子宫内膜癌患者术后应用性激素补充治疗的安全性荟萃分析

Security of hormone replacement therapy among postoperative patients with endometrial carcinoma： a Meta-analysis

目的评价子宫内膜癌患者术后应用性激素补充治疗（HRT）的安全性。方法采用荟萃分析方法，通过计算机检索Cochrane临床对照试验数据库（CENTRAL）、Medline数据库、Embase数据库、Ovid数据库、万方数据库及中国期刊全文数据库（CNKU等数据库与国际性临床试验网。纳入子宫内膜癌Ⅰ、Ⅱ期患者术后应用HRT的安全性研究文献。采用RevMan5．2软件对有关数据进行统计分析。结果通过相关文献检查，共计7篇文献符合本研究纳入标准，1篇为高质量文献，6篇为中等质量文献，共计纳入受试者为2038例。荟萃分析结果显示，子宫内膜癌早期患者术后应用HRT对复发率的影响差异无统计学意义[RR=0．69，95％CI（0．42，1．15），P=0．16]；因子宫内膜癌导致差异的死亡率与对照组相比，差异无统计学意义[RR：0．55，95％c，（0．25，1．21），P=0．14]。对相关数据进行亚组分析，结果证实：术后半年内开始HRT且连续用药超过10个月、单用雌激素方案，患者复发率、死亡率与对照组相比，差异均无统计学意义；雌激素加孕激素方案患者复发率差异无统计学意义。结论早期子宫内膜癌患者术后应用HRT对其复发率、因子宫内膜癌导致的死亡率无明显影响。

Objective To systematically evaluate the security of hormone replacement therapy （HRT） among postoperative patients with endometrial carcinoma （EC）. Methods A systematic review and Meta-analysis of studies on security of HRT among EC patients after operation was done by Revman 5.2 software. Studies were mainly searched from the CENTRAL, Medline, Embase, Ovid, Wanfang, CNKI databases. Results A total of 7 studies with 2 038 stage Ⅰ and stage Ⅱ endometrial carcinoma patients were included. The quality of 6 studies included were medium, and 1 study was high. The endometrial carcinoma patients on HRT did not have a statistically increased incidence in the EC recurrence （RR =0. 69, 95% CI （0.42 -1.15）, P=0. 16） and cancer-induced death （RR =0.55, 95%CI （0.25 - 1.21）, P=0. 14）. Subgroup analysis for the start of HRT within 6 months from time of surgery group and only estrogen replacement therapy group found no statistical different in the risk of the EC recurrence and cancer-induced death, compared with control group. No statistically increased risk of the EC recurrence was observed for estrogen plus progestin replacement therapy group. Conclusion There is no statistical difference in the recurrence rate and cancer-induced death rate of EC whether the early stage postoperative patients used HRT or not.