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Breast Cancer Research and Treatment

, Volume 112, Issue 1, pp 99–108 | Cite as

Prognosis of uterine corpus cancer after tamoxifen treatment for breast cancer

  • Wilhelmina E. Hoogendoorn
  • Harry Hollema
  • Hester H. van Boven
  • Elisabeth Bergman
  • Geri de Leeuw-Mantel
  • Inge Platteel
  • Renske Fles
  • Petra M. Nederlof
  • Marian J. E. Mourits
  • Flora E. van Leeuwen
  • The Comprehensive Cancer Centers’ TAMARISK-group
Epidemiology

Abstract

Tamoxifen increases the risk of uterine corpus cancer. Since only few, mostly small, studies have examined prognosis of uterine corpus cancer following tamoxifen, we conducted a large retrospective cohort study to further investigate this. We examined histopathologic and immunohistochemical characteristics of 332 patients with uterine corpus cancer following breast cancer, according to tamoxifen use. Survival was examined in the same patients combined with 309 patients from a previous study with updated follow-up. Histological review of all cancers was performed. Long-term tamoxifen users showed a higher proportion of non-endometrioid tumors than non-users (32.7% vs. 17.4%, P = 0.004), especially serous adenocarcinomas and carcinosarcomas. An increased proportion of FIGO stage III and IV tumors was also observed (20.0% vs. 11.3%, P = 0.049). Within FIGO stage I, both short-term and long-term tamoxifen users showed a higher proportion of tumors limited to the endometrium than non-users (35.7% vs. 22.9%, P = 0.049 and 0.004 respectively). Uterine corpus cancers in long-term tamoxifen users were more often steroid receptor-negative (ERα, PRA and PRB, P < 0.05) and P53-positive (P = 0.015). Three-year uterine corpus cancer-specific survival was worse for long-term tamoxifen users than for non-users (82% vs. 93% P = 0.0001). The survival difference remained after adjustment for histopathologic and immunohistochemical characteristics (hazard ratio (HR) for ≥2 years tamoxifen = 2.4; 95% CI = 1.2–4.6). In conclusion, this large study clearly shows that tamoxifen-associated tumors have less favorable histological features and a worse survival. Our results can be applied when weighing risks and benefits of tamoxifen versus other hormonal agents used in the prevention and treatment of breast cancer.

Keywords

Breast cancer Late effects Prognosis Tamoxifen Uterine corpus cancer 

Notes

Acknowledgments

We thank all treating specialists for providing access to patients’ medical charts, pathology laboratories for providing tumor tissue blocks, and the abstracting teams from the regional cancer registries for data collection. This study was supported by a grant (NKI 2002-2586) from the Dutch Cancer Society.

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Copyright information

© Springer Science+Business Media, LLC. 2007

Authors and Affiliations

  • Wilhelmina E. Hoogendoorn
    • 1
  • Harry Hollema
    • 2
  • Hester H. van Boven
    • 3
  • Elisabeth Bergman
    • 4
  • Geri de Leeuw-Mantel
    • 1
  • Inge Platteel
    • 2
  • Renske Fles
    • 5
  • Petra M. Nederlof
    • 3
  • Marian J. E. Mourits
    • 6
  • Flora E. van Leeuwen
    • 1
  • The Comprehensive Cancer Centers’ TAMARISK-group
    • 7
  1. 1.Department of EpidemiologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  2. 2.Department of PathologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
  3. 3.Department of PathologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  4. 4.Comprehensive Cancer Center WestLeidenThe Netherlands
  5. 5.Department of Experimental TherapyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  6. 6.Department of GynecologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
  7. 7.Association of Comprehensive Cancer CentersUtrechtThe Netherlands

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