medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-9-131-138medsovet-6925Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHИндукция овариального стероидогенеза как дополнительный потенциальный фактор риска прогрессирования у пременопаузальных пациенток с гормон-рецептор-позитивным раком молочной железы, получающих тамоксифен в качестве адъювантной терапииInduction of ovarian steroidogenesis as an additional potential risk factor for progression in premenopausal patients with hormone-receptor-positive breast cancer receiving tamoxifen as adjuvant therapyhttps://orcid.org/0000-0001-7127-7945ГоряиноваА. Ю.GoryainovaA. Yu.

Горяинова Алла Юрьевна - врач-онколог, заведующая координационным отделом лекарственного обеспечения, КОД №1; ассистент кафедры онкологии с курсом торакальной хирургии, КубГМУ.

350040, Краснодар, ул. Димитрова, д. 146; 350063, Краснодар, ул. Митрофана Седина, д. 4.

Alla Yu. Goryainova - Medical Oncologist, Head of the Drug Supply Coordination Department, Clinical Oncologic Dispensary No. 1; Assistant of the Department of Oncology with the Course of Thoracic Surgery, Kuban State Medical University.

146, Dimitrov St., Krasnodar, 350040; 4, Mitrofan Sedin St., Krasnodar, 350063.

mashelueva@yandex.ruhttps://orcid.org/0000-0002-0698-7710СтуканьА. И.StukanA. I.

Стукань Анастасия Игоревна – кандидат медицинских наук, врач-онколог координационного отдела лекарственного обеспечения, КОД №1; ассистент кафедры онкологии с курсом торакальной хирургии, КубГМУ.

350040, Краснодар, ул. Димитрова, д. 146; 350063, Краснодар, ул. Митрофана Седина, д. 4.

Anastasia I. Stukan - Cand. Sci (Med.), Medical Oncologist, Drug Supply Coordination Department, Clinical Oncologic Dispensary No. 1; Assistant of the Department of Oncology with the Course of Thoracic Surgery, Kuban State Medical University.

146, Dimitrov St., Krasnodar, 350040; 4, Mitrofan Sedin St., Krasnodar, 350063.

jolie86@bk.ruЛымарьЕ. В.LymarE. V.

Лымарь Елена Владимировна - врач-онколог координационного отдела лекарственного обеспечения.

350040, Краснодар, ул. Димитрова, д. 146.

Elena V. Lymar - Medical Oncologist, Drug Supply Coordination Department, Clinical Oncologic Dispensary No. 1.

146, Dimitrov St., Krasnodar, 350040.

tsari29@mail.ruhttps://orcid.org/0000-0001-7745-4631ХачмамукЗ. К.KhachmamukZ. K.

Хачмамук Зарема Казбековна - врач-онколог диспансерно-поликлинического отделения.

350040, Краснодар, ул. Димитрова, д. 146.

Zarema K. Khachmamuk - Medical Oncologist, Outpatient Department, Clinical Oncologic Dispensary No. 1.

146, Dimitrov St., Krasnodar, 350040.

zarema2332@icloud.comhttps://orcid.org/0000-0001-8202-8223СелезневаИ. Г.SeleznevaI. G.

Селезнева Ирина Геннадьевна - врач-онколог диспансерно-поликлинического отделения.

350040, Краснодар, ул. Димитрова, д. 146.

Irina G. Selezneva - Medical Oncologist, Outpatient Department, Clinical Oncologic Dispensary No. 1.

146, Dimitrov St., Krasnodar, 350040.

seleirin@mail.ruКлинический онкологический диспансер №1; Кубанский государственный медицинский университетРоссияClinical Oncologic Dispensary No. 1; Kuban State Medical UniversityRussian FederationКлинический онкологический диспансер №1РоссияClinical Oncologic Dispensary No. 1Russian Federation20221906202209131138Copyright © Горяинова А.Ю., Стукань А.И., Лымарь Е.В., Хачмамук З.К., Селезнева И.Г., 20222022Горяинова А.Ю., Стукань А.И., Лымарь Е.В., Хачмамук З.К., Селезнева И.Г.Goryainova A.Y., Stukan A.I., Lymar E.V., Khachmamuk Z.K., Selezneva I.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6925Введение

Введение. Пациентки с гормон-рецептор-позитивным (ГР+) раком молочной железы (РМЖ) старше 40 лет, принимающие тамоксифен, не подлежат обязательной кастрации. Однако данная когорта больных неоднородна.

Цель исследования - изучить особенности овариального стероидогенеза у больных ГР+ РМЖ в перименопаузе, получающих адъювантную гормонотерапию (ГТ) тамоксифеном.

Материалы и методы

Материалы и методы. В исследование включены 82 пациентки в возрасте от 42 до 53 лет с ГР+ РМЖ, получавшие ГТ тамоксифеном 20 мг/сут ежедневно. В течение 9 мес. от начала ГТ у больных исследовались уровни эстрадиола и фолликулостимулирующего гормона в венозной крови каждые 3 мес.

Результаты

Результаты. У 66,7% больных, получивших химиотерапию (ХТ), было отмечено развитие аменореи. В группе получивших только ГТ аменорею демонстрировала половина больных. Олигоменорея наблюдалась у 20,8 и 16,7% пациенток каждой группы соответственно. Частота наступления аменореи у женщин, получавших ХТ, была выше (ОШ 2,02; 95% ДИ: 0,73-5,67), однако различия не были статистически значимыми (p = 0,1766). В общей когорте у 15,7-16,8% больных уровень эстрадиола превышал 251 пг/мл - верхний предел нормы фолликулярной фазы менструального цикла. Различия между группами в частоте встречаемости уровней эстрадиола > 251 пг/мл были статистически значимы (p = 0,0293), 3,4-5,6% пациенток в общей когорте (в зависимости от периода наблюдения) имели уровень эстрадиола > 649 пг/мл, что соответствовало наибольшему овуляторному значению.

Выводы

Выводы. На фоне ГТ тамоксифеном у части перименопаузальных больных наблюдается гиперэстрогения, что свидетельствует о реализации эффекта индукции овариального стероидогенеза и может рассматриваться как дополнительный потенциальный фактор риска прогрессирования ГР+ РМЖ. Аменорея после проведенной ХТ не является надежным маркером подавления функции яичников.

Introduction

Introduction. Patients with hormone-receptor-positive (HR+) breast cancer (BC) over 40 years old who take tamoxifen are not subject to mandatory castration. However this cohort of patients is not homogeneous.

Aim

Aim. The present study is aimed at studying the features of ovarian steroidogenesis in perimenopausal breast cancer patients receiving adjuvant hormone therapy (HT) with tamoxifen.

Materialy and methods

Materialy and methods. The study included 82 patients aged 42 to 53 years with GH+BC who received HT with tamoxifen 20 mg daily. Within 9 months from the start of HT in patients, the levels of estradiol and follicle-stimulating hormone in the peripheral blood were studied every 3 months.

Results

Results. In 66.7% of patients who received chemotherapy (CT), the development of amenorrhea was noted. Half of the patients in the HT-only group demonstrated amenorrhea. Oligomenorrhea was observed in 20.8% and 16.7% in each group, respectively. The incidence of amenorrhea in women treated with chemotherapy was higher (OR 2.02; 95% CI: 0.73-5.67), but the differences were not statistically significant (p = 0.1766). In the general cohort, in 15.7-16.8% of patients, the level of estradiol exceeded 251 pg / ml - the upper limit of the norm of the follicular phase of the menstrual cycle. Differences between groups in the incidence of estradiol levels > 251 pg/ml were statistically significant (p = 0.0293). 3.4-5.6% of patients in the total cohort (depending on the period of observation) had an estradiol level > 649 pg / ml, which corresponded to the highest ovulatory value.

Conclusions

Conclusions. Against the background of HT with tamoxifen in some perimenopausal patients hyperestrogenism is observed which indicates the implementation of the effect of induction of ovarian steroidogenesis and can be considered as an additional potential risk factor for the progression of HR+BC. Amenorrhea after CT is not a reliable marker of ovarian suppression.

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The authors declare that there are no conflicts of interest present.