Risk of different histological types of postmenopausal breast cancer by type and regimen of menopausal hormone therapy
Risk of different histological types of postmenopausal breast cancer by type and regimen of menopausal hormone therapy
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DOI：
10.1002/ijc.23655
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发表时间：
2008-08-15
影响因子：
6.4
通讯作者：
Chang-Claude, Jenny
中科院分区：
文献类型：
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作者：
Fiesch-Janys, Dieter;Slanger, Tracy;Chang-Claude, Jenny
在德国进行的一项大型人群病例对照研究中，包括3，464例诊断时年龄在50 - 74岁的乳腺癌病例和6，657例基于人群和频率匹配的对照，我们研究了绝经激素治疗（HT）的类型，方案，时间和孕激素成分对绝经后乳腺癌风险的影响，并根据组织学类型。通过面对面访谈收集数据。Logistic和多分类Logistic回归分析用于估计比值比（OR）和95%置信区间（95%CI）。目前使用者浸润性乳腺癌的风险显著升高（OR，1.73，95%CI，1.55 - 1.94），并且在组织学类型上具有异质性（p <0.01），小叶癌和管状癌比导管癌高2倍以上。目前使用者的风险因HT的类型和治疗方案而显著不同，连续联合雌激素-孕激素治疗的年OR为1.05（95%CI，1.04 - 1.06），周期性EP治疗为1.03（95%CI，1.02 - 1.04），仅雌激素治疗为1.01（95%CI，1.00 - 1.03）。对于任何组织学类型，在停止使用HT 5年后，未观察到风险的统计学显著性增加。按方案分析孕激素含量显示，连续给予炔诺酮或左炔诺孕酮衍生孕激素的风险显著高于连续给予炔雌醇衍生孕激素的风险（OR，2.27，95% CI，1.98 - 2.62 vs. 1.47，95% CI，1.12 - 1.93，p = 0.003），这可能由剂量而不是孕激素类型解释。这些数据表明，与绝经期HT相关的风险因HT的类型和治疗方案以及乳腺癌的组织学类型而异，并且可能因孕激素成分而异，这取决于有效剂量。(c)2008 Wiley-Liss，Inc.
In a large population-based case-control study in Germany, including 3,464 breast cancer cases aged 50-74 at diagnosis and 6,657 population based and frequency matched controls, we investigated the effects of menopausal hormone therapy (HT) by type, regimen, timing and progestagenic constituent on postmenopausal breast cancer risk overall and according to histological type. Data were collected by face-to-face interviews. Logistic and polytomous logistic regression analysis were used to estimate odds ratios (OR) and 95%-confidence intervals (95% CI). Risk of invasive breast cancer was significantly elevated in current users (OR, 1.73, 95% CI, 1.55-1.94) and heterogeneous by histological type (p < 0.01), being more than 2-fold higher for lobular and tubular than for ductal cancer. Risks for current users varied significantly by type and regimen of HT, with ORs per year of use of 1.05 (95% CI, 1.04-1.06) for continuous combined estrogen-progestagen, 1.03 (95% CI, 1.02-1.04) for cyclical EP and 1.01 (95% CI, 1.00-1.03) for estrogen-only therapy. No statistically significant increase in risk was observed after 5 years of cessation of HT use for any histological type. Analyses of progestagenic content by regimen revealed a significantly higher risk for continuously administered norethisterone- or levonorgestrel-derived progestagens than for continuously administered progesterone-derived progestagens (OR, 2.27, 95% CI, 1.98-2.62 vs. 1.47, 95% CI, 1.12-1.93, respectively, p = 0.003), which may be explained by dose rather than type of progestagen. These data suggest that the risks associated with menopausal HT differ by type and regimen of HT and histological type of breast cancer and may vary by progestagenic component, depending on the effective dose.(c) 2008 Wiley-Liss, Inc.