绝经激素治疗对黑色素瘤和角质形成细胞皮肤癌风险的影响：观察性研究的系统评价和荟萃分析
The effect of menopausal hormone therapy on the risk of melanoma and keratinocyte skin cancer: A systematic review and meta-analysis of observational studies.
作者信息
Lallas Konstantinos, Anagnostis Panagiotis, Theocharis Patroklos, Boureka Eirini, Kyrgidis Athanasios, Klonos Eleftherios, Papazisis Georgios, Apalla Zoe, Lallas Aimilios, Vakirlis Efstratios
机构信息
Department of Medical Oncology, Papageorgiou General Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece.
Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
出版信息
Maturitas. 2023 Feb;168:20-28. doi: 10.1016/j.maturitas.2022.10.010. Epub 2022 Nov 4.
BACKGROUND
Whether menopausal hormone therapy (MHT) increases the risk of skin cancer is controversial.
AIM
To systematically review and meta-analyze evidence regarding the association of MHT with the risk of melanoma and keratinocyte cancer (KC).
MATERIAL AND METHODS
A comprehensive literature search was conducted of the PubMed, Scopus and Cochrane databases, through to 30 October 2021. Skin neoplasms were divided into melanoma and KC. In the latter category, both basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) were considered. The results are presented as hazard ratios (HR) with 95 % confidence intervals (CI). The I index was used to assess heterogeneity. Subgroup analysis and sensitivity analysis were also conducted in order to explore potential differences among studies.
RESULTS
Twenty-seven studies were included in the qualitative and 23 in the quantitative analysis, with a total of 2,612,712 menopausal women (25,126 with skin cancer; 20,150 with melanoma). MHT was associated with an increased risk of melanoma (HR 1.11; 95 % CI 1.05-1.19; I 45%). With regard to MHT type, both estrogen monotherapy (HR 1.22, 95 % CI 1.16-1.29; I 0%) and estrogen in combination with progestogen (HR 1.11, 95 % CI 1.05-1.18, I 26%) significantly increased that risk. Regarding melanoma subtype, superficial spreading melanoma (SSM) and lentigo maligna melanoma (LMM) were the only histologic subtypes associated with MHT use. MHT was also associated with an increased risk of KC (HR 1.17, 95 % CI 1.04-1.31, I 83%), specifically BCC (HR 1.22, 95 % CI 1.12-1.32; I 29%). Longer duration (>5 years) of MHT, current use and estrogen monotherapy were associated with an increased KC risk compared with no use.
CONCLUSION
The use of MHT by postmenopausal women was associated with an increased risk of melanoma and KC. This risk was higher for current MHT users and those treated for over 5 years.
背景
绝经激素治疗（MHT）是否会增加皮肤癌风险存在争议。
目的
系统评价和荟萃分析关于MHT与黑色素瘤和角质形成细胞癌（KC）风险关联的证据。
材料与方法
对PubMed、Scopus和Cochrane数据库进行全面文献检索，截至2021年10月30日。皮肤肿瘤分为黑色素瘤和KC。在KC类别中，同时考虑基底细胞癌（BCC）和鳞状细胞癌（SCC）。结果以风险比（HR）及95%置信区间（CI）呈现。I指数用于评估异质性。还进行了亚组分析和敏感性分析，以探索研究间的潜在差异。
结果
定性分析纳入27项研究，定量分析纳入23项研究，共有2612712名绝经后女性（25126例患皮肤癌；20150例患黑色素瘤）。MHT与黑色素瘤风险增加相关（HR 1.11；95%CI 1.05 - 1.19；I 45%）。就MHT类型而言，雌激素单药治疗（HR 1.22，95%CI 1.16 - 1.29；I 0%）和雌激素联合孕激素治疗（HR 1.11，95%CI 1.05 - 1.18，I 26%）均显著增加该风险。关于黑色素瘤亚型，浅表扩散性黑色素瘤（SSM）和恶性雀斑样痣黑色素瘤（LMM）是仅与使用MHT相关的组织学亚型。MHT还与KC风险增加相关（HR 1.17，95%CI 1.04 - 1.31，I 83%），特别是BCC（HR 1.22，95%CI 1.12 - 1.32；I 29%）。与未使用相比，MHT使用时间较长（>5年）、当前使用以及雌激素单药治疗与KC风险增加相关。
结论
绝经后女性使用MHT与黑色素瘤和KC风险增加相关。当前使用MHT者以及治疗超过5年者的该风险更高。
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