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Geburtshilfe Frauenheilkd 2002; 62(12): 1175-1182
DOI: 10.1055/s-2002-36365
Originalarbeit

Georg Thieme Verlag Stuttgart · New York

Verminderte Inzidenz von Brustkrebsmetastasen bei Patientinnen mit präoperativer Hormonersatztherapie (HRT)

Reduction of Metastases in Breast Cancer-Patients Treated with Preoperative Hormone Replacement Therapy (HRT): A Retrospective Analysis in 544 WomenF. Schütz 1 , I. J. Diel 1 , 2 , M. Püschel 1 , E. F. Solomayer 1 , T. von Holst 1 , P. Sinn 3 , U. Haus 4 , R. Kohnen 4 , G. Bastert 1
  • 1Universitätsfrauenklinik Heidelberg
  • 2CGG-Klinik Mannheim
  • 3Pathologische Universitätsklinik Heidelberg
  • 4Institute for Medical Research Management and Biometrics (IMEREM), Nürnberg
Further Information

Publication History

Eingang Manuskript: 18. Juni 2002 Eingang revidiertes Manuskript: 3. Oktober 2002

Akzeptiert: 8. Oktober 2002

Publication Date:
20 December 2002 (online)

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Zusammenfassung

Einführung

Die Substitution von Östrogenen und Gestagenen ist eine weit verbreitete Prophylaxe postmenopausaler Beschwerden wie Hitzewallungen, urogenitale Atrophie, Osteoporose und kardiovaskuläre Erkrankungen. Jedoch wurde in vielen Studien eine Langzeiteinnahme dieser Hormone mit einem erhöhten Risiko einer Brustkrebserkrankung verbunden, da die Mehrheit dieser Karzinome hormonabhängig wachsen. Auf der anderen Seite haben Brustkrebspatientinnen mit einer präoperativen HRT eine verminderte Mortalität und ein längeres Überleben gegenüber den nicht-substituierten.

Material und Methode

Wir haben bei 544 Patientinnen (zwischen 45 und 60 Jahren bei der Erstdiagnose) mit und ohne einer präoperativen HRT bezüglich des Risikos einer ossären Metastasierung untersucht. 154 Patientinnen waren prämenopausal (Mittel 48,0 ± 2,7 J.), 390 postmenopausal (54,5 ± 3,5 J.), 208 von letzteren waren hormonsubstituiert (Gruppe HRT+) und 182 nicht (Gruppe HRT-). Die (HRT+)-Patientinnen nahmen Östrogene über mindestens 12 Monate (Mittel 5,5 ± 4,0 J.) ein.

Ergebnisse

Obwohl die Tumorgröße der (HRT-)-Gruppe signifikant größer war als bei der (HRT+)-Gruppe (p = 0,024) und diese ein schlechteres Grading aufwiesen, konnte kein signifikanter Unterschied bezüglich des Nodalstatus, der S-Phase und der Hormonrezeptoren festgestellt werden. Die postoperative Therapie unterschied sich bei den postmenopausalen Patientinnen nicht signifikant. Bezüglich der Knochenmetastasen zeigte die Gruppe HRT- eine signifikant (p < 0,001) höhere Inzidenz gegenüber der Gruppe HRT+ (18 gegen 2 Patientinnen im Mittel nach 1,6 Jahren). Auch pulmonale (9 : 1) und hepatische Metastasen (13 : 5) waren häufiger bei nicht hormonsubstituierten Patientinnen anzutreffen.

Diskussion

In vivo und in klinischen Bisphosphonatstudien konnte gezeigt werden, dass ein gesunder Knochenstoffwechsel eine ossäre Metastasenbildung verhindern kann. Die Inzidenz von Knochen-, Leber- und Lungenmetastasen eines Mammakarzinoms kann durch eine präoperative HRT reduziert werden. Weitere, größere Studien sollten diesen Effekt aber noch genauer untersuchen.

Abstract

Introduction

Substitution of estrogenes and progestins is the most common therapy and prophylaxis for postmenopausal discomforts like hot flushes, osteoporosis, etc. However in the majority of studies long term HRT has been associated with an slightly increased risk of breast cancer. On the other hand patients with preoperative HRT have a lower mortality and a longer overall-survival.

Material and Methods

For further investigation we examined 544 patients between 45 and 60 years at time of first diagnosis of breast cancer with and without HRT with regard to the incidence of bone metastases. 154 patients were premenopausal (mean 48.0 ± 2.7 y), 390 were postmenopausal (54.5 ± 3.5 y), 208 of them received HRT (group HRT+) and 182 patients not (group HRT-). Patients of group HRT+ received estrogenes over a minimum of 12 months (mean 5.5 ± 4.0 y).

Results

Although tumor size and grading of group HRT- were significantly higher than in group HRT+ (p = 0.024), nodal status, S-phase fraction, and hormone-receptor status showed no significant differences. Adjuvant treatment in the postmenopausal groups were also not significantly different. In regard to the incidence of metastases patients without HRT have significantly (p < 0.001) more bone metastases (18 patients of group HRT- versus 2 patients of group HRT+). Also pulmonal (9 : 1) and liver (13 : 5) metastases were significantly more frequent in patients without a preoperative HRT.

Discussion

It was shown in vivo and in clinical bisphosphonate trials that a normalization of bone metabolism is able to reduce subsequent bone metastases efficiently. We may assume that the incidence of bone metastases can be reduced by normalizing bone metabolism (soil) and lowering conditions of tumor cell seeding by HRT.

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Dr. med. Florian Schütz

Universitätsfrauenklinik Heidelberg

Voss-Straße 9

69115 Heidelberg

Email: florian_schuetz@med.uni-heidelberg.de

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