Daling Janet R, Malone Kathleen E, Doody David R, Voigt Lynda F, Bernstein Leslie, Marchbanks Polly A, Coates Ralph J, Norman Sandra A, Weiss Linda K, Ursin Giske, Burkman Ronald T, Deapen Dennis, Folger Suzanne G, McDonald Jill A, Simon Michael S, Strom Brian L, Spirtas Robert
Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, Washington 98109-1024, USA.
Cancer Epidemiol Biomarkers Prev. 2003 Nov;12(11 Pt 1):1175-81.
This study was conducted to assess the histopathological features of breast cancers in women diagnosed with breast cancer at 50-64 years of age who have and have not used hormone replacement therapy (HRT). A case-case analysis of the tumors from women aged 50-64 years who participated in a multicenter population-based case-control study of invasive breast cancer was conducted. In-person interviews collected a detailed history of all episodes of hormone use. Information was collected on selected tumor characteristics from 2346 women with breast cancer. Polytomous logistic regression was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs), contrasting the histopathological characteristics of the tumors of women who used various regimens of HRT with those of women who have never used HRT. The tumors of cases who used each regimen of HRT were smaller and of earlier stage than those of non-HRT users. Adjustment for screening diminished the magnitude of the effect, and only cases who used estrogen alone (estrogen replacement therapy) had reduced odds of being diagnosed with later-stage disease (regional or distant) than cases who never used HRT (OR, 0.7; 95% CI, 0.6-0.9). Higher proportions of estrogen receptor (ER)- and progesterone receptor (PR)-positive tumors were seen in cases who used any regimen of HRT versus those who did not use HRT. However, after adjustment for age and race, only the tumors of cases who used continuous combined HRT remained more likely to be ER+ and PR+ [OR ER- = 0.6 (95% CI, 0.4-0.9) and OR PR- = 0.5 (95% CI, 0.4-0.7)]. The tumors of women with breast cancer who used HRT have some better prognostic factors than those of women who have not used HRT. However, with the exception of the results noted above, this advantage may be due to the racial and age differences in those who use the various regimens of HRT and the effect of more frequent screening among HRT users, leading to earlier diagnosis.
本研究旨在评估50至64岁确诊为乳腺癌且使用和未使用激素替代疗法（HRT）的女性乳腺癌的组织病理学特征。对参与一项基于多中心人群的浸润性乳腺癌病例对照研究的50至64岁女性的肿瘤进行病例对照分析。通过面对面访谈收集了所有激素使用情况的详细病史。收集了2346例乳腺癌女性患者的特定肿瘤特征信息。采用多分类逻辑回归计算比值比（OR）和95%置信区间（CI），对比使用不同HRT方案的女性与从未使用HRT的女性肿瘤的组织病理学特征。使用每种HRT方案的病例的肿瘤比未使用HRT者的肿瘤更小且分期更早。筛查因素的调整减小了效应的幅度，只有单独使用雌激素（雌激素替代疗法）的病例被诊断为晚期疾病（区域或远处转移）的几率低于从未使用HRT的病例（OR，0.7；95%CI，0.6 - 0.9）。与未使用HRT的病例相比，使用任何HRT方案的病例中雌激素受体（ER）和孕激素受体（PR）阳性肿瘤的比例更高。然而，在对年龄和种族进行调整后，只有使用连续联合HRT的病例的肿瘤更有可能为ER +和PR + [OR ER- = 0.6（95%CI，0.4 - 0.9）和OR PR- = 0.5（95%CI，0.4 - 0.7）]。使用HRT的乳腺癌女性患者的肿瘤比未使用HRT的女性患者具有一些更好的预后因素。然而，除上述结果外，这种优势可能归因于使用不同HRT方案的人群中的种族和年龄差异以及HRT使用者中更频繁筛查的影响，从而导致更早的诊断。
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