폐경 호르몬요법에서 경구용 Levonorgestrel 투여 1년 후 유방 치밀도에 대한 효과
Impact of Oral Levonorgestrel for 1 Year on Mammographic Density in Menopausal Hormone Therapy
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연구목적: 한국 폐경여성에서 levonorgestrel (LNG)를 이용한 호르몬 치료의 유방 치밀도에 대한 영향을 평가하였다. 연구재료 및 방법: 후향적 연구로서, 이전에 호르몬치료 기왕력이 없는 58명을 대상으로 하였다. 23명에게 estadiol valerate (E) ＋ LNG를 이용해 주기적으로 치료하였고, 25명의 비치료군을 대조군, 10명의 conjugated equine estrogen (CEE) ＋ medroxyprogesterone acetate (MPA) 치료군을 양성 대조군으로 두었다. 이후 기저치와 1년 후 유방촬영을 시행하여 치밀도를 비교하였다. 치료 전후의 X선 유방촬영술상 유방 치밀도의 변화는 J-image 프로그램을 이용하여 평가하였다. 자료는 chi-square 분석 및 Fisher’s exact 분석법, 그리고 analysis of variance (ANOVA)을 이용하여 분석하였다. 결과: 세 군 간의 기저 임상적 특성에 차이는 없었다. 1년의 호르몬요법 후, breast imaging reporting and data system (BI-RADS) 기준에 따른 변화를 보았을 때 CEE ＋ MPA 사용군 (77.8% [7/9])이, E ＋ LNG 사용군 (12.5% [2/16])보다 유의하게 증가하였으나 (P = 0.001), E ＋ LNG 사용군과 비치료군 (5.3% [1/19])사이에 유의한 차이는 없었다 (P = 0.446). 치밀도가 3단계인 환자만을 대상으로 한 분석에서도 E ＋ LNG 사용군은 비치료군과 유방 치밀도 변화에 차이가 없었다. J-image 프로그램을 이용한 분석 결과도 유사한 결과를 보였다. 또한 회귀 분석 결과, 기저 치밀도와 호르몬요법 후 치밀 면적의 변화 사이에는 상관 관계가 나타나지 않았다. 결론: 한국 폐경 여성에서 LNG를 이용한 호르몬요법은 유방 치밀도에 영향을 미치지 않는다. 향후 유방암 위험에 대한 추가 연구가 필요하다고 사료된다.
Abstract
Objectives: We evaluated changes in mammographic density (MMGD) after hormone therapy (HT) using levonorgestrel (LNG) in Korean postmenopausal women. Methods: In this retrospective study, 58 healthy postmenopausal women with no history of prior HT were included. Twenty-three women were given a cyclic regimen of estradiol valerate (E) 2 mg/day ＋ LNG 0.075 mg/day and 25 untreated women served as a negative control and 10 women treated with continuous combined regimen of conjugated equine estrogen (CEE) 0.625 mg/day ＋ medroxyprogesterone acetate (MPA) 2.5 mg/day as a positive control. Mammography was obtained at baseline and 1 year later, and MMGD was assessed. In addition, the change in the proportion of the dense area after HT was assessed using the J-image program. Data were analyzed with analysis of variance and chi-square or Fisher’s exact test. Results: There were no significant differences in baseline characteristics among three groups. After 1 year of HT, increase of BI-RADS grade in CEE ＋ MPA group (7/9, 77.8%) was higher than in E ＋ LNG group (2/16, 12.5%; P = 0.001). But there was no difference between untreated group (1/19, 5.3%) and E ＋ LNG group (2/16, 12.5%; P = 0.446). In subgroup analysis of women with BI-RADS grade 3 at baseline, no significant difference. Changes in the proportion of dense areas assessed by the J-image program showed similar results. Regression analysis revealed that there was no correlation between baseline dense area and changes after HT in E ＋ LNG group. Conclusion: HT using LNG did not influence MMGD in Korean postmenopausal women. Further study on breast cancer risk may be needed.
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