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虽然芳香酶抑制剂可以延长绝经后乳腺癌患者生存，但是芳香酶抑制剂所致关节疼痛可以导致停药。肥胖患者与非肥胖患者相比，芳香酶抑制剂所致关节疼痛发生率高，但是治疗选择有限。ω-3脂肪酸主要富含于鱼油，已有荟萃分析表明对于减轻类风湿关节炎所致关节疼痛有效，不过对于芳香酶抑制剂所致关节疼痛效果尚不明确。 2018年8月29日，施普林格·自然旗下《乳腺癌研究与治疗》在线发表纽约哥伦比亚大学、西南肿瘤学研究协作组（SWOG）统计中心、弗雷德哈钦森癌症研究中心、西雅图癌症治疗联盟、堪萨斯癌症中心、国家癌症研究所、伊利诺伊癌症治疗中心、AIM专业医疗集团、犹他大学亨斯特曼癌症研究所的研究报告，发现ω-3脂肪酸可以显著减轻肥胖乳腺癌患者芳香酶抑制剂所致关节疼痛。 该多中心随机安慰剂对照研究（SWOG S0927，NCT01385137）于2012年2月～2013年2月从美国52个地点入组绝经后I～III期乳腺癌接受芳香酶抑制剂治疗女性249例，随机分配每天口服3.3克的ω-3脂肪酸或安慰剂（大豆油或玉米油）24周。第0、12、24周时进行简明疼痛量表问卷调查和空腹血清采集，评定简明疼痛量表的最重疼痛、平均疼痛、疼痛干扰评分（范围0～10）。 该二次分析结果发现，根据世界卫生组织的定义，其中体重指数≥30kg/m²的肥胖患者为110例（44%）。 ω-3脂肪酸组与安慰剂组相比，肥胖患者24周时最重疼痛评分显著较低（4.36比5.70，P=0.02），非肥胖患者评分相似（5.27比4.58，P=0.28），组间存在差异（P=0.05）。同样，ω-3脂肪酸组与安慰剂组相比，肥胖患者24周时最重疼痛、疼痛干扰评分显著较低，非肥胖患者评分相似，组间存在显著差异（P=0.005、P=0.01）。 因此，对于肥胖的乳腺癌患者，ω-3脂肪酸与安慰剂相比，可以显著减轻芳香酶抑制剂所致关节疼痛。本文仅供专业人士参考，患者或家属请遵医嘱，切勿盲目购买食用鱼油。 Breast Cancer Res Treat. 2018 Aug 29. [Epub ahead of print] Omega-3 fatty acid use for obese breast cancer patients with aromatase inhibitor-related arthralgia (SWOG S0927). Sherry Shen, Joseph M. Unger, Katherine D. Crew, Cathee Till, Heather Greenlee, Julie Gralow, Shaker R. Dakhil, Lori M. Minasian, James L. Wade III, Michael J. Fisch, N. Lynn Henry, Dawn L. Hershman. Columbia University Medical Center, New York, USA; SWOG Statistical Center, Seattle, USA; Fred Hutchinson Cancer Research Center, Seattle, USA; Seattle Cancer Care Alliance, Seattle, USA; Cancer Center of Kansas, Wichita, USA; National Cancer Institute, Bethesda, USA; Cancer Care Specialists of Central Illinois, Decatur, USA; AIM Specialty Health, Chicago, USA; Hunstman Cancer Institute, Salt Lake City, USA. PURPOSE: Although aromatase inhibitors (AIs) prolong survival in post-menopausal breast cancer (BC) patients, AI-associated arthralgia can lead to discontinuation. Obese patients have higher rates of AI arthralgia than non-obese patients, but treatment options are limited. Omega-3 fatty acid (O3-FA) treatment for AI arthralgia has produced mixed results. METHODS: We performed an exploratory analysis of SWOG S0927, a multicenter randomized placebo-controlled trial of O3-FA use for AI arthralgia. Post-menopausal women with stage I-III BC taking an AI were randomized to 24 weeks of O3-FAs or placebo. Brief Pain Inventory (BPI) questionnaires and fasting serum were collected at baseline, 12, and 24 weeks. The BPI assessment included worst pain, average pain, and pain interference scores (range 0-10). RESULTS: Among the 249 participants, 139 had BMI<30 kg/m² (56%) and 110 had BMI≥30 kg/m² (44%). Among obese patients, O3-FA use was associated with significantly lower BPI worst pain scores at 24 weeks compared with placebo (4.36 vs. 5.70, p=0.02), whereas among non-obese patients, there was no significant difference in scores between treatment arms (5.27 vs. 4.58, p=0.28; interaction p=0.05). Similarly, O3-FA use was associated with lower BPI average pain and pain interference scores at 24 weeks compared with placebo among obese patients, but no significant difference between treatment arms in non-obese patients (interaction p=0.005 and p=0.01, respectively). CONCLUSIONS: In obese BC patients, O3-FA use was associated with significantly reduced AI arthralgia compared to placebo. KEYWORDS: Breast cancer Omega-3 fatty acids Aromatase inhibitor Obesity Arthralgia DOI: 10.1007/s10549-018-4946-0
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