背景:更年期激素治疗(MHT)是否会增加皮肤癌的风险存在争议。
目的:系统回顾和荟萃分析MHT与黑色素瘤和角质形成细胞癌(KC)风险相关的证据。
方法:对PubMed进行了全面的文献检索,Scopus和Cochrane数据库,至2021年10月30日。皮肤肿瘤分为黑色素瘤和KC。在后一类中,考虑基底细胞癌(BCC)和鳞状细胞癌(SCC).结果表示为具有95%置信区间(CI)的风险比(HR)。I2指数用于评估异质性。还进行了亚组分析和敏感性分析,以探索研究之间的潜在差异。
结果:27项研究被纳入定性分析,23项研究被纳入定量分析,共有2,612,712名绝经妇女(25,126例皮肤癌;20,150例黑色素瘤)。MHT与黑色素瘤风险增加相关(HR1.11;95%CI1.05-1.19;I245%)。关于MHT类型,雌激素单药治疗(HR1.22,95%CI1.16-1.29;I20%)和雌激素联合孕激素治疗(HR1.11,95%CI1.05-1.18,I226%)均显著增加了该风险.关于黑色素瘤亚型,浅表扩散黑色素瘤(SSM)和扁豆恶性黑色素瘤(LMM)是唯一与MHT使用相关的组织学亚型。MHT也与KC风险增加相关(HR1.17,95%CI1.04-1.31,I283%),特别是BCC(HR1.22,95%CI1.12-1.32;I229%)。MHT持续时间较长(>5年),与不使用相比,目前使用和雌激素单一疗法与KC风险增加相关.
结论:绝经后妇女使用MHT与黑色素瘤和KC的风险增加相关。对于目前的MHT使用者和那些治疗超过5年的人来说,这种风险更高。
BACKGROUND: Whether menopausal hormone therapy (MHT) increases the risk of skin cancer is controversial.
OBJECTIVE: To systematically
review and meta-analyze evidence regarding the association of MHT with the risk of melanoma and keratinocyte cancer (KC).
METHODS: A comprehensive literature search was conducted of the PubMed, Scopus and Cochrane databases, through to 30 October 2021. Skin neoplasms were divided into melanoma and KC. In the latter category, both basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) were considered. The results are presented as hazard ratios (HR) with 95 % confidence intervals (CI). The I2 index was used to assess heterogeneity. Subgroup analysis and sensitivity analysis were also conducted in order to explore potential differences among studies.
RESULTS: Twenty-seven studies were included in the qualitative and 23 in the quantitative analysis, with a total of 2,612,712 menopausal women (25,126 with skin cancer; 20,150 with melanoma). MHT was associated with an increased risk of melanoma (HR 1.11; 95 % CI 1.05-1.19; I2 45%). With regard to MHT type, both estrogen monotherapy (HR 1.22, 95 % CI 1.16-1.29; I2 0%) and estrogen in combination with progestogen (HR 1.11, 95 % CI 1.05-1.18, I2 26%) significantly increased that risk. Regarding melanoma subtype, superficial spreading melanoma (SSM) and lentigo maligna melanoma (LMM) were the only histologic subtypes associated with MHT use. MHT was also associated with an increased risk of KC (HR 1.17, 95 % CI 1.04-1.31, I2 83%), specifically BCC (HR 1.22, 95 % CI 1.12-1.32; I2 29%). Longer duration (>5 years) of MHT, current use and estrogen monotherapy were associated with an increased KC risk compared with no use.
CONCLUSIONS: The use of MHT by postmenopausal women was associated with an increased risk of melanoma and KC. This risk was higher for current MHT users and those treated for over 5 years.