在诊断和卵巢癌生存之前和之后使用更年期激素疗法 - 澳大利亚的前瞻性队列研究
Use of menopausal hormone therapy before and after diagnosis and ovarian cancer survival-A prospective cohort study in Australia
影响因子:4.70000
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,
摘要
在卵巢癌诊断之前使用更年期激素治疗（MHT）与生存率的提高有关，但是这种关联是否随使用类型和使用时间而变化，这是不确定的。治疗后MHT使用的数据，特别是对健康相关生活质量（HRQOL）的影响。我们根据MHT诊断前后的MHT使用研究了卵巢癌妇女的生存，治疗后MHT使用及其与HRQOL的相关性在澳大利亚的一个前瞻性全国人群中。我们使用COX比例危害回归对估计危险比（HR）和95％的置信区间（CI）和倾向得分来减少指示混淆。在诊断后的690名女性/绝经后妇女中，使用前的MHT使用前，使用卵巢癌特异性的生存率显着26％。高级浆液性癌的关联略牢固（HGSC，HR = 0.69，95％CI 0.54-0.87）。关联因新近度或使用时间而没有差异。在诊断前/临床前或≤55岁的HGSC女性中，治疗后使用MHT与生存差异无关（HR = 1.04，95％CI 0.48-2.22）。与非用户相比，在治疗后开始使用MHT的妇女在开始MHT之前的总体HRQOL较差，并且在开始MHT后1-3个月仍然看到这种差异。总之，诊断前MHT的使用与提高生存率有关，尤其是在HGSC中。在≤55岁的女性中，治疗后使用MHT与HGSC的生存率较差有关。还需要进一步的大规模研究来了解卵巢癌的更年期特异性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.