SpringerLink
Log in

Risk of postmenopausal hormone therapy and patient history factors for the survival rate in women with endometrial carcinoma

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Postmenopausal hormone therapy (HT) is known to affect the development of hormone-dependent endometrial carcinoma (type I EC). Several studies on breast and ovarian carcinoma have shown that HT influences the molecular profile and prognostic behavior of these tumors. This study aimed to investigate the influence of prior HT and other risk factors on the prognosis in a cohort of patients with invasive endometrial carcinoma (EC).

Methods

Among 525 patients diagnosed with EC between 1987 and 2010, 426 postmenopausal patients were identified. Information regarding HT was available in 287 of these patients, 78 of whom had a history of HT and 209 of whom did not. Both overall survival (OS) and progression-free survival (PFS) were analyzed. In addition to OS and PFS, risk factors such as age at diagnosis, postmenopausal HT, body mass index (BMI), diabetes mellitus, tumor stage, EC type (I or II), and recurrences were analyzed.

Results

Relative to HT alone, women with EC and a history of HT had a longer survival than those with no HT. However, the Cox proportional hazards model showed that it was not HT itself, but rather other characteristics in the HT group that were causally associated with longer survival.

Conclusions

Age (the older, the worse) and tumor stage (the higher, the worse) were significant influences on overall survival. Patients with HT also had lower BMIs, less diabetes, more type I EC, and fewer recurrences in comparison with the non-HT group. With regard to the PFS, it made no difference whether the patient was receiving HT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Yu X, Zhou S, Wang J et al (2017) Hormone replacement therapy and breast cancer survival: a systematic review and meta-analysis of observational studies. Breast Cancer 24:643–657

    PubMed  Google Scholar 

  2. Sjogren LL, Morch LS, Lokkegaard E (2016) Hormone replacement therapy and the risk of endometrial cancer: a systematic review. Maturitas 91:25–35

    CAS  PubMed  Google Scholar 

  3. Ethier JL, Desautels DN, Amir E et al (2017) Is hormonal therapy effective in advanced endometrial cancer? A systematic review and meta-analysis. Gynecol Oncol. https://doi.org/10.1016/j.ygyno.2017.07.002

    Article  PubMed  Google Scholar 

  4. Gemignani ML, Hetzel DJ (2017) Current advances in endocrine therapy options for premenopausal women with hormone receptor positive breast cancer. Gynecol Oncol. https://doi.org/10.1016/j.ygyno.2017.06.023

    Article  PubMed  PubMed Central  Google Scholar 

  5. Lux MP, Janni W, Hartkopf AD et al (2017) Update breast cancer 2017 implementation of novel therapies. Geburtshilfe Frauenheilkd 77:1281–1290

    PubMed  PubMed Central  Google Scholar 

  6. Schneeweiss A, Lux MP, Janni W et al (2018) Update breast cancer 2018 (part 2) advanced breast cancer, quality of life and prevention. Geburtshilfe Frauenheilkd 78:246–259

    PubMed  PubMed Central  Google Scholar 

  7. Taran FA, Schneeweiss A, Lux MP et al (2018) Update breast cancer 2018 (part 1) primary breast cancer and biomarkers. Geburtshilfe Frauenheilkd 78:237–245

    PubMed  PubMed Central  Google Scholar 

  8. Untch M, Huober J, Jackisch C et al (2017) Initial treatment of patients with primary breast cancer: evidence, controversies, consensus: spectrum of opinion of German Specialists at the 15th International St Gallen Breast Cancer Conference (Vienna 2017). Geburtshilfe Frauenheilkd 77:633–644

    PubMed  PubMed Central  Google Scholar 

  9. Rauh C, Gass P, Heusinger K et al (2015) Association of molecular subtypes with breast cancer risk factors: a case-only analysis. Eur J Cancer Prev 24:484–490

    CAS  PubMed  Google Scholar 

  10. Zhang Y, Zhao D, Gong C et al (2015) Prognostic role of hormone receptors in endometrial cancer: a systematic review and meta-analysis. World J Surg Oncol 13:208

    PubMed  PubMed Central  Google Scholar 

  11. Bokhman JV (1983) Two pathogenetic types of endometrial carcinoma. Gynecol Oncol 15:10–17

    CAS  PubMed  Google Scholar 

  12. Wise MR, Jordan V, Lagas A et al (2016) Obesity and endometrial hyperplasia and cancer in premenopausal women: a systematic review. Am J Obstet Gynecol 214:689

    PubMed  Google Scholar 

  13. Shaw E, Farris M, McNeil J et al (2016) Obesity and Endometrial Cancer. Recent results in cancer research. Fortschritte der Krebsforschung Progres dans les recherches sur le Cancer 208:107–136

    CAS  PubMed  Google Scholar 

  14. Painter JN, O’Mara TA, Marquart L et al (2016) genetic risk score mendelian randomization shows that obesity measured as body mass index, but not waist: hip ratio, is causal for endometrial cancer. Cancer Epidemiol Biomarkers Prev 25:1503–1510

    PubMed  PubMed Central  Google Scholar 

  15. Meireles CG, Pereira SA, Valadares LP et al (2017) Effects of metformin on endometrial cancer: systematic review and meta-analysis. Gynecol Oncol. https://doi.org/10.1016/j.ygyno.2017.07.120

    Article  PubMed  Google Scholar 

  16. Harris HR, Terry KL (2016) Polycystic ovary syndrome and risk of endometrial, ovarian, and breast cancer: a systematic review. Fertil Res Pract 2:14

    PubMed  PubMed Central  Google Scholar 

  17. Burghaus S, Haberle L, Schrauder MG et al (2015) Endometriosis as a risk factor for ovarian or endometrial cancer results of a hospital-based case-control study. BMC Cancer 15:751

    PubMed  PubMed Central  Google Scholar 

  18. Liu J, Jiang W, Mao K et al (2015) Elevated risks of subsequent endometrial cancer development among breast cancer survivors with different hormone receptor status: a SEER analysis. Breast Cancer Res Treat 150:439–445

    PubMed  PubMed Central  Google Scholar 

  19. Gusberg SB, Kardon P (1971) Proliferative endometrial response to theca-granulosa cell tumors. Am J Obstet Gynecol 111:633–643

    CAS  PubMed  Google Scholar 

  20. Ziel HK, Finkle WD (1975) Increased risk of endometrial carcinoma among users of conjugated estrogens. N Engl J Med 293:1167–1170

    CAS  PubMed  Google Scholar 

  21. Smith DC, Prentice R, Thompson DJ et al (1975) Association of exogenous estrogen and endometrial carcinoma. N Engl J Med 293:1164–1167

    CAS  PubMed  Google Scholar 

  22. Beral V, Bull D, Reeves G et al (2005) Endometrial cancer and hormone-replacement therapy in the Million Women Study. Lancet 365:1543–1551

    PubMed  Google Scholar 

  23. Boardman HM, Hartley L, Eisinga A et al (2015) Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD002229.pub4:CD002229

    Article  PubMed  Google Scholar 

  24. Painter JN, O’Mara TA, Morris AP et al (2018) Genetic overlap between endometriosis and endometrial cancer: evidence from cross-disease genetic correlation and GWAS meta-analyses. Cancer Med 7:1978–1987

    CAS  PubMed  PubMed Central  Google Scholar 

  25. O’Mara TA, Glubb DM, Amant F et al (2018) Identification of nine new susceptibility loci for endometrial cancer. Nat Commun 9:3166

    PubMed  PubMed Central  Google Scholar 

  26. Painter JN, O’Mara TA, Batra J et al (2015) Fine-map** of the HNF1B multicancer locus identifies candidate variants that mediate endometrial cancer risk. Hum Mol Genet 24:1478–1492

    CAS  PubMed  Google Scholar 

  27. Delahanty RJ, **ang YB, Spurdle A et al (2013) Polymorphisms in inflammation pathway genes and endometrial cancer risk. Cancer Epidemiol Biomarkers Prev 22:216–223

    CAS  PubMed  Google Scholar 

  28. Long J, Zheng W, **ang YB et al (2012) Genome-wide association study identifies a possible susceptibility locus for endometrial cancer. Cancer Epidemiol Biomarkers Prev 21:980–987

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Spurdle AB, Thompson DJ, Ahmed S et al (2011) Genome-wide association study identifies a common variant associated with risk of endometrial cancer. Nat Genet 43:451–454

    CAS  PubMed  PubMed Central  Google Scholar 

  30. Cheng TH, Thompson DJ, O’Mara TA et al (2016) Five endometrial cancer risk loci identified through genome-wide association analysis. Nat Genet 48:667–674

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Thompson DJ, O’Mara TA, Glubb DM et al (2016) CYP19A1 fine-map** and mendelian randomization: estradiol is causal for endometrial cancer. Endocr Relat Cancer 23:77–91

    CAS  PubMed  PubMed Central  Google Scholar 

  32. O’Mara TA, Glubb DM, Painter JN et al (2015) Comprehensive genetic assessment of the ESR1 locus identifies a risk region for endometrial cancer. Endocr Relat Cancer 22:851–861

    PubMed  PubMed Central  Google Scholar 

  33. Lobo RA (2017) Hormone-replacement therapy: current thinking. Nat Rev Endocrinol 13:220–231

    CAS  PubMed  Google Scholar 

  34. Rossouw JE, Anderson GL, Prentice RL et al (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 288:321–333

    CAS  PubMed  Google Scholar 

  35. Katalinic A, Stegmaier C, Rawal R et al (2007) Less hormone replacement therapy, less breast cancer in Germany? Geburtshilfe Frauenheilkd 67:1217–1221

    Google Scholar 

  36. Schwabe U, Paffrath D, Ludwig WD (2017) Arzneiverordnungs-report 2017. Springer, Berlin

    Google Scholar 

  37. Hodis HN, Mack WJ (2014) Hormone replacement therapy and the association with coronary heart disease and overall mortality: clinical application of the timing hypothesis. J Steroid Biochem Mol Biol 142:68–75

    CAS  PubMed  Google Scholar 

  38. Manson JE, Chlebowski RT, Stefanick ML et al (2013) Menopausal hormone therapy and health outcomes during the intervention and extended poststop** phases of the Women’s Health Initiative randomized trials. JAMA 310:1353–1368

    CAS  PubMed  Google Scholar 

  39. Chlebowski RT, Anderson GL, Sarto GE et al (2016) Continuous Combined Estrogen Plus Progestin and Endometrial Cancer: The Women’s Health Initiative Randomized Trial. J Natl Cancer Inst. https://doi.org/10.1093/jnci/djv350

    Article  PubMed  PubMed Central  Google Scholar 

  40. Beckmann MW, Gitsch G, Emons G et al (2006) The newly established subspecialty gynecological oncology a national and an international chance? Geburtshilfe Frauenheilkd 66:4

    Google Scholar 

  41. Binder PS, Mutch DG (2014) Update on prognostic markers for endometrial cancer. Womens Health (London) 10:277–288

    CAS  Google Scholar 

  42. Ko EM, Walter P, Clark L et al (2014) The complex triad of obesity, diabetes and race in Type I and II endometrial cancers: prevalence and prognostic significance. Gynecol Oncol 133:28–32

    PubMed  Google Scholar 

  43. Secord AA, Hasselblad V, Von Gruenigen VE et al (2016) Body mass index and mortality in endometrial cancer: a systematic review and meta-analysis. Gynecol Oncol 140:184–190

    PubMed  Google Scholar 

  44. Marshall SF, Clarke CA, Deapen D et al (2010) Recent breast cancer incidence trends according to hormone therapy use: the California Teachers Study cohort. Breast Cancer Res 12:R4

    PubMed  PubMed Central  Google Scholar 

  45. Rauh C, Schuetz F, Rack B et al (2015) Hormone therapy and its effect on the prognosis in breast cancer patients. Geburtshilfe Frauenheilkd 75:588–596

    CAS  PubMed  PubMed Central  Google Scholar 

  46. Schuetz F, Diel IJ, Pueschel M et al (2007) Reduced incidence of distant metastases and lower mortality in 1072 patients with breast cancer with a history of hormone replacement therapy. Am J Obstet Gynecol 196(342):e341–349

    Google Scholar 

  47. Collaborative Group on Epidemiological Studies of Ovarian C, Beral V, Gaitskell K et al (2015) Menopausal hormone use and ovarian cancer risk: individual participant meta-analysis of 52 epidemiological studies. Lancet 385:1835–1842

    Google Scholar 

  48. Pearce CL, Chung K, Pike MC et al (2009) Increased ovarian cancer risk associated with menopausal estrogen therapy is reduced by adding a progestin. Cancer 115:531–539

    PubMed  Google Scholar 

  49. Hein A, Thiel FC, Bayer CM et al (2013) Hormone replacement therapy and prognosis in ovarian cancer patients. Eur J Cancer Prev 22:52–58

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Susanna Tietz’s contribution to this publication was made in partial fulfillment of the requirements for obtaining the doctoral degree “Dr. med.” Parts of the study published here were used for her doctoral thesis at the Medical Faculty of Friedrich Alexander University of Erlangen–Nuremberg (FAU).

Author information

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center, Friedrich Alexander University of Erlangen–Nuremberg, Universitaetsstrasse 21–23, 91054, Erlangen, Germany

    Alexander Hein, Michael O. Schneider, Simone K. Renner, Peter A. Fasching, Susanna Titz & Matthias W. Beckmann

  2. Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen–Nuremberg, Erlangen, Germany

    Cornelia Fiessler

  3. Institute of Pathology, Erlangen University Hospital, Erlangen, Germany

    Arndt Hartmann

  4. Department of Gynecology and Obstetrics, ALB FILS KLINIKEN GmbH, Klinik am Eichert, Goep**en, Germany

    Falk C. Thiel

Authors
  1. Alexander Hein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael O. Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Simone K. Renner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter A. Fasching
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cornelia Fiessler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Susanna Titz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Arndt Hartmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Matthias W. Beckmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Falk C. Thiel
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AH: Data management, manuscript writing, and project development. MOS: Data collection and management, manuscript writing. SKR: Data collection, manuscript writing. PAF: Data management, manuscript writing, project development. CF: Data analysis. ST: Data collection. AH: Project development. MWB: Project development. FCT: Manuscript writing, project development.

Corresponding author

Correspondence to Alexander Hein.

Ethics declarations

Conflict of interest

There were no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hein, A., Schneider, M.O., Renner, S.K. et al. Risk of postmenopausal hormone therapy and patient history factors for the survival rate in women with endometrial carcinoma. Arch Gynecol Obstet 301, 289–294 (2020). https://doi.org/10.1007/s00404-019-05414-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-019-05414-3

Keywords

Search

Navigation