PDF(Pubmed)
Abstract：
Exogenous estrogen is associated with growth of hepatocellular adenomas (HCAs), although the influence of progestin-only agents is unknown. We therefore evaluated the association of progestin-only agents on HCA progression compared to no hormone exposure and compared to estrogen exposure in female patients.
In this single-center, retrospective cohort study of reproductive-aged female patients (ages 16-45) with diagnosed HCAs between 2003 and 2021, we evaluated radiographic HCA growth during discrete periods of well-defined exogenous hormone exposures.
A total of 34 patients were included. Nineteen (55.9%) had follow-up scans during periods without hormone exposure, 7 (20.6%) during estrogen exposure, and 8 (23.5%) during progestin-only exposure. Over a median follow-up of 11 months, percent change in sum of adenoma diameters from baseline to last available scan was -15.0% with progestin-only agents versus 29.4% with estrogen exposure (p = 0.04), and -7.4% with no hormonal exposure (p = 0.52 compared to progestin-only). Greater than 10% growth was observed in two individuals (25.0%) with progestin-only agent use (one patient on high-dose progestin for menorrhagia) versus five individuals (71.4%) with estrogen use (p = 0.13), and 7 (36.8%) with no exogenous hormone use (p = 0.68 vs progestin-only).
During discrete periods of progestin-only use, HCA growth overall declined, similar to declining growth during periods without exogenous hormonal exposure. This differed from discrete periods of exogenous estrogen exposure, during which time HCAs demonstrated overall increased growth. Though larger studies are needed, these findings support recent guidance supporting progestin-only agents for female patients with HCAs seeking non-estrogen alternatives for contraception.
In this small retrospective study, we observed overall decrease in HCA size during discrete periods of progestin-only contraception use, similar to that observed during periods without exogenous hormone exposure, supporting their use as a safe alternative to estrogen-containing contraceptives in this patient population.
In this single-center, retrospective cohort study of reproductive-aged female patients (ages 16-45) with diagnosed HCAs between 2003 and 2021, we evaluated radiographic HCA growth during discrete periods of well-defined exogenous hormone exposures.
A total of 34 patients were included. Nineteen (55.9%) had follow-up scans during periods without hormone exposure, 7 (20.6%) during estrogen exposure, and 8 (23.5%) during progestin-only exposure. Over a median follow-up of 11 months, percent change in sum of adenoma diameters from baseline to last available scan was -15.0% with progestin-only agents versus 29.4% with estrogen exposure (p = 0.04), and -7.4% with no hormonal exposure (p = 0.52 compared to progestin-only). Greater than 10% growth was observed in two individuals (25.0%) with progestin-only agent use (one patient on high-dose progestin for menorrhagia) versus five individuals (71.4%) with estrogen use (p = 0.13), and 7 (36.8%) with no exogenous hormone use (p = 0.68 vs progestin-only).
During discrete periods of progestin-only use, HCA growth overall declined, similar to declining growth during periods without exogenous hormonal exposure. This differed from discrete periods of exogenous estrogen exposure, during which time HCAs demonstrated overall increased growth. Though larger studies are needed, these findings support recent guidance supporting progestin-only agents for female patients with HCAs seeking non-estrogen alternatives for contraception.
In this small retrospective study, we observed overall decrease in HCA size during discrete periods of progestin-only contraception use, similar to that observed during periods without exogenous hormone exposure, supporting their use as a safe alternative to estrogen-containing contraceptives in this patient population.
摘要：
目的：外源性雌激素与肝细胞腺瘤（HCA）的生长有关，尽管仅孕激素药物的影响尚不清楚。因此，我们评估了女性患者中，与无激素暴露和雌激素暴露相比，仅孕激素药物与HCA进展的相关性。
方法：在这个单中心，在2003年至2021年期间,我们对诊断为HCA的育龄女性患者(年龄16~45岁)进行了回顾性队列研究,我们评估了明确的外源性激素暴露离散期间的放射学HCA生长情况.
结果：共纳入34例患者。十九（55.9％）在没有激素暴露的时期进行了随访扫描，七（20.6%）在雌激素暴露期间，和八个（23.5％）在仅暴露于孕激素期间。经过11个月的中位随访，从基线到最后一次扫描的腺瘤直径总和的变化百分比为-15.0%，仅孕激素药物对29.4%的雌激素暴露(p=0.04)，和-7.4％，没有激素暴露（与仅孕激素相比，p=0.52）。在仅使用孕激素的两个个体（25.0％）（一名患者使用高剂量孕激素治疗月经过多）与使用雌激素的五个个体（71.4％）（p=0.13）中观察到大于10％的增长，和7（36.8％），没有使用外源性激素（p=0.68vs仅孕激素）。
结论：在单独使用孕激素期间，HCA增长总体下降，类似于在没有外源激素暴露的时期生长下降。这不同于外源性雌激素暴露的离散时期，在此期间，HCA表现出整体增长。虽然需要更大的研究，这些研究结果支持了最近的指导意见,支持为寻求非雌激素替代避孕方法的HCA女性患者使用仅含孕激素的药物.
方法：在这个单中心，在2003年至2021年期间,我们对诊断为HCA的育龄女性患者(年龄16~45岁)进行了回顾性队列研究,我们评估了明确的外源性激素暴露离散期间的放射学HCA生长情况.
结果：共纳入34例患者。十九（55.9％）在没有激素暴露的时期进行了随访扫描，七（20.6%）在雌激素暴露期间，和八个（23.5％）在仅暴露于孕激素期间。经过11个月的中位随访，从基线到最后一次扫描的腺瘤直径总和的变化百分比为-15.0%，仅孕激素药物对29.4%的雌激素暴露(p=0.04)，和-7.4％，没有激素暴露（与仅孕激素相比，p=0.52）。在仅使用孕激素的两个个体（25.0％）（一名患者使用高剂量孕激素治疗月经过多）与使用雌激素的五个个体（71.4％）（p=0.13）中观察到大于10％的增长，和7（36.8％），没有使用外源性激素（p=0.68vs仅孕激素）。
结论：在单独使用孕激素期间，HCA增长总体下降，类似于在没有外源激素暴露的时期生长下降。这不同于外源性雌激素暴露的离散时期，在此期间，HCA表现出整体增长。虽然需要更大的研究，这些研究结果支持了最近的指导意见,支持为寻求非雌激素替代避孕方法的HCA女性患者使用仅含孕激素的药物.
