雌激素替代治疗降低了肝癌女性患者的发病风险并延长了其生存时间。
Estrogen Replacement Reduces Risk and Increases Survival Times of Women With Hepatocellular Carcinoma.
机构信息
Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, Texas.
出版信息
Clin Gastroenterol Hepatol. 2017 Nov;15(11):1791-1799. doi: 10.1016/j.cgh.2017.05.036. Epub 2017 Jun 1.
BACKGROUND & AIMS: Environmental factors have been identified that affect risk of hepatocellular carcinoma (HCC), but little is known about the effects of sex hormones on liver cancer development or outcome. The authors investigated whether menopause hormone therapy (MHT) affects risk, age at onset, or outcome of HCC.
METHODS
We performed a case-control study of 234 female patients treated for HCC at a tertiary medical center and with 282 healthy women (controls) from January 1, 2004 through May 31, 2015. We collected detailed information on environmental exposures, ages of menarche and menopause, hysterectomies, and uses of birth control and MHT. We performed multivariable logistic and Cox regression analyses to determine the independent effects of factors associated with women on risk and clinical outcome in HCC. The primary outcomes were effect of MHT on HCC risk, the relationship between MHT with hepatitis virus infection on HCC development, and effect of MHT on age at HCC onset or survival after diagnosis of HCC.
RESULTS
The estimated adjusted odds ratio (AOR) for HCC in women who ever used estrogen was 0.53 (95% confidence interval [CI], 0.32-0.88). This association was supported by the older age of HCC onset among estrogen users (mean, 64.5 ± 0.9 years) vs nonusers (mean 59.2 ± 1.1 years; P = .001) and the reduced risk of HCC among long-term users (more than 5 years) (AOR, 0.36; 95% CI, 0.20-0.63). Users of estrogen also had a reduced risk for hepatitis-associated HCC: AOR for users, 4.37 (95% CI, 1.67-11.44) vs AOR for nonusers, 17.60 (95% CI, 3.88-79.83). Estrogen use reduced risk of death from HCC (hazard ratio, 0.55; 95% CI, 0.40-0.77; P = .01). Median overall survival times were 33.5 months for estrogen users (95% CI, 25.7-41.3 months) and 24.1 months for nonusers (95% CI, 19.02-29.30 months; P = .008).
CONCLUSION
In a case-control study of women with HCC vs female control subjects at a single center, we associated use of estrogen MHT with reduced risk of HCC and increased overall survival times of patients with HCC. Further studies are needed to determine the benefits of estrogen therapy for women and patients with HCC, and effects of tumor expression of estrogen receptor.
背景与目的
已确定一些环境因素会影响肝细胞癌（HCC）的风险，但对于性激素对肝癌发展或结局的影响知之甚少。作者研究了绝经后激素治疗（MHT）是否会影响 HCC 的风险、发病年龄或结局。
方法
我们对 2004 年 1 月 1 日至 2015 年 5 月 31 日在一家三级医疗中心接受 HCC 治疗的 234 名女性患者（病例组）和 282 名健康女性（对照组）进行了病例对照研究。我们收集了有关环境暴露、初潮和绝经年龄、子宫切除术以及避孕药和 MHT 使用情况的详细信息。我们进行了多变量逻辑和 Cox 回归分析，以确定与女性相关的因素对 HCC 风险的独立影响以及 MHT 与 HCC 发展相关的乙型肝炎病毒感染之间的关系。主要结局是 MHT 对 HCC 风险的影响、MHT 与乙型肝炎病毒感染对 HCC 发病年龄或 HCC 诊断后生存时间的关系以及 MHT 对 HCC 发病年龄或 HCC 诊断后生存时间的影响。
结果
曾经使用过雌激素的女性患 HCC 的估计调整后比值比（AOR）为 0.53（95%置信区间[CI]，0.32-0.88）。这一关联得到了以下事实的支持：雌激素使用者的 HCC 发病年龄较大（平均 64.5±0.9 岁），而非使用者的 HCC 发病年龄较小（平均 59.2±1.1 岁；P=0.001），以及长期使用者（超过 5 年）的 HCC 风险降低（AOR，0.36；95%CI，0.20-0.63）。雌激素使用者也有较低的乙型肝炎相关 HCC 风险：使用者的 AOR 为 4.37（95%CI，1.67-11.44），而非使用者的 AOR 为 17.60（95%CI，3.88-79.83）。雌激素使用降低了 HCC 死亡风险（风险比，0.55；95%CI，0.40-0.77；P=0.01）。雌激素使用者的中位总生存时间为 33.5 个月（95%CI，25.7-41.3 个月），而非使用者为 24.1 个月（95%CI，19.02-29.30 个月；P=0.008）。
结论
在对单中心 HCC 女性患者与女性对照者进行的病例对照研究中，我们发现使用雌激素 MHT 与 HCC 风险降低和 HCC 患者总体生存时间延长相关。需要进一步研究来确定雌激素治疗对女性和 HCC 患者的益处，以及肿瘤中雌激素受体的表达的影响。
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