Estrogen plus progestin and colorectal cancer in postmenopausal women
Estrogen plus progestin and colorectal cancer in postmenopausal women
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DOI：
10.1056/nejmoa032071
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发表时间：
2004-03-04
影响因子：
158.5
通讯作者：
Carleton, R
中科院分区：
文献类型：
--
作者：
Chlebowski, RT;Wactawski-Wende, J;Carleton, R
背景：尽管妇女健康倡议(WHI)在绝经后妇女中使用雌激素和孕激素的试验发现，在荷尔蒙组的妇女中，雌激素和孕激素的总体健康风险大于益处，但雌激素和孕激素的使用与结直肠癌风险的显著降低有关。我们分析了发生结直肠癌的特征及其与参与者特征的关系。方法：在WHI试验中，16,608名年龄在50岁至79岁之间、子宫完整的绝经后妇女被随机分配到结合雌激素组(0.625 mg/d)+醋酸甲羟孕酮(2.5 mg/d)或安慰剂组。结果：激素组有43例浸润性结直肠癌，安慰剂组为72例(风险比0.56；95%可信区间0.38-0.81；P=0.003)。激素组的浸润性结直肠癌在组织学特征和分级上与安慰剂组相似，但有更多的阳性淋巴结(平均+/-SD3.2+/-4.1vs.0.8+/-1.7vs.0.8+/-1.7vs.0.8+/-1.7；P=0.002)，并且更晚期(区域或转移性疾病，76.2%vs.48.5%；P=0.004)。在探索性分析中，激素组有阴道出血先兆的女性与没有阴道出血的女性相比，结直肠癌的阳性结节数更多(3.8vs.0.7+/-1.5，P=0.006)。结论：相对短期使用雌激素和孕激素与降低结直肠癌风险有关。然而，与服用安慰剂的女性相比，服用雌激素和孕激素的女性被诊断为结直肠癌处于更晚期。
BACKGROUND:Although the Women's Health Initiative (WHI) trial of estrogen plus progestin in postmenopausal women identified more overall health risks than benefits among women in the hormone group, the use of estrogen plus progestin was associated with a significant decrease in the risk of colorectal cancer. We analyzed features of the colorectal cancers that developed and their relation to the characteristics of the participants.METHODS:In the WHI trial, 16,608 postmenopausal women who were 50 to 79 years of age and had an intact uterus were randomly assigned to a combination of conjugated equine estrogens (0.625 mg per day) plus medroxyprogesterone acetate (2.5 mg per day) or placebo. The main outcome measures were the incidence, stages, and types of colorectal cancer, as determined by blinded central adjudication.RESULTS:There were 43 invasive colorectal cancers in the hormone group and 72 in the placebo group (hazard ratio, 0.56; 95 percent confidence interval, 0.38 to 0.81; P=0.003). The invasive colorectal cancers in the hormone group were similar in histologic features and grade to those in the placebo group but with a greater number of positive lymph nodes (mean +/-SD, 3.2+/-4.1 vs. 0.8+/-1.7; P=0.002) and were more advanced (regional or metastatic disease, 76.2 percent vs. 48.5 percent; P=0.004). In exploratory analyses, women in the hormone group with antecedent vaginal bleeding had colorectal cancers with a greater number of positive nodes than women in the hormone group who did not have vaginal bleeding (3.8+/-4.3 vs. 0.7+/-1.5 nodes, P=0.006).CONCLUSIONS:Relatively short-term use of estrogen plus progestin was associated with a decreased risk of colorectal cancer. However, colorectal cancers in women who took estrogen plus progestin were diagnosed at a more advanced stage than those in women who took placebo.