澳大利亚一项前瞻性队列研究：绝经期激素治疗（MHT）在诊断前后对卵巢癌生存的影响

Use of menopausal hormone therapy before and after diagnosis and ovarian cancer survival-A prospective cohort study in Australia

INTERNATIONAL JOURNAL OF CANCER

影响因子:4.7

分区:医学2区 / 肿瘤学2区

发表日期:2025 Jan 15

作者: Renhua Na, Susan J Jordan, Anna DeFazio, Merran Williams, Karen Livingstone, Andreas Obermair, Michael Friedlander, Peter Grant, Penelope M Webb,

DOI: 10.1002/ijc.35154

摘要

在卵巢癌诊断前使用激素治疗（MHT）与改善生存有关，但其作用是否因使用类型和持续时间而异尚无定论；关于治疗后MHT使用的相关数据，尤其是对健康相关生活质量（HRQOL）的影响，仍然稀缺。我们在澳大利亚一项前瞻性全国队列中研究了MHT在诊断前后对卵巢癌患者生存的影响，以及治疗后MHT使用与HRQOL的关系。采用Cox比例风险模型估算风险比（HR）及其95%置信区间（CI），并使用倾向得分减少偏倚。在诊断时处于围绝经期/绝经期的690名女性中，诊断前使用MHT显著提高卵巢癌特异性生存率26%；高等级浆液性癌（HGSC）中这种关联略强（HR=0.69，95%CI 0.54-0.87）。该关联不随使用的近期性或持续时间变化。在HGSC患者中，诊断前/围绝经期或≤55岁（n=259）女性，治疗后使用MHT与生存差异无关（HR=1.04，95%CI 0.48-2.22）。与非使用者相比，治疗后开始MHT的女性在开始前的整体HRQOL较差，且这种差异在开始后1-3个月仍然存在。总之，诊断前MHT使用与改善生存相关，尤以HGSC为甚。在≤55岁的女性中，治疗后MHT的使用与HGSC的较差生存无关。未来需要大规模研究以深入理解卵巢癌中的绝经期特异性HRQOL问题。

Abstract

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.