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Menopausal hormone therapy prior to the diagnosis of ovarian cancer is associated with improved survival


PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Type Journal
ISBN 1095-6859 (Electronic) 0090-8258 (Linking)
Authors Brieger, K. K.; Peterson, S.; Lee, A. W.; Mukherjee, B.; Bakulski, K. M.; Alimujiang, A.; Anton-Culver, H.; Anglesio, M. S.; Bandera, E. V.; Berchuck, A.; Bowtell, D. D. L.; Chenevix-Trench, G.; Cho, K. R.; Cramer, D. W.; DeFazio, A.; Doherty, J. A.; Fortner, R. T.; Garsed, D. W.; Gayther, S. A.; Gentry-Maharaj, A.; Goode, E. L.; Goodman, M. T.; Harris, H. R.; Hogdall, E.; Huntsman, D. G.; Shen, H.; Jensen, A.; Johnatty, S. E.; Jordan, S. J.; Kjaer, S. K.; Kupryjanczyk, J.; Lambrechts, D.; McLean, K.; Menon, U.; Modugno, F.; Moysich, K.; Ness, R.; Ramus, S. J.; Richardson, J.; Risch, H.; Rossing, M. A.; Trabert, B.; Wentzensen, N.; Ziogas, A.; Terry, K. L.; Wu, A. H.; Hanley, G. E.; Pharoah, P.; Webb, P. M.; Pike, M. C.; Pearce, C. L.; Ovarian Cancer Association, Consortium
Published Date 2020-09-01
Published Volume 158
Published Issue 3
Published Pages 702-709
Status Published in-print
DOI 10.1016/j.ygyno.2020.06.481
URL link to publisher's version