Hormone replacement therapy (HRT) compared to no HRT for epithelial ovarian cancer (EOC)

Patients: women of any age diagnosed with any stage of EOC who had surgical treatment, regardless of chemotherapy treatment
Setting: multiple centres in the United Kingdom, Spain and Hungary, and single institutes in South Africa and China
Intervention: HRT; oestrogen‐alone, and oestrogen combined with progestin, oestrogen agonist/antagonist, testosterone or tibolone in any dose and any route of administration
Comparison: no HRT

Overall survival

HR 0.71
(0.54 to 0.93)

350
(3 RCTs)

⊕⊕⊝⊝
LOW ^{1, 2}

The median follow‐up time in the three included studies was 31.4 months, 90 months and 19.1 years.

Quality of life, general condition

‐

75
(1 RCT)

⊕⊝⊝⊝
VERY LOW ^{1, 2, 3}

The EORTC‐C30 questionnaire was used to evaluate this outcome; higher values correspond with improvement.

Progression‐free survival

HR 0.76
(0.57 to 1.01)

275
(2 RCTs)

⊕⊕⊝⊝
LOW ^{1, 2}

The median follow‐up time in the two studies was 90 months and 19.1 years.

Incidence of breast cancer

RR 2.00
(0.19 to 21.59)

225
(2 RCTs)

⊕⊝⊝⊝
VERY LOW ^{1, 4}

The median follow‐up time in the two studies was 31.41 months and 19.1 years.

Incidence of transient ischaemic attack

RR 5.00
(0.24 to 102.42)

150
(1 RCT)

⊕⊝⊝⊝
VERY LOW ^{1, 2, 4}

The median follow‐up time in the study was 19.1 years.

Incidence of cerebrovascular accident

RR 0.67
(0.11 to 3.88)

150
(1 RCT)

⊕⊝⊝⊝
VERY LOW ^{1, 2, 3}

The median follow‐up time in the study was 19.1 years.

Incidence of myocardial infarction

RR 0.20
(0.01 to 4.10)

150
(1 RCT)

⊕⊝⊝⊝
VERY LOW ^{1, 2, 3}

The median follow‐up time in the study was 19.1 years.

Incidence of gallstones

‐

‐

‐

The incidence of gallstones was not reported in the included studies.

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; RR: risk ratio; HR: hazard ratio

GRADE Working Group grades of evidence
High‐certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate‐certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low‐certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low‐certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect