绝经后雌激素使用可降低HCC的风险

StephenW

In the Journals
Postmenopausal estrogen use reduces risk for HCC

Hassan MM, et al. Clin Gastroenterol Hepatol. 2017;doi:10.1016/j.cgh.2017.05.036.
June 6, 2017

New data revealed an association between postmenopausal estrogen use and a reduced risk for hepatocellular carcinoma and increased overall survival time in women with HCC.

“In view of the notable male predominance of HCC, several investigators raised the question about the importance of sex hormones in HCC risk and prognosis. The liver expresses estrogen and androgen receptors, both of which may act as transcription factors and may regulate expression of several regulatory genes involved in several pathways including those associated with cell proliferation and immune response,” the researchers wrote. “This study demonstrates 50% reduction in HCC risk development among women who used [menopause hormone therapy].”

Between Jan. 1, 2004, and May 31, 2015, the researchers enrolled 234 women with HCC and 282 women controls for the study. Patients were asked about their age of menarche, age of menopause and the history and details of hysterectomy, any birth control use and of pregnancy.

Significant demographic risk factors associated with HCC in women included non-white ethnicity (adjusted odds ratio = 0.27; 95% CI, 0.14-0.55), HCV (aOR = 71.6; 95% CI, 9.6-536.04), positive HBsAg (aOR = 13.95; 95% CI, 1.28-151.58) or anti-HBc (aOR = 2.98; 95% CI, 1.1-8.07), alcohol consumption (aOR = 2.9; 95% CI, 1.81-4.64), history of diabetes (aOR = 3.84; 95% CI, 1.96-7.5), obesity (aOR = 2.35; 95% CI 1-5.18), hypothyroidism (aOR = 2.43; 95% CI, 1.43-4.16) and family history of cancer (aOR = 1.79; 95% CI, 1.07-2.98).

Among the patients with HCC, 146 reported previous use of hormonal birth control. Use of progesterone was not associated with a reduced risk for HCC in the study cohort. Sixty-three patients with HCC reported using estrogen alone and this was associated with a reduced risk for HCC (aOR = 0.5; 95% CI, 0.29-0.86), compared with non-users. Use of any estrogen by duration remained significant in association with reduced risk for HCC at 5 years or less (aOR = 0.56; 95% CI, 0.34-1.02), 6 to 10 years (aOR = 0.32; 95% CI, 0.13-0.77) and more than 10 years (aOR = 0.45; 95% CI, 0.24-0.85).

Estrogen use was mainly found in patients (87 of 94) and controls (177 of 179) who were postmenopausal. Mean age of HCC onset was higher in patients with history of estrogen use compared with non-users (64.5 vs. 59.2 years; P = .001). Overall survival time was longer among patients with history of estrogen use compared with non-users (P = .008). After controlling for all confounding factors of HCC overall survival, estrogen use was significantly associated with a 45% reduced mortality rate (adjusted hazard ratio = 0.55; 95% CI, 0.4-0.77).

“This study provides robust epidemiological evidence for the benefits of postmenopausal use of estrogen replacement against HCC development and has been corroborated by previous studies,” the researchers wrote. “This study ... [highlights] survival improvement among women with HCC who used estrogen replacement, after controlling for clinical prognostic factors, which raises the questions of whether similar effects can be observed in men who ever experienced hormonal exposure and whether estrogen can be used in targeted therapy for a selected population based on tumor expression and types of estrogen receptors.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.

StephenW

绝经后雌激素使用可降低HCC的风险

Hassan MM，et al。胃肠激素肝素2017; DOI：10.1016 / j.cgh.2017.05.036。
2017年6月6日

新数据揭示了绝经后雌激素使用与肝细胞癌风险降低之间的关系，并增加了HCC女性的总生存时间。

“鉴于HCC的显着男性优势，一些调查人员提出了性激素在HCC风险和预后中的重要性的问题。研究人员写道，肝脏表达雌激素和雄激素受体，两者都可以作为转录因子，并且可以调节参与几种途径的几种调节基因的表达，包括与细胞增殖和免疫应答有关的途径。 “这项研究表明使用[更年期激素治疗]的女性HCC风险发展降低了50％。”

2004年1月1日至2015年5月31日，研究人员共纳入234名女性HCC和282名女性对照。被问及患有月经初潮，绝经年龄，子宫切除术的历史和细节，任何避孕使用和怀孕的患者。

与女性HCC相关的重大人口危险因素包括非白种人（调整后的优势比= 0.27; 95％CI，0.14-0.55），HCV（aOR = 71.6; 95％CI，9.6-536.04），阳性HBsAg（aOR = （95％CI，1.28-151.58）或抗HBc（aOR = 2.98; 95％CI，1.1-8.07），饮酒量（aOR = 2.9; 95％CI，1.81-4.64），糖尿病史（aOR = （aOR = 2.35; 95％CI 1-5.18），甲状腺功能减退症（aOR = 2.43; 95％CI，1.43-4.16）和癌症家族史（aOR = 1.79; 95 ％CI，1.07-2.98）。

在HCC患者中，146例报道以前使用激素避孕。使用孕酮与研究队列中HCC风险降低无关。 63例HCC患者报告单独使用雌激素，与非用户相比，与HCC相比，风险降低（aOR = 0.5; 95％CI，0.29-0.86）。使用任何雌激素持续时间仍然显着，与5年或更短时间（AOR = 0.56; 95％CI，0.34-1.02），6至10年（aOR = 0.32; 95％CI，0.13-0.77）的HCC风险降低相关）和10年以上（aOR = 0.45; 95％CI，0.24-0.85）。

雌激素使用主要发现于绝经后患者（94例中的87例）和对照组（179例中的177例）。与非用户相比，雌激素使用史患者HCC发病平均年龄较高（64.5岁vs 59.2岁; P = 0.001）。与非用户相比，雌激素使用史患者的总生存时间更长（P = .008）。在控制HCC总体生存的所有混杂因素后，雌激素使用与死亡率降低45％显着相关（调整风险比= 0.55; 95％CI，0.4-0.77）。

研究人员写道：“这项研究为绝经后使用雌激素替代HCC发展的好处提供了强有力的流行病学证据，并得到以前的研究证实。 “这项研究... [突出显示]在控制临床预后因素后使用雌激素替代治疗的HCC妇女的生存改善，提出了在经历过激素暴露的男性以及雌激素是否可以观察到类似效果的问题用于基于肿瘤表达和雌激素受体类型的所选群体的靶向治疗。“ - 由Talitha Bennett

披露：研究人员报告没有相关的财务披露。