Abstract
BackgroundHormone replacement therapy (HRT) use has shown to be associated with a reduced risk of colorectal cancer, however, its impact on survival among women with colorectal cancer remains uncertain. This meta-analysis aimed to systematically assess the survival benefit of HRT use in patients with colorectal cancer.MethodsPRISMA guidelines for the reporting of meta-analyses were followed. We systematically searched PubMed, Embase, Cochrane library, Scopus, and PsycINFO from inception to 12 January 2019, with no language restrictions, for randomized controlled trials and cohort studies reporting the association between hormone replacement therapy and risk of colorectal cancer mortality or all-cause mortality in colorectal cancer survivors. We used the Newcastle-Ottawa Scale to assess the risk of bias of the included studies. We summarized the association as hazard ratio (HR; 95% CI) using random-effects meta-analysis. The study protocol was registered in PROSPERO (CRD42017071914).ResultsOf 1648 articles identified, five cohorts including 10,013 colorectal cancer survivors were included in this meta-analysis. Compared with women with no prior use of HRT, those reporting current use of HRT had lower risks of colorectal cancer-specific mortality (HR, 0.71 [95% CI, 0.62–0.80], I2 = 0%) and overall mortality (HR, 0.74 [95% CI, 0.67–0.81], I2 = 0%). Low between-study variance was also suggested by the narrow prediction interval for colorectal cancer-specific mortality (0.58–0.86) and overall mortality (0.63–0.87), which indicated that a future study will show survival benefits in women with current HRT use compared with those with no HRT exposure. Inverse associations with colorectal cancer-specific (HR, 1.02 [95% CI, 0.82–1.28], I2 = 0%) and overall mortality (HR, 1.07 [95% CI, 0.90–1.27], I2 = 0%) were not observed for former users of HRT. Sensitivity analyses revealed no differences in the risk estimates between two groups.ConclusionsThe findings suggest that the current use of HRT is associated with lower risks of colorectal cancer-specific and overall mortality in patients with colorectal cancer. Further investigations to elucidate the underlying mechanism are warranted.
Highlights
Hormone replacement therapy (HRT) use has shown to be associated with a reduced risk of colorectal cancer, its impact on survival among women with colorectal cancer remains uncertain
The study findings show that the current use of HRT was associated with a significant reduction in the risk of colorectal cancer-specific mortality and all-cause mortality in women with colorectal cancer
In addition to the well-documented chemoprevention effects, our results suggested a role of HRT on disease-specific and all-cause mortality among colorectal cancer survivors
Summary
Hormone replacement therapy (HRT) use has shown to be associated with a reduced risk of colorectal cancer, its impact on survival among women with colorectal cancer remains uncertain. Given the aging population and advances in treatment in the past decades, the 5-year colorectal cancer prevalence in women were estimated to be over 2 million in 2018 [3]. Despite these encouraging figures, the cumulative impact of cancer and ongoing chronic physical and emotional symptoms reduce quality of life and overall survival [4]. A comprehensive evaluation of the impact of hormone therapy use among cancer survivors is urgently needed to inform physicians and patients for treatment decision making
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