Tamoxifen-induced hepatic steatosis in premenopausal breast cancer patients

Meme kanserli postmenopozal hastalarda aromataz inhibitörleri tamoksifenin yerini alırken premenopazal hastalarda tamoksifen ilk basamak hormonal tedavi olmaya devam etmektedir. Tamoksifen kullanımına bağlı hepatosteatoz sonrası nonalkolik steatohepatit (NASH) gelişebilmekte ve NASH siroza ilerleyebilmektedir. Hepatosteatoz gelişimi önceden tespit edilirse fibratlar veya statinler ile bu hastalar tedavi edilebilirler. Biz bu çalışmamızda adjuvan tedavisinde tamoksifen kullandığımız hormon reseptörü pozitif premenopozal meme kanseri hastalarımızda hepasteatoz gelişimini araştırdık. Histopatolojik olarak meme kanseri olduğu tespit edilmiş ve östrojen ve/veya progesteron reseptör ekspresyonu immünohistokimyasal olarak gösterilmiş premenopozal hastalar çalışmaya alındı. Bütün hastalara tamoksifen kullanmadan önce, takibinin altıncı ayında ve birinci yılı sonunda aynı radyolog tarafından karaciğer ultrasonografisi yapıldı. Çalışma sonuçları 30 hastada değerlendirildi. Hastalardan dördünde (%13.3) başlangıç ultrasonografisinde grade 2 hepatosteatoz, takibinin altıncı ayında yapılan ultrasonografide bu hastaların hepatosteatozunda değişiklik tespit edilmez iken 7 hastada (%23.3) grade 1 hepatosteatoz, birinci yıl sonunda toplam 12 hastada (%40) hepatosteatoz saptandı. Ultrasonografi takip zamanları arasında hepatosteatoz farkını araştırmak için yapılan Wilcoxon testi ve Bonferroni düzeltmesi ile başlangıç ile altıncı ay bulguları anlamlı farklı idi (p=0.021). Başlangıç bulguları ile birinci yıl bulguları anlamlı farklı bulundu (p=0.003). Altıncı ay bulguları ile birinci yıl bulguları arasında fark tespit edilemedi. Sonuç olarak tamoksifen kullanımı ile ultrasonografik olarak tespit edilen hepatosteatoz oranı premenapozal hastalarda artmaktadır. Birinci yıl sonundaki ultrasonografi bulguları ile altıncı ay ultrasonografi bulguları arasında fark bulunmamaktadır. Bu hastalarda hepatosteatoz açısından altıncı ay ultrasonografisinin önemli olduğunu düşünmekteyiz.

Anahtar Kelimeler:

Meme kanseri, hepatosteatoz, tamoksifen

Premenapozal meme kanserli hastalarda tamoksifene bağlı hepatosteatoz

While aromatase inhibitors are replacing tamoxifen in postmenopausal breast cancer patients, tamoxifen continues to be the first-line hormonal therapy in premenopausal patients. Tamoxifen-induced hepatosteatosis may lead to nonalcoholic steatohepatitis (NASH), and NASH may develop into cirrhosis. If the development of hepatosteatosis is predicted, these patients may be treated with fibrates and statins. This study examines the development of hepatosteatosis in our premenopausal breast cancer patients that were taking tamoxifen for adjuvant therapy and were positive for the hormone receptors. Patients histopathologically diagnosed with breast cancer and with immunohistochemically demonstrated estrogen and/or progestron receptor expression were recruited for the study. All patients were assessed with ultrasonography by the same radiologist before tamoxifen therapy, at the sixth month of the follow-up and at the end of the first year. The study results were evaluated in thirty patients. Initial ultrasonography revealed grade 2 hepatosteatosis in four patients (13.3%), no change occurring at the repeat ultrasonography performed at the sixth month of the follow-up. Seven patients (23. 3%) were diagnosed as having grade 1 hepatosteatosis. A total of 12 patients (40%) were found to have hepatosteatosis at the end of the first year. Findings at the outset and those at the end of the first year were significantly different (p=0.021) as determined with the Wilcoxon test and Bonferroni correction performed to ascertain the difference in hepatosteatosis between the outset and the follow-up periods. No difference was obtained between the findings for the sixth month and those obtained at the end of the first year. In conclusion, the rate of hepatosteatosis as assessed with ultrasonography shows an increase with tamoxifen use in premenopausal patients. There was no difference between ultrasonography findings at the end of the first year and those at the sixth month of the follow-up. We think that the sitxh-month ultrasonography bears importance from the viewpoint of hepatosteatosis in these patients.

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