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首页 » JAMA » JAMA:激素治疗与罹患卵巢癌风险的增加有关

JAMA:激素治疗与罹患卵巢癌风险的增加有关

来源:EurekAlert! 2009-07-16 15:50

据7月15日刊JAMA上的一则研究披露,与那些从来没有接受过激素治疗的妇女相比,那些现在正在服用激素或是在过去曾经服用过激素的妇女,其罹患卵巢癌的风险会增加,这种风险的增加与激素使用的时间长短、制剂配方、雌激素剂量、治疗方式以及给药途径无关。

对卵巢癌的原发性预防是富有挑战性的,因为人们对其发病原因所知甚少。根据文章的背景资料,有研究表明,那些接受绝经后激素治疗(HT)的妇女,其罹患卵巢癌的风险会增加。有关激素配方、治疗方法以及给药途径所造成的不同影响的数据十分有限。

Rigshospitalet, Copenhagen University, Denmark的Lina Steinrud M?rch, M.Sc.及其同僚开展了一项研究,旨在对与激素疗法的使用与卵巢癌风险之间的关联进行调查。该项研究通过与丹麦国家登记记录挂钩而纳入的研究对象包括从1995年到2005年期间所有的年龄在50-79岁之间的丹麦妇女。来自National Register of Medicinal Product Statistics的处方药数据提供给研究人员有关HT使用的最新的个人资料。National Cancer Register和Pathology Register则提供给研究人员有关卵巢癌发病率的数据。这项分析中一共包括90万9946名没有罹患对激素敏感的癌症或是那些没有摘除双侧卵巢的妇女。在随访结束的时候,有63%的妇女没有接受过HT,有22%的妇女在过去服用过激素,有9%的妇女是现今的激素服用者。在激素的现今服用者中,有46%的人服用激素的时间在7年以上。

在为期平均8年的随访中,有3068人发现患有卵巢癌。在这些患者中,有2681人所罹患的是上皮性肿瘤(这是卵巢癌中的一种)。与从来没有服用过激素者相比,那些现行接受HT的妇女,其罹患卵巢癌的总体风险增加了38%。如果仅分析上皮性卵巢癌的发病率,与从来没有接受过HT的人相比,现行接受HT的人的相对风险增加了44%,而先前接受过HT的人的风险则增加了15%。卵巢癌及上皮性卵巢癌的风险没有因为接受HT的时间增加而有显著的增加。

罹患卵巢癌的风险会随着与最后接受HT治疗的时间的延长而下降。罹患卵巢癌的风险不会因为制剂的配方、治疗计划、孕酮的类型或给药途径而呈现显著的差别。

罹患卵巢癌的绝对风险表明,在每年服用激素的妇女中,大约每8300人中罹患卵巢癌者可能会多增加一人。文章的作者写道:“如果这种关联是因国关系的话,那么,服用激素在平均8年的随访期中已经导致了在丹麦大约140例的卵巢癌病例的增加,即,占本研究中的5%的卵巢癌病例。即使这一比率看来很低,但卵巢癌仍然是一种高度致命的肿瘤,因而,在决定是否应给予病人HT的时候这种风险仍然应该被考虑。”(生物谷Bioon.com)

生物谷推荐原始出处:

JAMA. 2009;302(3):298-305.

Hormone Therapy and Ovarian Cancer

Lina Steinrud M?rch, MSc; Ellen L?kkegaard, MD, PhD; Anne Helms Andreasen, MSc; Susanne Krüger-Kj?r, MD, DrMSci; ?jvind Lidegaard, MD, DrMSci

Context  Studies have suggested an increased risk of ovarian cancer among women taking postmenopausal hormone therapy. Data are sparse on the differential effects of formulations, regimens, and routes of administration.

Objective  To assess risk of ovarian cancer in perimenopausal and postmenopausal women receiving different hormone therapies.

Design and Setting  Nationwide prospective cohort study including all Danish women aged 50 through 79 years from 1995 through 2005 through individual linkage to Danish national registers. Redeemed prescription data from the National Register of Medicinal Product Statistics provided individually updated exposure information. The National Cancer Register and Pathology Register provided ovarian cancer incidence data. Information on confounding factors and effect modifiers was from other national registers. Poisson regression analyses with 5-year age bands included hormone exposures as time-dependent covariates.

Participants  A total of 909 946 women without hormone-sensitive cancer or bilateral oophorectomy.

Main Outcome Measure  Ovarian cancer.

Results  In an average of 8.0 years of follow-up (7.3 million women-years), 3068 incident ovarian cancers, of which 2681 were epithelial cancers, were detected. Compared with women who never took hormone therapy, current users of hormones had incidence rate ratios for all ovarian cancers of 1.38 (95% confidence interval [CI], 1.26-1.51) and 1.44 (95% CI, 1.30-1.58) for epithelial ovarian cancer. The risk declined with years since last use: 0 to 2 years, 1.22 (95% CI, 1.02-1.46); more than 2 to 4 years, 0.98 (95% CI, 0.75-1.28); more than 4 to 6 years, 0.72 (95% CI, 0.50-1.05), and more than 6 years, 0.63 (95% CI, 0.41-0.96). For current users the risk of ovarian cancer did not differ significantly with different hormone therapies or duration of use. The incidence rates in current and never users of hormones were 0.52 and 0.40 per 1000 years, respectively, ie, an absolute risk increase of 0.12 (95% CI, 0.01-0.17) per 1000 years. This approximates 1 extra ovarian cancer for roughly 8300 women taking hormone therapy each year.

Conclusion  Regardless of the duration of use, the formulation, estrogen dose, regimen, progestin type, and route of administration, hormone therapy was associated with an increased risk of ovarian cancer.

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