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Different patterns in the risk of newly developed fatty liver and lipid changes with tamoxifen versus aromatase inhibitors in postmenopausal women with early breast cancer: A propensity score-matched cohort study

 Namki Hong  ;  Han Gyul Yoon  ;  Da Hea Seo  ;  Seho Park  ;  Seung Il Kim  ;  Joo Hyuk Sohn  ;  Yumie Rhee 
 EUROPEAN JOURNAL OF CANCER, Vol.82 : 103-114, 2017 
Journal Title
Issue Date
Adult ; Aged ; Antineoplastic Agents, Hormonal/adverse effects* ; Aromatase Inhibitors/adverse effects* ; Biomarkers/blood ; Breast Neoplasms/drug therapy* ; Chemotherapy, Adjuvant/adverse effects ; Fatty Liver/chemically induced* ; Fatty Liver/epidemiology ; Female ; Humans ; Incidence ; Lipids/blood* ; Middle Aged ; Nitriles/adverse effects ; Propensity Score ; Retrospective Studies ; Tamoxifen/adverse effects* ; Triazoles/adverse effects
Adjuvant endocrine therapy ; Anastrozole ; Hepatic steatosis ; High-density lipoprotein cholesterol ; Letrozole ; Tamoxifen ; Triglyceride
BACKGROUND: Management of metabolic complications of long-term adjuvant endocrine therapy in early breast cancer remained an unmet need. We aimed to compare the effects of tamoxifen (TMX) and aromatase inhibitors (AIs) on the risk of fatty liver in conjunction with longitudinal changes in the serum lipid parameters. METHODS: Among 1203 subjects who were taking adjuvant TMX or AI (anastrozole or letrozole) without fatty liver at baseline, those taking TMX or AI were 1:1 matched on the propensity score. The primary outcome was newly developed fatty liver detected on annual liver ultrasonography. RESULTS: Among 328 matched subjects (mean age 53.5 years, body mass index 22.9 kg/m2), 62 cases of fatty liver in the TMX group and 41 cases in the AI group were detected in a total of 987.4 person-years. The incidence rate of fatty liver was higher in the TMX group than in the AI group (128.7 versus 81.1 per 1000 person-years, P = 0.021), particularly within the first 2 years of therapy. TMX was associated with an increased 5-year risk of newly developed fatty liver (adjusted hazard ratio 1.61, P = 0.030) compared with AI independent of obesity and cholesterol level. Subjects who developed fatty liver had higher triglycerides (TGs) and lower high-density lipoprotein cholesterol (HDL-C) level at baseline than those without, which was sustained during follow-up despite the serum cholesterol-lowering effect of TMX. CONCLUSIONS: TMX independently increased the 5-year risk of newly developed fatty liver compared with AI in postmenopausal women with early breast cancer. Our findings suggest the need for considering the risk of fatty liver as a different adverse event profile between AI and TMX, particularly in patients with obesity, high TGs and low HDL-C.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Seung Il(김승일)
Park, Se Ho(박세호) ORCID logo https://orcid.org/0000-0001-8089-2755
Seo, Da Hea(서다혜)
Sohn, Joo Hyuk(손주혁) ORCID logo https://orcid.org/0000-0002-2303-2764
Rhee, Yumie(이유미) ORCID logo https://orcid.org/0000-0003-4227-5638
Hong, Nam Ki(홍남기) ORCID logo https://orcid.org/0000-0002-8246-1956
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