子宫内膜癌激素替代治疗

Hormone replacement therapy in patients with endometrial cancer

子宫内膜癌(endometrial cancer,EMC)患者的激素替代治疗(hormone replacement therapy,HRT)相关研究有限,且至今为止医学界尚未对此达成统一观点。大部分妇产科医生考虑到雌激素是EMC的重要发病因素之一,并不建议给予EMC患者HRT治疗。目前认为EMC并非一定是HRT治疗的禁忌证。选择恰当的剂量和药物种类不会引起EMC的复发和死亡率增加,并可对EMC患者起到适当保护作用。HRT在提高骨密度和减轻未绝经期血管收缩症状已被证实有一定裨益,但在降低冠心病、癌症发病率,以及提高认识力和健康相关生活质量上并没有相关研究支持。由于数据有限,且大部分来自具有选择偏差的回顾性研究或小型前瞻性非随机研究,妇产科医生在评估EMC患者是否需要HRT治疗时一定要充分考虑利弊,个体化治疗。

The use of hormone replacement therapy （HRT） in endometrial cancer （EMC）surviviors is an uncertain subject with limited exploration among gynecologic cancer research. Most physicians are probably reluctant to provide a replacement therapy for estrogen is a well-recognized etiologic factor of EMC. We found that HRT did not seem to be contraindicated in EMC. HRT doesn＇t appear to increase the recurrence or death rates in EMC and may ever confer modest protection, depending on the doses and the specific drugs used. Although the medical community agrees on the positive effects for bone density and relief of vasomotor symptoms, the results of our review offer no clear consensus in regard to HRT＇s effects on coronary heart disease, health-related quality of life, cognitive functioning, and cancer incidence. Most information came from retrospective studies with selection bias, or from a small prospective non-randomized study. Because of a limitation of data, an individualized patient-based approach must be taken and all possible benefits and theoretical risks of recurrence or mortality should be thoroughly considered in HRT treatment to provide the best of care for EMC patients.