Riman Tomas, Dickman Paul W, Nilsson Staffan, Correia Nestor, Nordlinder Hans, Magnusson Cecilia M, Weiderpass Elisabete, Persson Ingemar R
Department of Obstetrics and Gynecology, Falu Hospital, Falun, Sweden.
J Natl Cancer Inst. 2002 Apr 3;94(7):497-504. doi: 10.1093/jnci/94.7.497.
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).
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.
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.
Ever users of ERT and HRTsp but not HRTcp may be at increased risk of EOC.
雌激素替代疗法（ERT）主要用于缓解更年期症状，但会增加女性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，雌激素常与孕激素联合使用以降低子宫内膜癌的风险。关于含孕激素的HRT与EOC风险之间关联的数据有限。这项全国性病例对照研究调查了序贯添加孕激素的HRT方案（HRTsp）和连续添加孕激素的HRT方案（HRTcp）与EOC风险的关系。
1993年至1995年期间，我们纳入了655例经组织学证实的EOC新发病例患者和3899名随机选取的50 - 74岁的人群对照。通过邮寄问卷收集HRT使用数据。使用无条件逻辑回归估计多变量调整后的优势比（OR）和95%置信区间（CI）。
与从未使用过ERT（OR = 1.43，95% CI = 1.02至2.00）和HRTsp（OR = 1.54，95% CI = 1.15至2.05）相比，曾经使用者患EOC的风险升高；浆液性、黏液性和子宫内膜样亚型的风险升高。对于所有合并的EOC类型，激素使用超过10年时风险增加最大。与从未使用过HRTcp相比，曾经使用过HRTcp与EOC风险增加无关（OR = 1.02，95% CI = 0.73至1.43）。与曾经使用过HRTcp的人相比，曾经使用过HRTsp的人患EOC的风险升高（OR = 1.78，95% CI = 1.05至3.01）。曾经使用低效雌激素后，口服雌激素患EOC的OR为1.18（95% CI = 0.89至1.55），阴道使用雌激素患EOC 的OR为1.33（95% CI = 1.03至1.72），但EOC风险与使用持续时间之间无关联。
曾经使用过ERT和HRTsp而非HRTcp的人可能患EOC的风险增加。
