Kotsopoulos Joanne, Lubinski Jan, Neuhausen Susan L, Lynch Henry T, Rosen Barry, Ainsworth Peter, Moller Pal, Ghadirian Parviz, Isaacs Claudine, Karlan Beth, Sun Ping, Narod Steven A
Centre for Research in Women's Health, 790 Bay Street, 7th Floor, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada M5G 1N8.
Gynecol Oncol. 2006 Jan;100(1):83-8. doi: 10.1016/j.ygyno.2005.07.110. Epub 2005 Aug 31.
Hormone replacement therapy (HRT) is commonly prescribed to alleviate the climacteric symptoms of menopause. Recent findings from the Women's Health Initiative has raised questions about the routine use of HRT due to the increased observed incidence of cardiovascular disease and of breast and ovarian cancers in the treatment arm of the trial. In the general population, the association between HRT use and risk of ovarian cancer has not yet been resolved. This association has not been evaluated in BRCA1 or BRCA2 mutation carriers who face very high lifetime risks of both breast and ovarian cancers.
We conducted a matched case-control study on 162 matched sets of women who carry a deleterious mutation in either the BRCA1 or BRCA2 gene. Women who had been diagnosed with ovarian cancer were matched to control subjects by mutation, year of birth, and age at menopause. Information on HRT use was derived from a questionnaire routinely administered to women who were found to be carriers of a mutation in either gene. Conditional logistic regression was used to estimate the association between HRT use and the risk of ovarian cancer, stratified by mutation status and type of HRT.
Compared with those who had never used HRT, the odds ratio associated with ever use of HRT was 0.93 (95% CI = 0.56-1.56). There was no significant relationship with increasing duration of HRT use. There was a suggestion that progestin-based HRT regimens might protect against ovarian cancer (odds ratio = 0.57) but this association was not statistically significant (P = 0.20).
HRT use does not appear to adversely influence the risk of ovarian cancer in BRCA mutation carriers.
激素替代疗法（HRT）通常用于缓解更年期的潮热症状。女性健康倡议的最新研究结果引发了对常规使用HRT的质疑，因为在该试验的治疗组中观察到心血管疾病以及乳腺癌和卵巢癌的发病率增加。在一般人群中，HRT使用与卵巢癌风险之间的关联尚未明确。对于面临乳腺癌和卵巢癌终生风险极高的BRCA1或BRCA2突变携带者，尚未评估这种关联。
我们对162对携带BRCA1或BRCA2基因有害突变的女性进行了匹配病例对照研究。被诊断患有卵巢癌的女性通过突变、出生年份和绝经年龄与对照对象进行匹配。HRT使用信息来自对发现携带任一基因突變的女性常规发放的问卷。采用条件逻辑回归估计HRT使用与卵巢癌风险之间的关联，并按突变状态和HRT类型进行分层。
与从未使用过HRT的女性相比，曾经使用过HRT的女性的比值比为0.93（95%置信区间=0.56-1.56）。HRT使用时间的增加与之没有显著关系。有迹象表明基于孕激素的HRT方案可能预防卵巢癌（比值比=0.57），但这种关联没有统计学意义（P=0.20）。
在BRCA突变携带者中，使用HRT似乎不会对卵巢癌风险产生不利影响。
