Menopausal hormone therapy and the risk of breast cancer by histological type and race: a meta-analysis of randomized controlled trials and cohort studies
Menopausal hormone therapy and the risk of breast cancer by histological type and race: a meta-analysis of randomized controlled trials and cohort studies
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DOI：
10.1007/s10549-018-4782-2
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发表时间：
2018-08-01
影响因子：
3.8
通讯作者：
Lim, Jung-eun
中科院分区：
文献类型：
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作者：
Kim, Sohyun;Ko, Yeonsook;Lim, Jung-eun
这项荟萃分析调查了乳腺癌风险与激素替代疗法（HRT）之间的关系。根据种族（亚洲人/西方人）、HRT类型（所有激素治疗、雌激素单独治疗（ET）或雌激素-黄体酮联合治疗（EPT））、组织学乳腺癌类型（导管/小叶/混合导管-小叶）和雌激素受体状态（er阳性/ er阴性）进行各种分层分析。使用Pubmed、Embase和KoreaMed进行文献检索。本meta分析纳入25项流行病学研究，包括23项队列研究和2项随机对照试验。使用随机效应模型，发现HRT使用与乳腺癌风险呈正相关，合并风险比（HR）为1.33[95%置信区间（CI） 1.24, 1.44]。与ET相比，EPT与乳腺癌风险的相关性更强。EPT与导管性乳腺癌和小叶性乳腺癌的风险均相关[导管性乳腺癌，HR = 1.51 (95% CI 1.28, 1.78)；小叶型乳腺癌的HR = 1.38 （95% CI 1.20, 1.60）。根据ER状态，所有hrt均与ER阳性乳腺癌的风险相关，但与ER阴性乳腺癌的风险无关。亚洲HRT使用者比西方HRT使用者患乳腺癌的风险更高。ET和EPT与所有乳腺癌组织学类型和er阳性乳腺癌的风险均显著相关。
This meta-analysis investigated the association between the risk of breast cancer and hormone replacement therapy (HRT). Various stratified analyses were performed according to race (Asian/Westerner), HRT type [all hormone therapies, estrogen-only therapy (ET), or combined estrogen-progestin therapy (EPT)], histological breast cancer type (ductal/lobular/mixed ductal-lobular), and estrogen receptor status (ER-positive/ER-negative).A literature search was performed using Pubmed, Embase, and KoreaMed. Twenty-five epidemiological studies including 23 cohort studies and two randomized controlled trials were included in this meta-analysis.Using a random-effects model, HRT use was found to be positively associated with the risk of breast cancer with a pooled hazard ratio (HR) of 1.33 [95% confidence interval (CI) 1.24, 1.44]. Compared with ET, EPT was more strongly associated with breast cancer risk. EPT was associated with both ductal and lobular breast cancer risks [for ductal breast cancer, HR = 1.51 (95% CI 1.28, 1.78); for lobular breast cancer, HR = 1.38 (95% CI 1.20, 1.60)]. According to ER status, all HRTs were associated with the risk of ER-positive breast cancer, but not with that of ER-negative breast cancer.Asian HRT users had a higher risk of breast cancer than western HRT users. Both ET and EPT were significantly associated with the risk of all breast cancer histological types and ER-positive breast cancer.