Eeles R A, Tan S, Wiltshaw E, Fryatt I, A'Hern R P, Shepherd J H, Harmer C L, Blake P R, Chilvers C E
Gynaecological Oncology Unit, Royal Marsden Hospital, London.
BMJ. 1991 Feb 2;302(6771):259-62. doi: 10.1136/bmj.302.6771.259.
To evaluate whether hormone replacement therapy affects survival in women who have undergone bilateral salphingo-oophorectomy because of epithelial ovarian cancer.
Retrospective analysis by review of patients' notes and questionnaires completed by general practitioners to compare the overall survival and disease free survival in patients with ovarian cancer who did or did not receive hormone replacement therapy after diagnosis. Data were analysed by Cox regression, with hormone replacement therapy as a time dependent covariate because patients who received hormone replacement did so at different times after diagnosis.
Gynaecological oncology unit of Royal Marsden Hospital.
373 patients aged 50 years or younger who attended the hospital from 1972 to 1988. All of the women had undergone bilateral salpingoophorectomy for epithelial ovarian cancer. In all, 78 had received hormone replacement therapy, starting at a median of four months after diagnosis.
A questionnaire was sent to the general practitioners of all patients who were not recorded as having received hormone replacement therapy.
Overall survival and disease free survival.
There was no significant difference in survival between women receiving hormone replacement therapy and those not receiving it after accounting for the effects of other known prognostic factors (stage of cancer, differentiation of tumour, histological results, and time to relapse). The relative risk of dying in those who received hormone replacement therapy was 0.73 (95% confidence interval 0.44 to 1.20). In addition, there was no significant difference in disease free survival (relative risk in those receiving hormone replacement therapy was 0.90; 95% confidence interval 0.52 to 1.54).
This study shows that hormone replacement therapy is unlikely to have a detrimental effect on the prognosis of patients with ovarian cancer, but this would be shown conclusively only by a randomised controlled trial.
评估激素替代疗法是否会影响因上皮性卵巢癌而接受双侧输卵管卵巢切除术的女性的生存率。
通过查阅患者病历以及全科医生填写的问卷进行回顾性分析，以比较卵巢癌患者在诊断后接受或未接受激素替代疗法的总生存率和无病生存率。由于接受激素替代疗法的患者在诊断后的不同时间开始治疗，因此将激素替代疗法作为时间依赖性协变量，采用Cox回归分析数据。
皇家马斯登医院妇科肿瘤科。
1972年至1988年期间到该医院就诊的373名年龄在50岁及以下的患者。所有女性均因上皮性卵巢癌接受了双侧输卵管卵巢切除术。其中78人接受了激素替代疗法，中位起始时间为诊断后4个月。
向所有未记录接受过激素替代疗法的患者的全科医生发送问卷。
总生存率和无病生存率。
在考虑其他已知预后因素（癌症分期、肿瘤分化程度、组织学结果和复发时间）的影响后，接受激素替代疗法的女性与未接受该疗法的女性在生存率上没有显著差异。接受激素替代疗法者的死亡相对风险为0.73（95%置信区间为0.44至1.20）。此外，在无病生存率方面也没有显著差异（接受激素替代疗法者的相对风险为0.90；95%置信区间为0.52至1.54）。
本研究表明，激素替代疗法不太可能对卵巢癌患者的预后产生不利影响，但只有通过随机对照试验才能得出确凿结论。
