|
编者按：卵巢癌女性的生存率较低，而且难以提高，因此初级预防尤为重要。左炔诺孕酮属于孕激素类快速避孕短效药物，可以抑制排卵，同时使宫颈黏液浓度增大，阻止精子前进。左炔诺孕酮宫内缓释系统（LNG-IUS）可以预防子宫内膜癌，最新研究表明也可以预防卵巢癌，但是同时可能增加乳腺癌风险。 2018年2月24日，美国妇科肿瘤学会《妇科肿瘤学》在线发表挪威北极大学、法国巴黎第五大学的人群前瞻队列研究结果，对LNG-IUS曾经使用者与从未使用者卵巢癌、子宫内膜癌和乳腺癌校正风险进行比较，结果发现LNG-IUS平均使用4年与卵巢癌减少47%和子宫内膜癌风险减少78%相关，而且并未明显增加患乳腺癌风险。 该人群前瞻队列研究（NOWAC）于1991～2007年从挪威人口登记库和挪威癌症登记库并通过自填问卷入组女性10万4318人（中位年龄52岁），其中LNG-IUS曾经使用者9144人、从未使用者9万5174人。通过泊松回归，利用稳健（鲁棒）误差估计，推算相对风险及其95%置信区间。 结果，平均随访时间为12.5±3.7年，共计130万5435人-年，其中LNG-IUS曾经使用者发生卵巢上皮癌18例、15例内膜子宫癌、乳腺癌297例。 LNG-IUS曾经使用者与从未使用者相比，根据多因素（口服避孕药、随访开始时的年龄和绝经状态、母亲乳腺癌史、生育史、体重指数、体力活动）进行校正后：
因此，根据该人群前瞻队列研究，LNG-IUS曾经使用者与从未使用者相比，卵巢癌和子宫内膜癌风险大大减少，乳腺癌风险无明显增加。 Gynecol Oncol. 2018 Feb 24. [Epub ahead of print] Levonorgestrel-releasing intrauterine system use is associated with a decreased risk of ovarian and endometrial cancer, without increased risk of breast cancer. Results from the NOWAC Study. Mie Jareid, Jean-Christophe Thalabard, Morten Aarflot, Hege M. Bovelstad, Eiliv Lund, Tonje Braaten. UiT - The Arctic University of Norway, Tromso, Norway; Paris Descartes University, USPC, Paris, France. HIGHLIGHTS
OBJECTIVE: Women with ovarian cancer have poor survival rates, which have proven difficult to improve; therefore primary prevention is important. The levonorgestrel-releasing intrauterine system (LNG-IUS) prevents endometrial cancer, and recent studies suggested that it may also prevent ovarian cancer, but with a concurrent increased risk of breast cancer. We compared adjusted risks of ovarian, endometrial, and breast cancer in ever users and never users of LNG-IUS. METHODS: Our study cohort consisted of 104,318 women from the Norwegian Women and Cancer Study, 9144 of whom were ever users and 95,174 of whom were never users of LNG-IUS. Exposure information was taken from self-administered questionnaires, and cancer cases were identified through linkage to the Cancer Registry of Norway. Relative risks (RRs) with 95% confidence intervals (CIs) were estimated with Poisson regression using robust error estimates. RESULTS: Median age at inclusion was 52 years and mean follow-up time was 12.5 (standard deviation 3.7) years, for a total of 1,305,435 person-years. Among ever users of LNG-IUS there were 18 cases of epithelial ovarian cancer, 15 cases of endometrial cancer, and 297 cases of breast cancer. Whenever users were compared to never users of LNG-IUS, the multivariable RR of ovarian, endometrial, and breast cancer was 0.53 (95% CI: 0.32, 0.88), 0.22 (0.13, 0.40), and 1.03 (0.91, 1.17), respectively. CONCLUSION: In this population-based prospective cohort study, ever users of LNG-IUS had a strongly reduced risk of ovarian and endometrial cancer compared to never users, with no increased risk of breast cancer. KEYWORDS: Epidemiology, Prospective cohort study, Ovarian neoplasms, Uterine neoplasms, Breast neoplasms, Intrauterine device, Intrauterine device, medicated, Levonorgestrel, Levonorgestrel-releasing intrauterine system, Hormonal contraceptives DOI: 10.1016/j.ygyno.2018.02.006 |
|
|
