Long‐term effects of hormone replacement therapy on hepatocellular carcinoma risk and overall survival rate in women with chronic hepatitis C: A population‐based cohort study in Taiwan

Abstract

The relationship between hormone replacement therapy (HRT) and hepatocellular carcinoma (HCC) was discussed for several decades. However, the long‐term effects of HRT on female patients with hepatitis C during nature postmenopausal periods are unclear. This study aimed at investigating the effect of HRT on HCC risk and overall survival. We conducted a retrospective population‐based cohort study using data from Taiwan's National Health Insurance Research Database from January 1, 2000 to December 31, 2013. The treated cohort, consisting of 1022 patients with hepatitis C who received hormone analog therapy for at least 90 days (treated cohort), was matched with the control cohort, consisting of 1022 untreated patients with hepatitis C (controls) who had never received a hormone prescription, through propensity score adjustment; furthermore, cumulative incidence was calculated, and multivariable analyses were performed. The treated and control cohorts were followed up for mean periods of 7.47 and 6.64 years, respectively. The treated cohort had a significantly lower crude hazard ratio (HR) of HCC of 0.43 (95% confidence interval [CI]: 0.30‐0.61, P < .001), with an adjusted HR of 0.49 (95% CI 0.31‐0.76, P = .001). After adjustment for other confounders and comorbidities, the hormone analog treatment was associated with a reduced risk of HCC. Subgroup analyses provided estimates of the strength of the associations between HRT and reduced HCC risk in different age categories. Our retrospective population study in Taiwan revealed that using hormone analog reduces the risk of HCC and mortality in patients with hepatitis C virus infection who are receiving HRT, such as menopausal women.

Estrogen Receptor 1 Inhibition of Wnt/β-Catenin Signaling Contributes to Sex Differences in Hepatocarcinogenesis

“…A case-control study of 234 post-menopausal women treated for HCC showed that estrogen replacement therapy reduced incidence (HR 0.53; 95%CI 0.32-0.88) and was associated with better survival (HR 0.55; 95%CI 0.40-0.77) (5). Other retrospective studies suggest oral contraceptive use to be protective against HCC (6)(7)(8). These studies suggest that HCC biology is subject to sex hormone modulation (3,4,(9)(10)(11)(12)(13)(14)(15)(16).…”

Hormone replacement therapy and risk of hepatocellular carcinoma

“…In this issue of Advances in Digestive Medicine , Chang et al 13 aimed to investigate the chemoprevention effect of HRT on HCC risk and overall survival in women with chronic hepatitis C, and some interesting findings were disclosed after a long period of follow‐up. In this retrospective population‐based cohort study using data from Taiwan's National Health Insurance Research Database, 1022 patients who received HRT and 1022 matched controls were recruited, and HRT was independently associated with a reduced risk of HCC (adjusted hazard ratio 0.49).…”