更年期激素治疗和卵巢和子宫内膜癌症:妇女健康倡议随机试验的长期随访
Rowan T Chlebowski1, Aaron K Aragaki2, Kathy Pan3
1The Lundquist Institute, Torrance, CA.
概括
结合性马类雌激素 (CEE) 单独增加了卵巢癌的风险和死亡率. 然而,CEE加上美德乙酸 (MPA) 没有增加卵巢癌风险,但显著降低了子宫内膜癌的发病率.
科学领域:
- 妇科瘤学 妇科瘤学
- 激素治疗研究研究 激素治疗研究
- 临床试验分析
背景情况:
- 更年期激素治疗 (MHT) 的使用广泛,但其对妇科癌症的长期影响需要澄清.
- 以前的研究已经产生了相互矛盾的结果,关于MHT与卵巢和子宫内膜癌风险之间的关联.
- 了解这些风险对于绝经后妇女的临床决策至关重要.
研究的目的:
- 评估单独和与美德酸 (MPA) 结合的结合性马雌激素 (CEE) 对卵巢和子宫内膜癌发病率和死亡率的长期影响.
- 分析来自妇女健康倡议 (WHI) 随机临床试验的数据,以确定这些具体结果.
- 提供基于证据的见解,了解不同MHT方案的安全概况.
主要方法:
- 分析来自两项大型,随机的,安慰剂对照的临床试验的数据. 妇女健康倡议.
- 包括50-79岁的绝经后妇女,为有子宫的妇女 (CEE + MPA与安慰剂) 和先前进行过子宫切除的妇女 (CEE-单独与安慰剂) 提供专门的手臂.
- 长期跟踪 (长达20年) 以评估癌症发病率,死亡率和诊断后的存活率.
主要成果:
- 与安慰剂相比,单独结合的马类雌激素 (CEE) 显著增加了卵巢癌发病率 (HR, 2.04) 和死亡率.
- CEE加上麦德洛西孕酸 (MPA) 并没有显著增加卵巢癌发病率 (HR,1.14) 或死亡率.
- 与安慰剂相比,CEE加MPA显著降低了子宫内膜癌发病率 (HR,0.72).
结论:
- 单独结合的马类雌激素 (CEE) 与卵巢癌发病率和死亡率的风险增加有关.
- 结合CEE和美德酸 (MPA) 不会增加卵巢癌的风险,并提供对子宫内膜癌的保护作用.
- 这些发现突出了MHT配方对妇科癌症风险和死亡率的差异性影响.
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