Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Republic of Korea.
Department of Preventive Medicine, Institute of Health Services Research, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
BMC Gastroenterol. 2021 Nov 23;21(1):440. doi: 10.1186/s12876-021-02021-y.
The effect of menopausal hormone therapy (MHT) on gastrointestinal (GI) cancers is controversial, and no research has been conducted in the East. This study investigates the association between MHT and GI cancer risks in South Korea.
A prescription-based cohort study was conducted using the NHIS Sample Cohort (2002-2013) of Korea. We used 1:5 propensity score matching, and 22,577 MHT users and 111,113 non-users were selected. Kaplan-Meier survival curves with log-rank tests were used. Cox proportional hazard models were used to estimate hazard ratios (HR) with 95% confidence intervals (CI). Landmark analysis was used to determine dose-response relationship.
The median follow-up was 79.6 of months. Kaplan-Meier survival curve showed less frequent GI cancer diagnoses in MHT users compared to non-users (0.13 vs. 0.16 per 100,000 person-years). Menopausal hormone therapy was associated with decreased incidence of GI cancer (HR = 0.809, 95%CI = 0.691-0.946) and colorectal cancer (CRC) (HR = 0.757, 95%CI = 0.577-0.995). Gastric cancer (GC) incidence showed marginal significance (HR = 0.787, 95%CI = 0.605-1.023). The mortality from GI cancer was lower in MHT users than in non-users (HR = 0.737, 95%CI = 0.547-0.993). The relationship between MHT and GI cancer was stronger with increasing MHT dose in terms of both incidence (P = 0.0002) and mortality (P = 0.0064).
The association between MHT use and reduced risks of GI cancers was attributed to CRC and GC and showed a dose-response relationship in a population-based cohort study.
绝经激素治疗（MHT）对胃肠道（GI）癌症的影响存在争议，而在东亚地区尚未开展相关研究。本研究旨在探讨 MHT 与韩国 GI 癌症风险之间的关联。
采用韩国国民健康保险服务（NHIS）样本队列（2002-2013 年）进行基于处方的队列研究。我们使用 1:5 倾向评分匹配，选择了 22577 名 MHT 使用者和 111113 名非使用者。使用 Kaplan-Meier 生存曲线和对数秩检验。使用 Cox 比例风险模型估计风险比（HR）及其 95%置信区间（CI）。使用 landmark 分析确定剂量-反应关系。
中位随访时间为 79.6 个月。Kaplan-Meier 生存曲线显示，与非使用者相比，MHT 使用者中 GI 癌症诊断的频率较低（每 100000 人年分别为 0.13 和 0.16）。MHT 与 GI 癌症（HR=0.809，95%CI=0.691-0.946）和结直肠癌（CRC）（HR=0.757，95%CI=0.577-0.995）的发生率降低相关。胃癌（GC）的发生率具有显著的边缘意义（HR=0.787，95%CI=0.605-1.023）。与非使用者相比，MHT 使用者的 GI 癌症死亡率较低（HR=0.737，95%CI=0.547-0.993）。MHT 与 GI 癌症之间的关系随着 MHT 剂量的增加而增强，无论是在发病率（P=0.0002）还是死亡率（P=0.0064）方面。
在基于人群的队列研究中，MHT 的使用与 GI 癌症风险降低之间存在关联，这种关联归因于 CRC 和 GC，并呈现出剂量-反应关系。
