a Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden.
b Division of Cancer Studies , King's College London , London , UK.
Acta Oncol. 2019 Mar;58(3):290-295. doi: 10.1080/0284186X.2018.1549367. Epub 2019 Jan 18.
This study tested the hypothesis that contemporary menopausal hormonal therapy (MHT) increases the risk of biliary tract cancer. The risk of cancer of the biliary tract (gallbladder and extra-hepatic bile ducts) may be increased following estrogen exposure.
This was a nationwide population-based matched cohort study in Sweden. Data from the Swedish Prescribed Drug Register identified all women exposed to systemic MHT in 2005-2012. Group-level matching (1:3 ratio) was used to select women unexposed to MHT from the same study base, matched for history of delivery, thrombotic events, hysterectomy, age, smoking- and alcohol related diseases, obesity, and diabetes. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI).
Comparing 290,186 women exposed to MHT with 870,165 unexposed, MHT did not increase the OR of biliary tract cancer. The OR of gallbladder cancer was rather decreased in MHT users (OR 0.58, 95% CI 0.43-0.79), but this association became attenuated and statistically non-significant after adjusting for gallstone disease (OR 0.84, 95% CI 0.60-1.15). The OR of extra-hepatic bile duct cancers was 0.83 (95% CI 0.61-1.15). There were no clear differences when the analyses were stratified for estrogen or estrogen/progestogen combinations. MHT increased the risk of gallstone disease (OR 6.95, 95% CI 6.64-7.28).
Contemporary MHT does not seem to increase the risk of biliary tract cancer. The decreased risk of gallbladder cancer may be explained by the increased use of surgery for symptomatic gallstones in MHT users.
本研究检验了这样一个假设，即当代绝经激素治疗（MHT）会增加胆道癌的风险。雌激素暴露可能会增加胆道（胆囊和肝外胆管）癌症的风险。
这是一项在瑞典进行的全国性基于人群的匹配队列研究。从瑞典处方药物登记处获得的数据确定了所有在 2005 年至 2012 年期间接受全身性 MHT 治疗的女性。使用群组水平匹配（1:3 比例），从同一研究基础中选择未接受 MHT 治疗的女性，按照分娩史、血栓事件、子宫切除术、年龄、吸烟和饮酒相关疾病、肥胖和糖尿病进行匹配。使用条件逻辑回归计算比值比（OR）和 95%置信区间（CI）。
与 290186 名接受 MHT 治疗的女性相比，870165 名未接受 MHT 治疗的女性，MHT 并未增加胆道癌的 OR。MHT 使用者的胆囊癌 OR 反而降低（OR 0.58，95%CI 0.43-0.79），但在调整胆囊疾病后，这种关联减弱且统计学上无显著性（OR 0.84，95%CI 0.60-1.15）。肝外胆管癌的 OR 为 0.83（95%CI 0.61-1.15）。当按雌激素或雌激素/孕激素组合进行分层分析时，结果没有明显差异。MHT 增加了胆囊疾病的风险（OR 6.95，95%CI 6.64-7.28）。
当代 MHT 似乎不会增加胆道癌的风险。胆囊癌风险降低可能是由于 MHT 使用者中接受手术治疗有症状胆囊结石的增加所导致。
