Menopausal hormone therapy prior to the diagnosis of ovarian cancer is associated with improved survival
Prior studies of menopausal hormone therapy (MHT) and ovarian cancer survival have been limited by lack of hormone regimen detail and insufficient sample sizes. To address these limitations, a comprehensive analysis of 6419 post-menopausal women with pathologically confirmed ovarian carcinoma was conducted to examine the association between MHT use prior to diagnosis and survival. Data from 15 studies in the Ovarian Cancer Association Consortium were included. MHT use was examined by type (estrogen-only (ET) or estrogen+progestin (EPT)), duration, and recency of use relative to diagnosis. Cox proportional hazards models were used to estimate the association between hormone therapy use and survival. Logistic regression and mediation analysis was used to explore the relationship between MHT use and residual disease following debulking surgery. Use of ET or EPT for at least five years prior to diagnosis was associated with better ovarian cancer survival (hazard ratio, 0.80; 95% CI, 0.74 to 0.87). Among women with advanced stage, high-grade serous carcinoma, those who used MHT were less likely to have any macroscopic residual disease at the time of primary debulking surgery (p for trend <0.01 for duration of MHT use). Residual disease mediated some (17%) of the relationship between MHT and survival. Pre-diagnosis MHT use for 5+ years was a favorable prognostic factor for women with ovarian cancer. This large study is consistent with prior smaller studies, and further work is needed to understand the underlying mechanism.
Journal
Gynecologic OncologyAuthors
Funding
CASE CONTROL STUDY OF OVARIAN CANCER HORMONAL ETIOLOGYEpidemiology of Ovarian Cancer:New HypothesesMedical Research Council Grant MC_UU_12023/20RISK FACTOR ANALYSIS OF BRCA1 AND BRCA2 CARRIERSDana-Farber/Harvard Cancer Center Ovarian Cancer SPOREOVARIAN CANCER RISK AND SURVIVAL IN BRCA CARRIERSPathologyMichigan Medical Scientist Training ProgramOvarian Cancer and Gonadotropin SignalingCancer Research UK Grant 10119Phytoestrogens, alcohol, and endometrial cancer riskRegulatory T Cell Function in Ovarian CancerCancer Research UK Grant 16561SURVEILLANCE EPIDEMIOLOGY & END RESULTS PROGRAMProject 1Cancer Center AdministrationInflammation and Ovarian CancerThe Progesterone Receptor Gene and Ovarian Cancer RiskCollaborative Genetic Study of Ovarian Cancer RiskObesity in ovarian cancer prognosisHereditary Breast Cancer: Genetic and Molecular StudiesGeneral Clinical Research CenterDNA POLYMORPHISMS IN OVARIAN CANCER--CASE CONTROL STUDYUniversity of Michigan Training Program in Genomic ScienceCancer Research Training and Education CoordinationESTROGEN, DIET, GENETICS AND ENDOMETRIAL CANCERGenes, Hormones & Environment in an Ovarian Cancer ModelGenetic Variation in the NF-kappaB Pathway and Ovarian Cancer EtiologyCancer Risk Assessment, Early Detection, and Interception Research ProgramHormone Therapy and Risk of Ovarian CancerSURVEILLANCE EPIDEMIOLOGY AND END RESULTSSteroid Hormone Genes and Ovarian Cancer RiskProject 2: Next Generation TOP1 Inhibition for the Treatment of Ovarian CancerCalifornia Breast Cancer Research Program FundingMayo Foundation for Medical Education and Research FundingMinnesota Ovarian Cancer Alliance FundingU.S. Army Medical Research and Development Command FundingOak Foundation FundingOvarian Cancer Australia FundingPeter MacCallum Cancer Centre FundingNational Institutes of Health FundingUS Department of Defense FundingGerman Cancer Research Center FundingNational Health and Medical Research Council FundingDanish Cancer Society Research Center Funding