Oral contraceptives and cancer of the liver: a review with two additional cases.
Oral contraceptives and cancer of the liver: a review with two additional cases.
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口服避孕药和肝癌：对另外两个病例的回顾。
DOI：
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发表时间：
1982
期刊：
影响因子：
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通讯作者：
Wood Wg
中科院分区：
文献类型：
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作者：
Helling Ts;Wood Wg
服用避孕药后的荷尔蒙环境会促进肝脏肿瘤的生长，特别是肝细胞腺瘤。使用避孕药也会导致肝癌的证据不太令人信服；本文描述了2名服用避孕药并患上肝细胞癌的年轻女性的病例。两名女性均无肝病病史，均死于癌症。肝细胞癌在美国是一种非常罕见的疾病，发病率在报告的尸检病例中为0.23-0.47%，通常被描述为主要发生在50岁以上的男性，并与既往存在的肝硬变有关。最近的调查显示，女性患者的比例更高；在美国，面临风险的患者现在包括没有既往肝病病史的育龄妇女。口服避孕药(OCS)对人体肝脏的影响包括：1)胆汁分泌功能受损；2)肝肿大并伴有外周和中带血窦充血；3)肝疱疹。OC使用者发生肝脏肿瘤的重要危险因素是：1)长期使用(1-3岁)，2)年龄超过30岁，3)使用高激素效力的化合物。含有甲孕醇的产品比那些含有乙炔雌二醇的产品受到的影响更大。OCS的使用与肝细胞癌的发展之间的联系尚不确定，但后者已与男性使用合成类固醇密切相关。具体地说，只涉及与OCS中使用的C-17取代的19-去甲肾上腺素密切相关的C-17取代的合成类固醇羟甲醇酮和甲基睾酮。研究还发现：1)女性肝细胞癌多见于育龄女性；2)女性肝细胞癌与肝脏良性肿瘤的发生有关。在明确诊断为肝肿瘤后，几乎一致建议在手术后退出OCS，以避免破裂和可能的死亡风险。
The hormonal milieu that follows the ingestion of contraceptive agents promotes the growth of hepatic tumors particularly hepatocellular adenomas. Evidence that the use of contraceptive drugs can also cause carcinoma of the liver is less convincing; this article describes the cases of 2 young women who had taken contraceptives and contracted hepatocellular carcinoma. Both women had no prior history of liver disease and died as a result of the carcinoma. Hepatocellular carcinoma has been a distinctly uncommon disease in the U.S. ranging in incidence from 0.23-0.47% in reported autopsy cases and being typically described as occurring mostly in men over 50 and associated with preexisting cirrhosis. Recent surveys show a greater proportion of female patients; in the U.S. patients at risk now include women in the reproductive age group with no history of prior liver disease. Some recorded changes in the human liver caused by oral contraceptives (OCs) include: 1) impairment of bile secretory function 2) hepatomegaly associated with peripheral and midzonal sinusoidal congestion and 3) peliosis hepatis. Significant risk factors in the occurrence of hepatic tumors in OC users are: 1) prolonged usage (1-3 years) 2) age over 30 and 3) use of compounds of high hormonal potency. Products containing mestranol have been implicated to a greater degree than those containing ethinyl estradiol. The link between use of OCs and development of hepatocellular carcinoma is not certain; however the latter has been firmly linked with the use of anabolic steroids in men. Specifically only the C-17 substituted anabolic steroids oxymetholone and methyltestosterone have been implicated which are closely related to the C-17 substituted 19-norsteroids used in OCs. The following observations have also been made: 1) when hepatocellular carcinoma occurs in women it is mostly in those of reproductive age and 2) OCs are associated with the development of benign hepatic tumors. Withdrawal from OCs is almost uniformly recommended after definitive diagnosis of a hepatic tumor along with surgery to avoid the risk of rupture and possible mortality.