Journal List > J Gynecol Oncol > v.30(4) > 1148322

Cho, Ouh, Hong, and Lee: Effects of hormone therapy on recurrence in endometrial cancer survivors: a nationwide study using the Korean Health Insurance Review and Assessment Service database

Abstract

Objective

The aim of this study was to verify the effects of hormone therapy (HT) on recurrence in endometrial cancer (EC) survivors using the Korean Health Insurance Review and Assessment Service (HIRA) database.

Methods

Using the HIRA claims database, we identified all Korean women who were newly diagnosed with EC and underwent surgical staging between 2010 and 2013. Patient characteristics such as age, HT exposure, lymphadenectomy, and adjuvant therapy were evaluated. Cox proportional hazards models were used to estimate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the recurrence of EC.

Results

The mean follow-up time of all 5,667 eligible patients was 47.5 months. Of these, 847 (14.9%) received HT. Recurrence was seen in 446 (7.8%) patients. Univariate analysis revealed an increased recurrence rate in patients older than 50 years (HR=2.05; 95% CI=1.62–2.63), patients with high-risk EC (HR=24.51; 95% CI=18.63–32.35), and patients who underwent lymphadenectomy (HR=1.52; 95% CI=1.21–2.03), and a reduced recurrence rate in patients who received HT (HR=0.62; 95% CI=0.46–0.83). Multivariate analysis confirmed the significant increase in recurrence in patients older than 50 years (HR=1.47; 95% CI=1.14–1.89) and in patients with high-risk EC (HR=23.90; 95% CI=18.12–31.51). HT did not increase the recurrence rate of EC (HR=0.81; 95% CI=0.31–2.10).

Conclusion

This study demonstrates that HT does not increase disease recurrence in EC survivors, despite lack of data that could affect the outcome.

References

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Fig. 1.
A flowchart of the study design. EC, endometrial cancer; HT, hormone therapy; KNHI, Korean National Health Insurance.
jgo-30-e51f1.tif
Table 1.
Annual number of patients who newly diagnosed with endometrial cancer between 2010 and 2015 in Korea
Characteristics Age (yr) 2010 (n=1,241) 2011 (n=1,412) 2012 (n=1,391) 2013 (n=1,623) 2014 (n=1,506) 2015 (n=1,573)
 <30 13 (1) 7 (<1) 10 (1) 7 (1) 12 (1) 13 (1)
 31–40 90 (7) 92 (7) 85 (6) 87 (5) 103 (7) 98 (6)
 41–50 295 (24) 302 (21) 297 (21) 307 (19) 327 (22) 309 (20)
 51–60 497 (40) 627 (44) 594 (43) 703 (43) 639 (42) 641 (41)
 61–70 250 (20) 281 (20) 294 (21) 354 (22) 290 (19) 356 (23)
 >70 96 (8) 103 (7) 111 (8) 165 (10) 135 (9) 156 (10)
Postoperative HT            
 No 1,021 (82) 1,193 (84) 1,184 (85) 1,422 (88) 1,340 (89) 1,446 (92)
 Yes 220 (18) 219 (16) 207 (16) 201 (12) 166 (11) 127 (8)

Values are presented as number of patients (%). HT, hormone therapy.

Table 2.
Clinical characteristics of patients by use of HT (2010–2015)
Characteristics HT (n=1,140) Control (n=7,606) p-value
Age (yr)     <0.001
 <30 18 (2) 44 (1)  
 31–40 134 (12) 421 (6)  
 41–50 389 (34) 1,448 (19)  
 51–60 477 (42) 3,224 (42)  
 61–70 90 (8) 1,735 (23)  
 >70 32 (3) 734 (10)  
Lymphadenectomy     0.051
 No 274 (24) 1,633 (21)  
 Yes 866 (76) 5,973 (79)  
Adjuvant therapy     <0.001
 No 874 (77) 5,219 (69)  
 Brachytherapy 27 (2) 378 (5)  
 Radiotherapy 58 (5) 497 (7)  
 Chemotherapy 181 (16) 1,512 (20)  
Type of HT    
 Estrogen only 253 (22)  
 Estrogen plus progesterone e 178 (16)  
 Tibolone 363 (32)  
 Progesterone only 346 (30)  

Values are presented as number of patients (%). HT, hormone therapy.

Table 3.
Univariate Cox regression model for associations between clinical factors and recurrence (2010–2013)
Characteristics Recurrence* (n=446) HR 95% CI p-value
Age (yr)       <0.001
 <50 75 (4.7) 1.00    
 ≥50 371 (9.1) 2.05 1.62–2.63  
Lymphadenectomy       0.002
 No 75 (5.5) 1.00    
 Yes 379 (8.5) 1.52 1.21–2.03  
Adjuvant therapy       <0.001
 No adjuvant therapy+brachytherapy+EBRT (low-intermediate risk EC) 59 (1.3) 1.00    
 Chemotherapy (high-risk EC) 387 (31.7) 24.51 18.63–32.35  
Postoperative HT       0.001
 No 396 (8.2) 1.00    
 Yes 50 (5.9) 0.62 0.46–0.83  
Type of HT        
 No 396 (8.2) 1.00    
 Estrogen 10 (3.9) 0.39 0.23–0.71 0.002
 Estrogen plus progesterone 6 (5.4) 0.45 0.29–0.98 0.034
 Tibolone 14 (5.3) 0.50 0.35–0.84 0.008
 Progesterone 20 (9.5) 0.89 0.62–1.43 0.588

CI, confidence interval; EBRT, external beam radiation therapy; EC, endometrial cancer; HR, hazard ratio; HT, hormone therapy.

* Recurrence presented as number of patients (%).

Table 4.
Multivariate Cox regression model for recurrence risk of EC according to each prognostic factor
Characteristics HR 95% CI p-value
Age ≥50 yr 1.47 1.14–1.89 0.003
Assessment of lymph node 1.07 0.82–1.39 0.365
Adjuvant therapy* 23.90 18.12–31.51 <0.001
Postoperative HT 0.81 0.31–2.10 0.662
Type of HT      
 Estrogen 0.78 0.31–1.96 0.602
 Estrogen plus progesterone 0.57 0.21–1.57 0.278
 Tibolone 0.88 0.34–2.29 0.795
 Progesterone 1.02 0.39–2.67 0.977

CI, confidence interval; EC, endometrial cancer; HR, hazard ratio; HT, hormone therapy.

* Adjuvant therapy is chemotherapy (high-risk EC).

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