{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T19:07:51Z","timestamp":1775070471057,"version":"3.50.1"},"reference-count":63,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,2,14]],"date-time":"2023-02-14T00:00:00Z","timestamp":1676332800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Science and Technology Council (NSTC)","award":["NSTC 110-2320-B-038-029-MY3"],"award-info":[{"award-number":["NSTC 110-2320-B-038-029-MY3"]}]},{"name":"National Science and Technology Council (NSTC)","award":["NSTC 111-2321-B-038-004"],"award-info":[{"award-number":["NSTC 111-2321-B-038-004"]}]},{"name":"Ministry of Education in Taiwan","award":["NSTC 110-2320-B-038-029-MY3"],"award-info":[{"award-number":["NSTC 110-2320-B-038-029-MY3"]}]},{"name":"Ministry of Education in Taiwan","award":["NSTC 111-2321-B-038-004"],"award-info":[{"award-number":["NSTC 111-2321-B-038-004"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>The chronic receipt of renin-angiotensin-aldosterone system (RAAS) inhibitors including angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have been assumed to be associated with a significant decrease in overall gynecologic cancer risks. This study aimed to investigate the associations of long-term RAAS inhibitors use with gynecologic cancer risks. A large population-based case-control study was conducted from claim databases of Taiwan\u2019s Health and Welfare Data Science Center (2000\u20132016) and linked with Taiwan Cancer Registry (1979\u20132016). Each eligible case was matched with four controls using propensity matching score method for age, sex, month, and year of diagnosis. We applied conditional logistic regression with 95% confidence intervals to identify the associations of RAAS inhibitors use with gynecologic cancer risks. The statistical significance threshold was p &lt; 0.05. A total of 97,736 gynecologic cancer cases were identified and matched with 390,944 controls. The adjusted odds ratio for RAAS inhibitors use and overall gynecologic cancer was 0.87 (95% CI: 0.85\u20130.89). Cervical cancer risk was found to be significantly decreased in the groups aged 20\u201339 years (aOR: 0.70, 95% CI: 0.58\u20130.85), 40\u201364 years (aOR: 0.77, 95% CI: 0.74\u20130.81), \u226565 years (aOR: 0.87, 95% CI: 0.83\u20130.91), and overall (aOR: 0.81, 95% CI: 0.79\u20130.84). Ovarian cancer risk was significantly lower in the groups aged 40\u201364 years (aOR: 0.76, 95% CI: 0.69\u20130.82), \u226565 years (aOR: 0.83, 95% CI: 0.75\u2013092), and overall (aOR: 0.79, 95% CI: 0.74\u20130.84). However, a significantly increased endometrial cancer risk was observed in users aged 20\u201339 years (aOR: 2.54, 95% CI: 1.79\u20133.61), 40\u201364 years (aOR: 1.08, 95% CI: 1.02\u20131.14), and overall (aOR: 1.06, 95% CI: 1.01\u20131.11). There were significantly reduced risks of gynecologic cancers with ACEIs users in the groups aged 40\u201364 years (aOR: 0.88, 95% CI: 0.84\u20130.91), \u226565 years (aOR: 0.87, 95% CI: 0.83\u20130.90), and overall (aOR: 0.88, 95% CI: 0.85\u20130.80), and ARBs users aged 40-64 years (aOR: 0.91, 95% CI: 0.86\u20130.95). Our case-control study demonstrated that RAAS inhibitors use was associated with a significant decrease in overall gynecologic cancer risks. RAAS inhibitors exposure had lower associations with cervical and ovarian cancer risks, and increased endometrial cancer risk. ACEIs\/ARBs use was found to have a preventive effect against gynecologic cancers. Future clinical research is needed to establish causality.<\/jats:p>","DOI":"10.3390\/ijms24043814","type":"journal-article","created":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T02:31:23Z","timestamp":1676428283000},"page":"3814","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Renin-Angiotensin-Aldosterone System Inhibitors and Development of Gynecologic Cancers: A 23 Million Individual Population-Based Study"],"prefix":"10.3390","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7195-6171","authenticated-orcid":false,"given":"Nhi Thi Hong","family":"Nguyen","sequence":"first","affiliation":[{"name":"School of Health Care Administration, College of Management, Taipei Medical University, Taipei 11031, Taiwan"},{"name":"Health Personnel Training Institute, University of Medicine and Pharmacy, Hue University, Hue 491-20, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7436-9041","authenticated-orcid":false,"given":"Phung-Anh","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei 106339, Taiwan"},{"name":"Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei 11031, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2551-6199","authenticated-orcid":false,"given":"Chih-Wei","family":"Huang","sequence":"additional","affiliation":[{"name":"International Center for Health Information Technology (ICHIT), College of Medical Science and Technology, Taipei Medical University, Taipei 106339, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ching-Huan","family":"Wang","sequence":"additional","affiliation":[{"name":"Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei 106339, Taiwan"},{"name":"Biomedical Informatics & Data Science (BIDS) Section, School of Medicine, Johns Hopkins University, 2024 E Monument St, Suite 1-200, Baltimore, MD 21205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9624-9705","authenticated-orcid":false,"given":"Ming-Chin","family":"Lin","sequence":"additional","affiliation":[{"name":"Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei 106339, Taiwan"},{"name":"Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan"},{"name":"Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Min-Huei","family":"Hsu","sequence":"additional","affiliation":[{"name":"Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei 106339, Taiwan"},{"name":"Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei 11031, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hoang Bui","family":"Bao","sequence":"additional","affiliation":[{"name":"Health Personnel Training Institute, University of Medicine and Pharmacy, Hue University, Hue 491-20, Vietnam"},{"name":"Internal Medicine Department, University of Medicine and Pharmacy, Hue University, Hue 491-20, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuo-Chen","family":"Chien","sequence":"additional","affiliation":[{"name":"International Center for Health Information Technology (ICHIT), College of Medical Science and Technology, Taipei Medical University, Taipei 106339, Taiwan"},{"name":"Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei 106339, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9198-0697","authenticated-orcid":false,"given":"Hsuan-Chia","family":"Yang","sequence":"additional","affiliation":[{"name":"Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei 11031, Taiwan"},{"name":"International Center for Health Information Technology (ICHIT), College of Medical Science and Technology, Taipei Medical University, Taipei 106339, Taiwan"},{"name":"Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei 106339, Taiwan"},{"name":"Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei 116079, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"405","DOI":"10.2174\/156800911795538057","article-title":"Role of the renin-angiotensin system in gynecologic cancers","volume":"11","author":"Ino","year":"2011","journal-title":"Curr. Cancer Drug Targets"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"A Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung","year":"2021","journal-title":"Cancer J. Clin."},{"key":"ref_3","unstructured":"(2023, January 29). Cervical Cancer. World Health Organization. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cervical-cancer."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"7018","DOI":"10.1002\/cam4.2560","article-title":"Ovarian cancer: Current status and strategies for improving therapeutic outcomes","volume":"8","author":"Chandra","year":"2019","journal-title":"Cancer Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1240","DOI":"10.1016\/S0140-6736(18)32552-2","article-title":"Epithelial ovarian cancer","volume":"393","author":"Lheureux","year":"2019","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"191","DOI":"10.6004\/jnccn.2021.0007","article-title":"Ovarian Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology","volume":"19","author":"Armstrong","year":"2021","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_7","unstructured":"(2022, December 10). Endometrial Cancer Statistics. Available online: https:\/\/www.wcrf.org\/cancer-trends\/endometrial-cancer-statistics\/."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"349","DOI":"10.2147\/CLEP.S196293","article-title":"Taiwan\u2019s National Health Insurance Research Database: Past and future","volume":"11","author":"Hsieh","year":"2019","journal-title":"Clin. Epidemiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1177\/1470320312437070","article-title":"Elevated serum angiotensin converting enzyme levels as a reflection of bone marrow renin-angiotensin system activation in multiplloma","volume":"13","author":"Albayrak","year":"2012","journal-title":"J. Renin-Angiotensin-Aldosterone Syst."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1177\/1470320310379876","article-title":"Pathobiological aspects of the local bone marrow renin-angiotensin system: A review","volume":"11","author":"Haznedaroglu","year":"2010","journal-title":"J. Renin-Angiotensin-Aldosterone Syst."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1810","DOI":"10.1093\/eurheartj\/ehaa373","article-title":"Circulating plasma concentrations of angiotensin-converting enzyme 2 in men and women with heart failure and effects of renin-angiotensin-aldosterone inhibitors","volume":"41","author":"Sama","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1111\/j.1365-2125.2012.04170.x","article-title":"Long term use of drugs affecting the renin-angiotensin system and the risk of cancer: A population-based case-control study","volume":"74","author":"Hallas","year":"2012","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"645","DOI":"10.4143\/crt.2019.509","article-title":"Impact of Angiotensin Receptor Blockers, Beta Blockers, Calcium Channel Blockers and Thiazide Diuretics on Survival of Ovarian Cancer Patients","volume":"52","author":"Cho","year":"2020","journal-title":"Cancer Res. Treat."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"581","DOI":"10.17219\/acem\/118843","article-title":"Evaluation of the association between angiotensin converting enzyme insertion\/deletion polymorphism and the risk of endometrial cancer in and characteristics of Polish women","volume":"29","author":"Raba","year":"2020","journal-title":"Adv. Clin. Exp. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/S0140-6736(98)03228-0","article-title":"Do inhibitors of angiotensin-I-converting ezyme protect against risk of cancer?","volume":"352","author":"Lever","year":"1998","journal-title":"Lancet"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/S1470-2045(10)70106-6","article-title":"Angiotensin-receptor blockade and risk of cancer: Meta-analysis of randomised controlled trials","volume":"11","author":"Sipahi","year":"2010","journal-title":"Lancet Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1007\/s00404-015-3661-x","article-title":"Assessment of serum angiotensin-converting enzyme in patients with epithelial ovarian cancer","volume":"292","author":"Beyazit","year":"2015","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_18","first-page":"669","article-title":"Local regulatory factors in regulation of ovarian function: Role of prorenin-renin-angiotensin-system","volume":"41","author":"Mukhopadhyay","year":"2003","journal-title":"Indian J. Exp. Biol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1530\/EC-16-0082","article-title":"Expression of renin-angiotensin system (RAS) components in endometrial cancer","volume":"6","author":"Delforce","year":"2017","journal-title":"Endocr. Connect."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1177\/1470320311418140","article-title":"Is there a role of the local tissue RAS in the regulation of physiologic and pathophysiologic conditions in the reproductive tract?","volume":"12","author":"Schwentner","year":"2011","journal-title":"J. Renin-Angiotensin-Aldosterone Syst."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1093\/humrep\/12.4.651","article-title":"Tissue renin-angiotensin systems and reproduction","volume":"12","author":"Vinson","year":"1997","journal-title":"Hum. Reprod."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1016\/j.ajog.2003.12.013","article-title":"Activation of invasiveness of cervical carcinoma cells by angiotensin II","volume":"190","author":"Kikkawa","year":"2004","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1097\/01.LAB.0000017372.76297.EB","article-title":"Angiotensin II angiogenic effect in vivo involves vascular endothelial growth factor- and inflammation-related pathways","volume":"82","author":"Tamarat","year":"2002","journal-title":"Lab. Investig."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2686","DOI":"10.1158\/1078-0432.CCR-04-1946","article-title":"Functional expression of the angiotensin II type 1 receptor in human ovarian carcinoma cells and its blockade therapy resulting in suppression of tumor invasion, angiogenesis, and peritoneal dissemination","volume":"11","author":"Suganuma","year":"2005","journal-title":"Clin. Cancer Res."},{"key":"ref_25","first-page":"294","article-title":"The involvement of the renin-angiotensin system (RAS) in cancerogenesis","volume":"54","year":"2008","journal-title":"Postep. Biochem."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.tem.2005.07.009","article-title":"Angiotensin receptors: A new role in cancer?","volume":"16","author":"Deshayes","year":"2005","journal-title":"Trends Endocrinol. Metab."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1007\/s000180050307","article-title":"The involvement of the renin-angiotensin system in the regulation of cell proliferation in the rat endometrium","volume":"55","author":"Pawlikowski","year":"1999","journal-title":"Cell. Mol. Life Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.3892\/or.2016.4887","article-title":"Angiotensin II promotes endometrial cancer cell survival","volume":"36","author":"Nowakowska","year":"2016","journal-title":"Oncol. Rep."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1038\/sj.bjc.6602961","article-title":"Angiotensin II type 1 receptor expression in ovarian cancer and its correlation with tumour angiogenesis and patient survival","volume":"94","author":"Ino","year":"2006","journal-title":"Br. J. Cancer"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1016\/j.placenta.2005.07.001","article-title":"Angiotensin II augmented migration and invasion of coriocarcinoma cells involves PI3K activation through the AT1 receptor","volume":"27","author":"Ishimatsu","year":"2006","journal-title":"Placenta"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Ziaja, M., Urbanek, K.A., Kowalska, K., and Piastowska-Ciesielska, A.W. (2021). Angiotensin II and Angiotensin Receptors 1 and 2-Multifunctional System in Cells Biology, What Do We Know?. Cells, 10.","DOI":"10.3390\/cells10020381"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1016\/j.ajog.2011.05.042","article-title":"Understanding obesity and endometrial cancer risk: Opportunities for prevention","volume":"205","author":"Schmandt","year":"2011","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.ygyno.2015.10.020","article-title":"Body mass index and mortality in endometrial cancer: A systematic review and meta-analysis","volume":"140","author":"Secord","year":"2016","journal-title":"Gynecol. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"4225","DOI":"10.1200\/JCO.2016.69.4638","article-title":"Addressing the Role of Obesity in Endometrial Cancer Risk, Prevention, and Treatment","volume":"34","author":"Onstad","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1038\/nrc3967","article-title":"Adiposity and cancer risk: New mechanistic insights from epidemiology","volume":"15","author":"Renehan","year":"2015","journal-title":"Nat. Rev. Cancer"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1530\/ERC-15-0400","article-title":"Obesity and cancer: Mechanistic insights from transdisciplinary studies","volume":"22","author":"Allott","year":"2015","journal-title":"Endocr. Relat. Cancer"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1038\/nrendo.2014.94","article-title":"Obesity and cancer\u2014mechanisms underlying tumour progression and recurrence","volume":"10","author":"Park","year":"2014","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1158\/1078-0432.CCR-11-1916","article-title":"Omental adipose tissue-derived stromal cells promote vascularization and growth of endometrial tumors","volume":"18","author":"Klopp","year":"2012","journal-title":"Clin. Cancer Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1016\/j.tcb.2016.05.005","article-title":"Microenvironmental Control of Adipocyte Fate and Function","volume":"26","author":"Pope","year":"2016","journal-title":"Trends Cell Biol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.ebiom.2019.02.051","article-title":"OVA66 promotes tumour angiogenesis and progression through enhancing autocrine VEGF-VEGFR2 signalling","volume":"41","author":"Song","year":"2019","journal-title":"EBioMedicine"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1940","DOI":"10.1158\/1078-0432.CCR-15-1994","article-title":"KDR Amplification Is Associated with VEGF-Induced Activation of the mTOR and Invasion Pathways but does not Predict Clinical Benefit to the VEGFR TKI Vandetanib","volume":"22","author":"Nilsson","year":"2016","journal-title":"Clin. Cancer Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1002\/ijc.23963","article-title":"Autocrine VEGF-A\/KDR loop protects epithelial ovarian carcinoma cells from anoikis","volume":"124","author":"Sher","year":"2009","journal-title":"Int. J. Cancer"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/j.cell.2011.02.013","article-title":"Hallmarks of cancer: The next generation","volume":"144","author":"Hanahan","year":"2011","journal-title":"Cell"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Lee, S.-H., Park, J., Park, R.W., Shin, S.J., Kim, J., Sung, J.D., Kim, D.J., and Yang, K. (2022). Renin-Angiotensin-Aldosterone System Inhibitors and Risk of Cancer: A Population-Based Cohort Study Using a Common Data Model. Diagnostics, 12.","DOI":"10.3390\/diagnostics12020263"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"20420986221129335","DOI":"10.1177\/20420986221129335","article-title":"Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and cancer risk: An updated meta-analysis of observational studies","volume":"13","author":"Shin","year":"2022","journal-title":"Ther. Adv. Drug Saf."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1698","DOI":"10.1038\/sj.bjc.6605866","article-title":"Angiotensin-2 receptors (AT1-R and AT2-R), new prognostic factors for renal clear-cell carcinoma?","volume":"103","author":"Jouan","year":"2010","journal-title":"Br. J. Cancer"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2189","DOI":"10.1007\/s11605-009-1055-8","article-title":"Angiotensin II regulates the expression of monocyte chemoattractant protein-1 in pancreatic cancer cells","volume":"13","author":"Chehl","year":"2009","journal-title":"J. Gastrointest. Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2210","DOI":"10.1073\/pnas.1818357116","article-title":"Losartan treatment enhances chemotherapy efficacy and reduces ascites in ovarian cancer models by normalizing the tumor stroma","volume":"116","author":"Zhao","year":"2019","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_49","first-page":"1104","article-title":"Ovarian angiotensin-converting enzyme activity in humans: Relationship to estradiol, age, and uterine pathology","volume":"81","author":"Erman","year":"1996","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/S0954-6111(97)90045-7","article-title":"Elevated serum angiotensin converting enzyme levels in metastatic ovarian dysgerminoma","volume":"91","author":"Cotter","year":"1997","journal-title":"Respir. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/S1470-2045(10)70260-6","article-title":"Antihypertensive drugs and risk of cancer: Network meta-analyses and trial sequential analyses of 324,168 participants from randomised trials","volume":"12","author":"Bangalore","year":"2011","journal-title":"Lancet Oncol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2462","DOI":"10.1002\/1097-0142(20011101)92:9<2462::AID-CNCR1596>3.0.CO;2-L","article-title":"Angiotensin-converting enzyme inhibitors and the risk of cancer: A population-based cohort study in Denmark","volume":"92","author":"Friis","year":"2001","journal-title":"Cancer"},{"key":"ref_53","unstructured":"Universal Health Coverage in Taiwan (2022, December 10). National Health Insurance Administration, MOHAW, Taiwan, Available online: https:\/\/www.nhi.gov.tw\/English\/Content_List.aspx?n=4D7051840BF42F52&topn=ED4A30E51A609E49."},{"key":"ref_54","unstructured":"National Health Insurance Administration (2020). ICD-9-CM and ICD-10-CM\/PCS Mapping Table, MOHAW."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1016\/S0140-6736(05)66379-9","article-title":"Compared to what? Finding controls for case-control studies","volume":"365","author":"Grimes","year":"2005","journal-title":"Lancet"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.critrevonc.2016.06.006","article-title":"Metformin use and gynecological cancers: A novel treatment option emerging from drug repositioning","volume":"105","author":"Gadducci","year":"2016","journal-title":"Crit. Rev. Oncol. Hematol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"215","DOI":"10.5468\/ogs.2020.63.3.215","article-title":"Associations between metabolic syndrome and gynecologic cancer","volume":"63","author":"Lee","year":"2020","journal-title":"Obstet. Gynecol. Sci."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Chen, Y.H., Wang, P.H., Chen, P.N., Yang, S.F., and Hsiao, Y.H. (2021). Molecular and Cellular Mechanisms of Metformin in Cervical Cancer. Cancers, 13.","DOI":"10.3390\/cancers13112545"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"461","DOI":"10.21037\/atm.2020.03.125","article-title":"Aspirin use and endometrial cancer risk: A meta-analysis and systematic review","volume":"8","author":"Wang","year":"2020","journal-title":"Ann. Transl. Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1016\/j.ygyno.2016.04.543","article-title":"Is aspirin use associated with a decreased risk of ovarian cancer? A systematic review and meta-analysis of observational studies with dose-response analysis","volume":"42","author":"Zhang","year":"2016","journal-title":"Gynecol. Oncol."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Markowska, A., Antoszczak, M., Markowska, J., and Huczy\u0144ski, A. (2020). Statins: HMG-CoA Reductase Inhibitors as Potential Anticancer Agents against Malignant Neoplasms in Women. Pharmaceuticals, 13.","DOI":"10.3390\/ph13120422"},{"key":"ref_62","unstructured":"Rosner, B. (2015). Fundamentals of Biostatistics, Nelson Education."},{"key":"ref_63","unstructured":"Zhang, C., Man, Z., and Nguyen, T. (2017, January 3\u20138). Analysis of 1: M conditional logistic regression modelling method. Proceedings of the International Congress on Modelling and Simulation, Hobart, Australia."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/24\/4\/3814\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:35:00Z","timestamp":1760121300000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/24\/4\/3814"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,14]]},"references-count":63,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["ijms24043814"],"URL":"https:\/\/doi.org\/10.3390\/ijms24043814","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,14]]}}}