乳腺癌患者选择性雌激素受体调节剂治疗相关子宫内膜安全管理的中国专家共识(2021版)

doi:10.3969/j.issn.1006-7795.2021.04.026

摘要/Abstract

摘要： 激素受体阳性的乳腺癌患者术后需接受内分泌治疗,时间为5~10年。其中选择性雌激素受体调节剂(selective estrogen receptor modulators, SERMs)是乳腺癌患者,尤其是绝经前患者内分泌治疗的主要药物之一。他莫昔芬(tamoxifen,TAM)是SERMs类药物的代表,在乳腺组织中表现为拮抗作用,能抑制癌细胞的生长和发育,而对子宫内膜的作用是弱雌激素样效应。长期使用标准剂量的TAM可能与子宫内膜息肉、子宫内膜增生、子宫内膜浸润性癌及子宫肉瘤等疾病相关。为了防控在内分泌治疗期间发生的妇科疾病,尤其是使用SERMs类药物的乳腺癌患者,应该有妇科医师共同参与内分泌治疗期间的随访,加强监测与风险管控。首先,接受SERMs类药物治疗的患者,在用药前需充分知情同意,告知有子宫内膜增生、子宫内膜不典型增生甚至子宫内膜浸润性癌和子宫肉瘤的发生风险。其次,在随访过程中,应根据患者的高危因素、妇科相关临床表现进行分层监管。最后,符合手术适应证的患者推荐行宫腔镜检查以及诊断性刮宫术。综上,对于使用SERMs类药物治疗的乳腺癌患者,为筛查妇科疾病与管控相关并发症,应做到尽早识别高危人群,定期监测妇科临床症状,适时干预。

关键词: 乳腺癌, 内分泌治疗, 选择性雌激素受体调节剂, 子宫内膜病变

中图分类号:

R737.9

中华预防医学会妇女保健分会; 中国人体健康科技促进会妇科内分泌与生育力促进专委会. 乳腺癌患者选择性雌激素受体调节剂治疗相关子宫内膜安全管理的中国专家共识(2021版)[J]. 首都医科大学学报, 2021, 42(4): 672-677.

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