Highlights
- •People with hepatitis C infection are at high risk of developing hepatocellular carcinoma.
- •Menopause may increase the risk of hepatocellular carcinoma.
- •We investigated the risk of bilateral oophorectomy in women with hepatitis C.
- •Bilateral oophorectomy did not increase the risk of hepatocellular carcinoma.
Abstract
Objective
Patients with chronic hepatitis C virus (HCV) infection are at high risk of developing
hepatocellular carcinoma (HCC). Previous studies suggested that menopause may increase
the risk of HCC. We investigated the association between bilateral oophorectomy (BO)
and the risk of HCC in women with HCV infection.
Study design
We used data from the National Health Insurance Research Database of Taiwan and conducted
a matched cohort study.
Main outcome measures
The main outcome was HCC. We used a competing risk model to adjust for potential confounding
factors.
Results
From 1997–2013, we identified 2176 patients with BO and 8704 controls. A total of
107 HCC cases (4.9 %, 107/2176) were identified in the BO group compared with 465
HCC cases (5.3 %, 465/8704) in the control group. The incidence rates were 506.3 and
538.9 cases per 100,000 person-years among the HCV-infected patients with and without
BO, respectively. The competing risk model showed that BO did not increase the risk
of developing HCC. Furthermore, a sub-analysis of only women under 50 years of age
similarly showed that BO did not increase the risk of developing HCC after adjusting
for additional covariates. The log-rank test revealed that whether or not the patients
had received HRT, patients with BO did not have an increased risk of developing HCC
(non-BO vs BO with HRT, p = 0.10; non-BO vs BO without HRT, p = 0.09). The use of
HRT after BO did not influence the risk of developing HCC.
Conclusions
This study examined a large dataset with a long follow-up period to test the relationship
between BO and the risk of HCC in HCV-infected women. Our findings suggest that BO
did not increase the risk of HCC, regardless of HRT usage, in these women.
Abbreviations:
ACEIs (angiotensin-converting enzyme inhibitors), BO (bilateral oophorectomy and bilateral oophorectomy), CI (confidence interval), HR (hazard ratio), HCV (hepatitis C virus), HCC (hepatocellular carcinoma), HRT (hormone replacement therapy), ICD-9 (International Classification of Diseases, ninth revision), NHI (National Health Insurance), NHIRD (National Health Insurance Research Database), NSAID (nonsteroidal anti-inflammatory drug)Keywords
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References
- Chronic hepatitis C and liver fibrosis.World J. Gastroenterol. 2014; 20: 11033-11053
- The global epidemiology of hepatocellular carcinoma: present and future.Clin. Liver Dis. 2011; 15 (vii-x): 223-243
- Hepatocellular carcinoma.N. Engl. J. Med. 2011; 365: 1118-1127
- Surgical menopause and increased risk of nonalcoholic fatty liver disease in endometrial cancer.Menopause. 2016; 23: 189-196
- A longer duration of estrogen deficiency increases fibrosis risk among postmenopausal women with nonalcoholic fatty liver disease.Hepatology. 2016; 64: 85-91
- Evolving concepts in the pathogenesis of NASH: beyond steatosis and inflammation.Int. J. Mol. Sci. 2014; 15: 8591-8638
- Estrogen replacement reduces risk and increases survival times of women with hepatocellular carcinoma.Clin. Gastroenterol. Hepatol. 2017; 15: 1791-1799
- Estrogen receptor expression in chronic hepatitis C and hepatocellular carcinoma pathogenesis.World J. Gastroenterol. 2017; 23: 6802-6816
- Reproductive factors, exogenous hormone use and risk of hepatocellular carcinoma among US women: results from the liver cancer pooling Project.Br. J. Cancer. 2015; 112: 1266-1272
- The many Menopauses: searching the cognitive research literature for menopause types.Menopause. 2019; 26: 45-65
- Role of reproductive factors in hepatocellular carcinoma: impact on hepatitis B- and C-related risk.Hepatology. 2003; 38: 1393-1400
- Effects of hepatitis C virus infection on menopause status and symptoms.Menopause. 2009; 16: 401-406
- Risk of depression following uterine cancer: a nationwide population-based study.Psychooncology. 2017; 26: 1770-1776
- Statin use and the risk of cirrhosis development in patients with hepatitis C virus infection.J. Hepatol. 2015; 63: 1111-1117
- Taiwan’s national health insurance research database: past and future.Clin. Epidemiol. 2019; 11: 349-358
- Statins and the risk of hepatocellular carcinoma in patients with hepatitis C virus infection.J. Clin. Oncol. 2013; 31: 1514-1521
- NSAID use and risk of hepatocellular carcinoma and intrahepatic cholangiocarcinoma: the liver cancer pooling project.Cancer Prev. Res. (Phila.). 2015; 8: 1156-1162
- Comparative effectiveness of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in chemoprevention of hepatocellular carcinoma: a nationwide high-risk cohort study.BMC Cancer. 2018; 18: 401
- Surgical trends for benign ovarian tumors among hospitals of different accreditation levels: an 11-year nationwide population-based descriptive study in Taiwan.Taiwan. J. Obstet. Gynecol. 2013; 52: 498-504
- Trends in bilateral salpingo-oophorectomy among Taiwanese women undergoing benign hysterectomy: a population-based, pooled, cross-sectional study.Menopause. 2015; 22: 765-772
- 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy.Climacteric. 2016; 19: 109-150
- Guidelines for ATC Classification and DDD Assignment 2020.(Available from:)2021
- A proportional hazards model for the subdistribution of a competing risk.J. Am. Stat. Assoc. 1999; 94: 469-509
- Gender and menopause impact severity of fibrosis among patients with nonalcoholic steatohepatitis.Hepatology. 2014; 59: 1406-1414
- Progression of liver fibrosis in women infected with hepatitis C: long-term benefit of estrogen exposure.Hepatology. 2004; 40: 1426-1433
- Hormone replacement therapy in young women with surgical primary ovarian insufficiency.Fertil. Steril. 2016; 106: 1580-1587
Article info
Publication history
Published online: January 14, 2021
Accepted:
December 22,
2020
Received in revised form:
December 21,
2020
Received:
May 15,
2020
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
