14%,atypical hyperplasia 1case,endometrioid carcinoma 2 cases) occurred in premenopausal group,while 10 cases (10/32,31.25%,atypical hyperplasia 3 cases,endometrioid carcinoma 7 cases ) in menopausal group.2 The further treatment according to the endometrial pathologic findings:9(9/74,12.16 %)endometrial cancer patients were performed fascia outside all hysterectomy,double annex resection,pelvic lymph node enucleations.The results are that endometrial adenocarcinoma periodⅠA 2 cases,endometrial moderately differentiated adenocarcinoma periodⅠB 3 cases,endometrial high-moderately differentiated adenocarcinoma periodⅡA 1 case,endometrial adenocarcinoma with papillary differentiation periodⅠA 2 cases and endometrial squamous cell carcinoma with moderately-low differentiation periodⅠA 1 case,based on the FIGO 2000 endometrial cancer staging surgery-pathology diagnosis criteria for diagnosis. From the pathological point of view, the higher incidence of endometrial adenocarcinoma, of which 6 cases of endometrial adenocarcinoma (6/9, 66.67%), endometrial adenocarcinoma with papillary differentiation in 2 cases (2/9, 22.22%), endometrial carcinoma in 1 case (1/ 9, 11.11%). StagingⅠA period were 5 cases (5/9,55.56%),ⅠB period in 3 patients (3/ 9,33.33%),ⅡA period in 1 case (1/9,11.11%),ⅡB period in 0 case (0/9,0.00%). The endometrial cancers by TAM are mostly well differentiated and earlier stages.3 The relationship between the duration of TAM taken and endometrial cancer: the duration more than 5 years were more likely to have endometrial cancer than in 5 years,more longer more greater chances of endometrial cancer, especially for taking longer than 5 years.4 The relationship between endometrial thickness and endometrial cancer: the endometrial thicker,the occurrence of endometrial cancer greater,particularly patients whose endometrial thickness more than 8mm should be regularly reviewed to prevent endometrial cancer.5 The related factors analysis:risk factors of endometrial diseases were positive related with menopause.Conclusions:1 TAM can lead to endometrial lesions, pathological types: endometrial polyps, hyperplasia polyps, fibroids/adenomyosis, hyperplasia and endometrial cancer.2 Postmenopausal and TAM taking-time> 5 years patients are prone to endometrial cancer.3 Detection of B-ultrasound and hysteroscopy in patients with endometrial thickness is an effective way.When the endometrial thickness more than 8mm, we should timely biopsy for early detection of endometrial cancer.4 Master breast cancer postoperative patients'menstruation conditions.To prevent the occurrence of endometrial lesions,especially endometrial cancers,the menopausal patients with TAM taken should be paied more attention before and/or during TAM usage.Menopausal patients should be get more care due to TAM used,or change to fadrozol such as Anastrozole,Letrozole.