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Estrogen Replacement Reduces Risk and Increases Survival Times of Women With Hepatocellular Carcinoma
Estrogen Replacement Reduces Risk and Increases Survival Times of Women With Hepatocellular Carcinoma
- Source :
- Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 15(11)
- Publication Year :
- 2017
-
Abstract
- Background & Aims Environmental factors have been identified that affect risk of hepatocellular carcinoma (HCC), but little is known about the effects of sex hormones on liver cancer development or outcome. The authors investigated whether menopause hormone therapy (MHT) affects risk, age at onset, or outcome of HCC. Methods We performed a case–control study of 234 female patients treated for HCC at a tertiary medical center and with 282 healthy women (controls) from January 1, 2004 through May 31, 2015. We collected detailed information on environmental exposures, ages of menarche and menopause, hysterectomies, and uses of birth control and MHT. We performed multivariable logistic and Cox regression analyses to determine the independent effects of factors associated with women on risk and clinical outcome in HCC. The primary outcomes were effect of MHT on HCC risk, the relationship between MHT with hepatitis virus infection on HCC development, and effect of MHT on age at HCC onset or survival after diagnosis of HCC. Results The estimated adjusted odds ratio (AOR) for HCC in women who ever used estrogen was 0.53 (95% confidence interval [CI], 0.32–0.88). This association was supported by the older age of HCC onset among estrogen users (mean, 64.5 ± 0.9 years) vs nonusers (mean 59.2 ± 1.1 years; P = . 001) and the reduced risk of HCC among long-term users (more than 5 years) (AOR, 0.36; 95% CI, 0.20–0.63). Users of estrogen also had a reduced risk for hepatitis-associated HCC: AOR for users, 4.37 (95% CI, 1.67–11.44) vs AOR for nonusers, 17.60 (95% CI, 3.88–79.83). Estrogen use reduced risk of death from HCC (hazard ratio, 0.55; 95% CI, 0.40–0.77; P = . 01). Median overall survival times were 33.5 months for estrogen users (95% CI, 25.7–41.3 months) and 24.1 months for nonusers (95% CI, 19.02–29.30 months; P = . 008). Conclusion In a case–control study of women with HCC vs female control subjects at a single center, we associated use of estrogen MHT with reduced risk of HCC and increased overall survival times of patients with HCC. Further studies are needed to determine the benefits of estrogen therapy for women and patients with HCC, and effects of tumor expression of estrogen receptor.
- Subjects :
- Oncology
Adult
medicine.medical_specialty
Carcinoma, Hepatocellular
medicine.drug_class
Estrogen receptor
Risk Assessment
Article
03 medical and health sciences
0302 clinical medicine
Internal medicine
Medicine
Humans
Risk factor
Aged
Gynecology
Gastroenterology & Hepatology
Hepatology
business.industry
Proportional hazards model
Incidence
Hazard ratio
Estrogen Replacement Therapy
Liver Neoplasms
Gastroenterology
Odds ratio
Middle Aged
medicine.disease
Survival Analysis
digestive system diseases
Menopause
Treatment Outcome
Estrogen
030220 oncology & carcinogenesis
Case-Control Studies
Menarche
030211 gastroenterology & hepatology
Female
business
Subjects
Details
- ISSN :
- 15427714
- Volume :
- 15
- Issue :
- 11
- Database :
- OpenAIRE
- Journal :
- Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
- Accession number :
- edsair.doi.dedup.....11a7770ed6ff9e6a01364bec86d6d42b