Na Renhua, Jordan Susan J, DeFazio Anna, Williams Merran, Livingstone Karen, Obermair Andreas, Friedlander Michael, Grant Peter, Webb Penelope M
Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
School of Public Health, University of Queensland, Brisbane, Australia.
Int J Cancer. 2025 Jan 15;156(2):280-292. doi: 10.1002/ijc.35154. Epub 2024 Sep 2.
Menopausal hormone therapy (MHT) use before ovarian cancer diagnosis has been associated with improved survival but whether the association varies by type and duration of use is inconclusive; data on MHT use after treatment, particularly the effect on health-related quality of life (HRQOL), are scarce. We investigated survival in women with ovarian cancer according to MHT use before and after diagnosis, and post-treatment MHT use and its association with HRQOL in a prospective nationwide cohort in Australia. We used Cox proportional hazards regression to estimate hazard ratios (HR) and 95% confidence intervals (CI) and propensity scores to reduce confounding by indication. Among 690 women who were peri-/postmenopausal at diagnosis, pre-diagnosis MHT use was associated with a significant 26% improvement in ovarian cancer-specific survival; with a slightly stronger association for high-grade serous carcinoma (HGSC, HR = 0.69, 95%CI 0.54-0.87). The associations did not differ by recency or duration of use. Among women with HGSC who were pre-/perimenopausal or aged ≤55 years at diagnosis (n = 259), MHT use after treatment was not associated with a difference in survival (HR = 1.04, 95%CI 0.48-2.22). Compared to non-users, women who started MHT after treatment reported poorer overall HRQOL before starting MHT and this difference was still seen 1-3 months after starting MHT. In conclusion, pre-diagnosis MHT use was associated with improved survival, particularly in HGSC. Among women ≤55 years, use of MHT following treatment was not associated with poorer survival for HGSC. Further large-scale studies are needed to understand menopause-specific HRQOL issues in ovarian cancer.
在卵巢癌确诊前使用绝经激素治疗（MHT）与生存率提高有关，但这种关联是否因使用类型和持续时间而异尚无定论；关于治疗后使用MHT的数据，尤其是其对健康相关生活质量（HRQOL）的影响，非常稀少。我们在澳大利亚一个全国性前瞻性队列中，根据卵巢癌患者确诊前后使用MHT的情况，以及治疗后使用MHT的情况及其与HRQOL的关联，对患者的生存率进行了调查。我们使用Cox比例风险回归来估计风险比（HR）和95%置信区间（CI），并使用倾向评分来减少指征性混杂因素。在690名确诊时处于围绝经期/绝经后的女性中，确诊前使用MHT与卵巢癌特异性生存率显著提高26%相关；对于高级别浆液性癌（HGSC），这种关联稍强（HR = 0.69，95%CI 0.54 - 0.87）。这种关联在使用的近期程度或持续时间方面没有差异。在确诊时处于围绝经期/绝经前或年龄≤55岁的HGSC女性中（n = 259），治疗后使用MHT与生存率差异无关（HR = 1.04，95%CI 0.48 - 2.22）。与未使用者相比，治疗后开始使用MHT的女性在开始使用MHT前报告的总体HRQOL较差，并且在开始使用MHT后1 - 3个月仍存在这种差异。总之，确诊前使用MHT与生存率提高相关，尤其是在HGSC中。在≤55岁的女性中，治疗后使用MHT与HGSC生存率降低无关。需要进一步的大规模研究来了解卵巢癌中特定于绝经的HRQOL问题。
