绝经激素治疗与妇科恶性肿瘤风险

Menopausal Hormone Therapy and the Risk of Gynecological Malignancy

绝经激素治疗(menopausal hormone therapy,MHT)是缓解绝经综合征的有效治疗方案,目前18.16%围绝经期妇女接受MHT治疗。因妇科恶性肿瘤大多具有激素依赖性,MHT的应用对绝经综合征妇女以及罹患妇科恶性肿瘤合并绝经综合征妇女的安全性及有效性,仍存在争议。对于未患有妇科恶性肿瘤的绝经综合征患者合理选择雌激素治疗方案可能降低卵巢癌发病风险,选择含孕激素的MHT方案可能降低子宫内膜癌、宫颈癌发病风险,合理选择MHT方案对于上皮性卵巢癌、早期子宫内膜癌、宫颈鳞状细胞癌、阴道鳞状细胞癌和外阴鳞状细胞癌等可能并不增加复发风险,并延长生存期。本文通过回顾近年全球颁布的MHT指南以及相关临床研究,旨在合理选择MHT方案降低绝经综合征妇女罹患妇科恶性肿瘤的风险,降低已患妇科恶性肿瘤合并绝经综合征患者的复发风险和提高妇科恶性肿瘤患者生存率。

Menopausal hormone therapy(MHT)is an effective treatment for alleviating menopausal syndrome,and 18.16%of perimenopausal women are receiving MHT treatment at present.Most gynecological malignancies are hormone-dependent,so the safety and efficacy of MHT in women with menopausal syndrome and those women with gynecological malignancies combined with menopausal syndrome are still controversial.For the menopausal syndrome patients without gynecological malignancies,reasonable selection of estrogen therapy may reduce the risk of ovarian cancer,and selection of MHT containing progesterone may reduce the risk of endometrial cancer and cervical cancer.As for epithelial ovarian cancer,early endometrial cancer,cervical squamous cell carcinoma,vaginal squamous cell carcinoma and vulvar squamous cell carcinoma,reasonable selection of MHT regimen may not increase the risk of recurrence,while may prolong the survival.By reviewing the MHT guidelines and the related clinical studies issued globally in recent years,we discuss how to rationally select MHT regimens to reduce the risk of gynecological malignancies in women with menopausal syndrome,how to reduce the recurrence risk of patients with gynecological malignancies combined with menopausal syndrome,and how to improve the survival rate of patients with gynecological malignant tumors.