编者按：激素补充疗法用于绝经前乳腺癌存活者的风险尚不明确。由于年轻（年龄<50岁）女性的雌激素受体阴性乳腺癌发生率较高，与年来（年龄≥50岁）女性相比，激素补充疗法促进乳腺癌复发的风险可能不同。
2018年5月12日，欧洲乳腺癌专科学会《BREAST》在线发表加拿大西安大略大学、多伦多大学、爱尔兰皇家外科医师学院的系统回顾，首次总结了激素补充疗法与年轻（年龄<50岁）乳腺癌存活者复发风险的最佳证据。
该研究于2016年6月通过Medline、EMBASE、CINAHL检索激素补充疗法使用者和非使用者的所有观察研究论文，计算复发率的相对风险和95%置信区间。利用随机效应模型，通过分层卡方检验，推算汇总相对风险。
结果共有4篇论文符合系统回顾纳入标准，对3477例患者进行了荟萃分析。
根据乳腺癌复发观察研究汇总荟萃分析，激素补充疗法与复发风险之间无显著相关性（相对风险：1.04，95%置信区间：0.45～2.41）。
根据随机对照研究发现，对于乳腺癌年轻（年龄<50岁）女性，激素补充疗法的复发风险增加56%（相对风险：1.56，95%置信区间：1.1～2.2）。
不过，对于各年龄段的乳腺癌女性，雌激素受体阴性肿瘤与激素受体阳性肿瘤相比，激素补充疗法的复发率无显著差异（相对风险：1.15，95%置信区间：0.7～1.8，P=0.55）。
因此，该系统回顾发现激素补充疗法用于乳腺癌年轻（年龄<50岁）存活者的随机与观察研究结果数据之间存在矛盾。根据观察研究结果，激素补充疗法对复发风险无显著影响。根据随机对照研究结果，激素替代疗法应该谨慎用于雌激素受体阳性乳腺癌年轻（年龄<50岁）女性。对于三阴性乳腺癌年轻（年龄<50岁）女性，虽然数据有限，但是表明激素替代疗法对复发率无显著影响。有必要开展进一步研究，调查激素补充疗法与乳腺癌年轻（年龄<50岁）存活者复发率之间的相关性。
Breast. 2018 May 12;40:123-130. [Epub ahead of print]
The oncologic impact of hormone replacement therapy in premenopausal breast cancer survivors: A systematic review.
Yimeng Wang, Naomi Lewin, Yazan Qaoud, A. Nikoo Rajaee, Adena S. Scheer.
Western University, London, ON, Canada; Royal College of Surgeons in Ireland; University of Toronto, Toronto, ON, Canada.
HIGHLIGHTS
This review summarizes the best available evidence for hormone replacement therapy use in young breast cancer survivors.
Hormone replacement therapy should be used with caution in young women with estrogen receptor positive breast cancer.
In young women with triple negative breast cancers the data is limited but suggests a lack of harm.
SYNOPSIS: This is the first systematic review to investigate the risk of recurrence in breast cancer survivors <50 years old who have used hormone replacement therapy (HRT).
BACKGROUND: The risk of HRT in premenopausal breast cancer survivors is unclear. Due to the higher incidence of estrogen receptor negative tumours in women <50, the potential for HRT to promote breast cancer recurrence may differ from older age groups.
METHODS: We performed a search of Medline, EMBASE and CINAHL through June 2016. For the observational studies relative risk (RR) and 95% confidence interval (CI) were calculated for the recurrence rate among HRT users and nonusers. A random effects model was used to estimate the combined RR using the Mantel-Haenszel method.
RESULTS: Four papers satisfied our inclusion criteria. 3477 subjects were analyzed. On pooled meta-analysis of breast cancer recurrence in the observational studies, no significant association was found between HRT and risk of recurrence (RR 1.04 [95% CI 0.45, 2.41]). The randomized controlled trial (RCT) included found an increased risk of recurrence with HRT among women <50 (HR 1.56 [95% CI 1.1-2.2]). However, among women of all ages with an estrogen receptor negative tumour there was no significant difference in recurrence when compared to hormone receptor positive tumours (HR 1.15 [95% CI 0.7-1.8, p = 0.55]).
DISCUSSION: This review on HRT in breast cancer survivors <50 revealed conflicting results between randomized and observational study data. Further studies are warranted to investigate the association between HRT and recurrence rates in younger breast cancer survivors.
KEYWORDS: Hormone replacement therapy, Breast cancer, Survivor, Breast cancer recurrence, Premenopausal
DOI: 10.1016/j.breast.2018.05.002
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