Menopausal hormone therapy use and risk of primary liver cancer in the clinical practice research datalink.
Menopausal hormone therapy use and risk of primary liver cancer in the clinical practice research datalink.
复制标题
DOI：
10.1002/ijc.29960
复制
发表时间：
2016-05-01
影响因子：
6.4
通讯作者：
Sahasrabuddhe VV
中科院分区：
文献类型：
--
作者：
McGlynn KA;Hagberg K;Chen J;Braunlin M;Graubard BI;Suneja N;Jick S;Sahasrabuddhe VV
在几乎所有国家，原发性肝癌在妇女中的发生率低于男子。这种差异表明激素水平和/或外源性激素的使用可能对风险产生影响，尽管先前的研究得出了不一致的结论。因此，目前的研究是为了研究绝经期激素治疗（MHT）的使用和肝癌的发展之间的关系。在英国临床实践研究数据链（CPRD）中进行了一项巢式病例对照研究。对照组与1988年至2011年期间诊断为原发性肝癌的女性以4比1的比例匹配。还进行了第二次匹配，基于病例和对照组是否患有糖尿病。采用条件Logistic回归分析对已知危险因素进行校正，估计MHT与肝癌相关性的比值比（OR）和95%置信区间（95%CI）。在总体匹配中，339名肝癌女性与1318名对照组相匹配。MHT使用与肝癌风险显著降低相关（ORadj=0.58，95%CI=0.37-0.90），尤其是在仅使用雌激素的MHT使用者（ORadj=0.44，95%CI=0.22-0.88）和既往使用者（ORadj=0.53，95%CI=0.32-0.88）中。在糖尿病匹配病例组（n=58）和对照组（n=232）中，比值比与总体分析相似（ORadj=0.57，95%CI=0.09-3.53），但未达到统计学显著性。在目前的研究中，使用MHT，特别是仅使用雌激素的MHT，与肝癌风险显著降低相关。这些结果支持需要进一步调查激素病因是否可以解释男性和女性之间肝癌发病率的变化。
Primary liver cancer occurs less commonly among women than men in almost all countries. This discrepancy has suggested that hormone levels and/or exogenous hormone use could have an effect on risk, although prior studies have reached inconsistent conclusions. Thus, the current study was conducted to examine the relationship between menopausal hormone therapy (MHT) use and development of liver cancer. A nested case-control study was conducted within the United Kingdom’s Clinical Practice Research Datalink (CPRD). Controls were matched, at a 4-to-1 ratio, to women diagnosed with primary liver cancer between 1988 and 2011. A second match, based on whether the cases and controls had diabetes, was also conducted. Odds ratios (OR) and 95% confidence intervals (95%CI) for associations of MHT with liver cancer were estimated using conditional logistic regression adjusted for known risk factors. In the overall match, 339 women with liver cancer were matched to 1318 controls. MHT use was associated with a significantly lower risk of liver cancer (ORadj=0.58, 95%CI=0.37–0.90) especially among users of estrogen-only MHT (ORadj=0.44, 95%CI=0.22–0.88) and among past users (ORadj=0.53, 95%CI=0.32–0.88). Among the matched cases (n=58) and controls (n=232) with diabetes, the odds ratios were similar to the overall analysis (ORadj=0.57, 95%CI=0.09–3.53), but did not attain statistical significance. In the current study, MHT use, especially estrogen-only MHT use, was associated with a significantly lower risk of liver cancer. These results support the need of further investigation into whether hormonal etiologies can explain the variation in liver cancer incidence between men and women.