Hormone replacement therapy and the risk of invasive epithelial ovarian cancer in Swedish women
Hormone replacement therapy and the risk of invasive epithelial ovarian cancer in Swedish women
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DOI：
10.1093/jnci/94.7.497
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发表时间：
2002-04-03
影响因子：
10.3
通讯作者：
Persson, IR
中科院分区：
文献类型：
--
作者：
Riman, T;Dickman, PW;Persson, IR
背景：雌激素替代疗法(ERT)主要用于缓解更年期症状，但会增加妇女患子宫内膜癌和上皮性卵巢癌(EOC)的风险。在激素替代疗法(HRT)中，雌激素通常与孕激素联合使用，以降低子宫内膜癌的风险。关于激素替代疗法(包括孕激素)和卵巢癌风险之间的关联的数据有限。这项全国性的病例对照研究考察了顺序添加孕激素(HRTsp)和持续添加孕激素(HRTcp)的HRT方案对EOC风险的影响。方法：1993-1995年间，我们登记了655例经组织学证实的卵巢癌患者和3899名随机选择的人群对照，年龄均为50-74岁。有关HRT使用的数据是通过邮寄的问卷收集的。采用非条件Logistic回归估计多变量调整后的优势比(OR)和95%可信区间(CI)。结果：与从未使用过ERT(OR=1.43，95%CI=1.02~2.00)和HRTSP(OR=1.54，95%CI=1.15~2.05)的患者相比，曾经使用过ERT的患者发生卵巢癌的风险较高，浆液型、粘液型和子宫内膜型的风险较高。在所有类型的EOC中，激素使用超过10年的风险增加最大。与从未使用HRTcp相比，使用HRTcp与EoC风险增加无关(OR=1.02，95%CI=0.73~1.43)。与曾经使用HRTcp的患者相比，HRTSP患者发生EOC的风险显著增加(OR=1.78，95%CI=1.05~3.01)。口服和阴道应用低效雌激素后的ORS分别为1.18(95%CI=0.89~1.55)和1.33(95%CI=1.03~1.72)，但EOC风险与用药时间无关。结论：曾经使用ERT和HRTSP但不使用HRTcp的患者发生EOC的风险可能增加。
Background: Estrogen replacement therapy (ERT), which is mainly used to relieve climacteric symptoms, increases a woman's risk for uterine endometrial cancer and epithelial ovarian cancer (EOC). Estrogens are often combined with progestins in hormone replacement therapy (HRT) to reduce the risk of uterine endometrial cancer. Data on the association between HRT including progestins and EOC risk are limited. This nationwide case-control study examined EOC risk in relation to HRT regimens with sequentially added progestins (HRTsp) and continuously added progestins (HRTcp). Methods: Between 1993 and 1995, we enrolled 655 histologically verified incident case patients with EOC and 3899 randomly selected population controls, all 50-74 years of age. Data on HRT use were collected through mailed questionnaires. Multivariate-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by the use of unconditional logistic regression. Results: Risks of EOC were elevated among ever users as compared with never users of both ERT (OR = 1.43, 95% CI = 1.02 to 2.00) and HRTsp (OR = 1.54, 95% CI = 1.15 to 2.05); risks were elevated for serous, mucinous, and endometrioid subtypes. For all EOC types combined, the greatest risk increases were seen with hormone use exceeding 10 years. Ever use of HRTcp was not associated with increased EOC risk relative to HRTcp never use (OR = 1.02,95% CI = 0.73 to 1.43). The risk of EOC was elevated among HRTsp ever users as compared with HRTcp ever users (OR = 1.78, 95% CI = 1.05 to 3.01). ORs for EOC after ever use of low-potency estrogens were 1.18 (95% CI = 0.89 to 1.55) for oral and 1.33 (95% CI = 1.03 to 1.72) for vaginal applications, but no relationship was seen between EOC risk and duration of use. Conclusion: Ever users of ERT and HRTsp but not HRTcp may be at increased risk of EOC.