Swerdlow A J, Higgins C D, Adlard P, Preece M A
Section of Epidemiology, Institute of Cancer Research, Sutton SM2 5NG, UK.
Lancet. 2002 Jul 27;360(9329):273-7. doi: 10.1016/s0140-6736(02)09519-3.
Growth hormone raises serum concentrations of insulin-like growth factor IGF-I, which is mitogenic and antiapoptotic. There is evidence that raised endogenous levels of growth hormone and IGF-I might be associated with increased risk of certain solid cancers, but there have been no data on long-term risks of solid cancers after growth hormone treatment.
We did a cohort study to investigate cancer incidence and mortality in 1848 patients in the UK who were treated during childhood and early adulthood with human pituitary growth hormone during the period from 1959 to 1985. Patients were followed up for cancer incidence to December, 1995 and for mortality to December, 2000. Risk of cancer in the cohort was compared with that in the general population, controlling for age, sex, and calendar period.
Patients treated with human pituitary growth hormone had significantly raised risks of mortality from cancer overall (standardised mortality ratio 2.8, 95% CI 1.3-5.1; ten cases), colorectal cancer (10.8, 1.3-38.8; two cases), and Hodgkin's disease (11.4, 1.4-41.3; two cases). Incidence of colorectal cancer was also greatly raised (7.9, 1.0-28.7). After exclusion of patients whose original diagnosis rendered them at high risk of cancer, the significance and size of the risks of colorectal cancer incidence and mortality, and of Hodgkin's disease mortality were increased.
Although based on small numbers, the risk of colorectal cancer is of some concern and further investigation in other cohorts is needed. We have no evidence as to whether growth hormone in modern dosage regimens is associated with an increased risk of colorectal cancer.
生长激素可提高血清胰岛素样生长因子IGF-I的浓度，该因子具有促有丝分裂和抗凋亡作用。有证据表明，内源性生长激素和IGF-I水平升高可能与某些实体癌风险增加有关，但尚无关于生长激素治疗后实体癌长期风险的数据。
我们进行了一项队列研究，以调查1959年至1985年期间在英国接受儿童期和成年早期垂体生长激素治疗的1848例患者的癌症发病率和死亡率。对患者进行随访，观察至1995年12月的癌症发病率以及至2000年12月的死亡率。将该队列中的癌症风险与一般人群的风险进行比较，并对年龄、性别和日历时间进行校正。
接受垂体生长激素治疗的患者总体癌症死亡风险显著升高（标准化死亡比2.8，95%可信区间1.3 - 5.1；10例），结直肠癌（10.8，1.3 - 38.8；2例）和霍奇金病（11.4，1.4 - 41.3；2例）。结直肠癌发病率也大幅升高（7.9，1.0 - 28.7）。排除最初诊断使其患癌风险较高的患者后，结直肠癌发病率和死亡率以及霍奇金病死亡率的风险的显著性和幅度均增加。
尽管基于样本量较小，但结直肠癌风险值得关注，需要在其他队列中进行进一步研究。我们没有证据表明现代剂量方案的生长激素是否与结直肠癌风险增加有关。
