Impact of hormone replacement therapy on all-cause and cancer-specific mortality in colorectal cancer: A systematic review and dose‒response meta-analysis of observational studies

IF 3.6 2区医学 Q1 MEDICINE, GENERAL & INTERNAL Journal of Evidence‐Based Medicine Pub Date : 2024-06-20 DOI:10.1111/jebm.12622

Kefeng Liu, Yazhou He, Qiong Li, Shusen Sun, Zubing Mei, Jie Zhao

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Abstract

Objective

The effect of hormone replacement therapy (HRT) on colorectal cancer (CRC) mortality and all-cause mortality remains unclear. We conducted a systematic review and dose–response meta-analysis to determine the effects of HRT on CRC mortality and all-cause mortality.

Methods

We searched the electronic databases of PubMed, Embase, and The Cochrane Library for all relevant studies published until January 2024 to investigate the effects of HRT exposure on survival rates for patients with CRC. Two reviewers independently extracted individual study data and evaluated the risk of bias between the studies using the Newcastle‒Ottawa Scale. We performed a two-stage random-effects dose–response meta-analysis to examine a possible nonlinear relationship between the year of HRT use and CRC mortality.

Results

Ten cohort studies with 480,628 individuals were included. HRT was inversely associated with the risk of CRC mortality (hazard ratios (HR) = 0.77, 95% CI (0.68, 0.87), I² = 69.5%, p < 0.05). The pooled results of seven cohort studies revealed a significant association between HRT and the risk of all-cause mortality (HR = 0.71, 95% CI (0.54, 0.92), I² = 89.6%, p < 0.05). A linear dose–response analysis (p for nonlinearity = 0.34) showed a 3% decrease in the risk of CRC for each additional year of HRT use; this decrease was significant (HR = 0.97, 95% CI (0.94, 0.99), p < 0.05). An additional linear (p for nonlinearity = 0.88) dose–response analysis showed a nonsignificant decrease in the risk of all-cause mortality for each additional year of HRT use.

Conclusions

This study suggests that the use of HRT is inversely associated with all-cause and colorectal cancer mortality, thus causing a significant decrease in mortality rates over time. More studies are warranted to confirm this association.

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激素替代疗法对结直肠癌全因死亡率和癌症特异性死亡率的影响：观察性研究的系统回顾和剂量反应荟萃分析。

目的：激素替代疗法（HRT）对结直肠癌（CRC）死亡率和全因死亡率的影响仍不清楚。我们进行了一项系统综述和剂量反应荟萃分析，以确定激素替代疗法对 CRC 死亡率和全因死亡率的影响：我们在 PubMed、Embase 和 Cochrane 图书馆的电子数据库中检索了 2024 年 1 月之前发表的所有相关研究，研究内容是探讨接触 HRT 对 CRC 患者生存率的影响。两名审稿人独立提取了单个研究数据，并使用纽卡斯尔-渥太华量表评估了研究之间的偏倚风险。我们进行了两阶段随机效应剂量反应荟萃分析，以研究使用 HRT 的年份与 CRC 死亡率之间可能存在的非线性关系：结果：共纳入了 10 项队列研究，涉及 480628 人。HRT与CRC死亡风险成反比（危险比（HR）=0.77，95% CI（0.68，0.87），I2=69.5%，P 2=89.6%，P 结论：HRT与CRC死亡风险成反比：本研究表明，使用 HRT 与全因死亡率和结直肠癌死亡率成反比，从而使死亡率随着时间的推移显著下降。需要进行更多的研究来证实这种关联。

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来源期刊

Journal of Evidence‐Based Medicine MEDICINE, GENERAL & INTERNAL-

CiteScore

11.20

自引率

1.40%

发文量

期刊介绍： The Journal of Evidence-Based Medicine (EMB) is an esteemed international healthcare and medical decision-making journal, dedicated to publishing groundbreaking research outcomes in evidence-based decision-making, research, practice, and education. Serving as the official English-language journal of the Cochrane China Centre and West China Hospital of Sichuan University, we eagerly welcome editorials, commentaries, and systematic reviews encompassing various topics such as clinical trials, policy, drug and patient safety, education, and knowledge translation.