Purdie D M, Bain C J, Siskind V, Russell P, Hacker N F, Ward B G, Quinn M A, Green A C
Department of Social and Preventive Medicine, The University of Queensland, Medical School, Herston, Australia.
Br J Cancer. 1999 Oct;81(3):559-63. doi: 10.1038/sj.bjc.6690731.
It has been suggested that oestrogen replacement therapy is associated with risk of epithelial ovarian cancer of the endometrioid type. Using data from an Australian population-based case-control study, the relation between unopposed oestrogen replacement therapy and epithelial ovarian cancer, both overall and according to histological type, was examined. A total of 793 eligible incident cases of epithelial ovarian cancer diagnosed from 1990 to 1993 among women living in Queensland, New South Wales and Victoria were identified. These were compared with 855 eligible female controls selected at random from the electoral roll, stratified by age and geographic region. Trained interviewers administered standard questionnaires to obtain detailed reproductive and contraceptive histories, as well as details about hormone replacement therapy and pelvic operations. No clear associations were observed between use of hormone replacement therapy overall and risk of ovarian cancer. Unopposed oestrogen replacement therapy was, however, associated with a significant increase in risk of endometrioid or clear cell epithelial ovarian tumours (odds ratio (OR) 2.56; 95% confidence interval (CI) 1.32-4.94). In addition, the risk associated with oestrogen replacement therapy was much larger in women with an intact genital tract (OR 3.00; 95% CI 1.54-5.85) than in those with a history of either hysterectomy or tubal ligation. Post-menopausal oestrogen replacement therapy may, therefore, be a risk factor associated with endometrioid and clear cell tumours in particular. Additionally, the risk may be increased predominantly in women with an intact genital tract. These associations could reflect a possible role of endometriosis in the development of endometrioid or clear cell ovarian tumours.
有人提出，雌激素替代疗法与子宫内膜样型上皮性卵巢癌的风险相关。利用澳大利亚一项基于人群的病例对照研究的数据，研究了单纯雌激素替代疗法与上皮性卵巢癌之间的总体关系以及按组织学类型划分的关系。在昆士兰、新南威尔士和维多利亚州居住的女性中，共确定了1990年至1993年期间确诊的793例符合条件的上皮性卵巢癌新发病例。将这些病例与从选民名单中随机选取的855名符合条件的女性对照进行比较，并按年龄和地理区域进行分层。训练有素的访员发放标准问卷，以获取详细的生殖和避孕史，以及有关激素替代疗法和盆腔手术的详细信息。总体而言，未观察到激素替代疗法的使用与卵巢癌风险之间存在明显关联。然而，单纯雌激素替代疗法与子宫内膜样或透明细胞上皮性卵巢肿瘤的风险显著增加相关（比值比（OR）2.56；95%置信区间（CI）1.32 - 4.94）。此外，生殖道完整的女性中，雌激素替代疗法相关的风险（OR 3.00；95% CI 1.54 - 5.85）比有子宫切除术或输卵管结扎史的女性要大得多。因此，绝经后雌激素替代疗法可能特别是与子宫内膜样和透明细胞肿瘤相关的一个风险因素。此外，风险可能主要在生殖道完整的女性中增加。这些关联可能反映了子宫内膜异位症在子宫内膜样或透明细胞卵巢肿瘤发生发展中可能发挥的作用。
