Kaufman D W, Kelly J P, Welch W R, Rosenberg L, Stolley P D, Warshauer M E, Lewis J, Woodruff J, Shapiro S
Slone Epidemiology Unit, School of Public Health, Boston University School of Medicine, Brookline, MA.
Am J Epidemiol. 1989 Dec;130(6):1142-51. doi: 10.1093/oxfordjournals.aje.a115441.
The relation of noncontraceptive estrogen use to epithelial ovarian cancer was evaluated in a case-control study conducted in hospitals mainly in the northeastern United States. There were 377 cases diagnosed within the year before hospital admission and 2,030 hospital controls; data were collected by interview in the hospital. Compared with women who never took noncontraceptive estrogens, the overall relative risk estimate for women whose estrogen use lasted at least one year and was not combined with progestogens or testosterone was 1.2 (95% confidence interval (CI) 0.8-1.9), after taking into account risk factors for ovarian cancer. There were 55 cases of the endometrioid, clear cell, or malignant mixed mesodermal cell type; the corresponding relative risk estimate was 0.9 (95% CI 0.3-3.0). There were 26 cases of undifferentiated cell type, with a relative risk estimate of 3.6 (95% CI 1.2-11). Relative risk estimates were similar in a subset of the cases (57%) for which pathology slides were reviewed. For estrogen use of long duration, use of high-dose preparations, or use in the distant past, the relative risk estimates were not significantly different from 1.0. The estimates were elevated for some categories of use, but not consistently--for example, for an interval of 5-9 years since estrogen use began (relative risk (RR) = 2.7), but not after shorter or longer intervals, and for use of conjugated estrogens with a dose of 0.3 mg (RR = 3.2) or 1.25 mg (RR = 2.4), but not for doses of 0.625 mg or 2.5 mg. The relative risk estimate was also elevated for use by nulliparous women (RR = 2.4). The results suggest that, overall, noncontraceptive estrogen use is not associated with the risk of epithelial ovarian cancer. Furthermore, our data do not support the hypothesis that estrogens increase the risk of endometrioid ovarian cancer. The elevated estimates could be due to multiple stratification of the data, but they should be explored in further studies, given the lethality of ovarian cancer and the common use of estrogens by postmenopausal women.
在美国东北部主要医院开展的一项病例对照研究中，评估了非避孕雌激素的使用与上皮性卵巢癌之间的关系。在入院前一年确诊了377例病例，选取2030名医院对照；通过在医院进行访谈收集数据。在考虑了卵巢癌的风险因素后，与从未使用过非避孕雌激素的女性相比，雌激素使用至少一年且未与孕激素或睾酮联合使用的女性的总体相对风险估计值为1.2（95%置信区间（CI）0.8 - 1.9）。有55例子宫内膜样、透明细胞或恶性混合中胚层细胞类型的病例；相应的相对风险估计值为0.9（95% CI 0.3 - 3.0）。有26例未分化细胞类型的病例，相对风险估计值为3.6（95% CI 1.2 - 11）。在对病理切片进行复查的部分病例（57%）中，相对风险估计值相似。对于长期使用雌激素、使用高剂量制剂或在过去很久之前使用雌激素的情况，相对风险估计值与1.0无显著差异。某些使用类别下的估计值有所升高，但并不一致——例如，自开始使用雌激素起5至9年的时间段（相对风险（RR）= 2.7），但在更短或更长时间段后则不然，以及使用剂量为0.3毫克（RR = 3.2）或1.25毫克（RR = 2.4）的结合雌激素时，但0.625毫克或2.5毫克剂量时则不然。未生育女性使用雌激素时相对风险估计值也有所升高（RR = 2.4）。结果表明，总体而言，非避孕雌激素的使用与上皮性卵巢癌风险无关。此外，我们的数据不支持雌激素会增加子宫内膜样卵巢癌风险这一假设。估计值升高可能是由于数据的多重分层，但鉴于卵巢癌的致死性以及绝经后女性对雌激素的普遍使用，应在进一步研究中对其进行探讨。
