Hemminki Kari, Aaltonen Lauri, Li Xinjun
Department of Biosciences at Novum, Karolinska Institute, Huddinge, Sweden.
Cancer. 2003 May 15;97(10):2432-9. doi: 10.1002/cncr.11372.
Population-based data on subsequent neoplasms after women are diagnosed with endometrial and ovarian carcinomas are limited, particularly regarding specific histologic tumor types.
The nationwide Swedish Family-Cancer Database of 10.2 million individuals, which includes 19,128 invasive endometrial carcinomas and 19,440 ovarian carcinomas, was used to calculate standardized incidence ratios (SIRs) and 95% confidence intervals (95% CIs) for second primary carcinomas. SIRs were calculated for specific follow-up periods. Data on histopathologic types also were used.
An excess of subsequent malignancies after women were diagnosed with endometrial carcinoma was noted at 11 sites. The highest SIRs were recorded for synchronous or metasynchronous ovarian carcinomas (SIR, 55.77; 95% CI, 48.82-63.43) and carcinomas of the small intestines (SIR, 14.71; 95% CI, 4.64-34.59). Primary ovarian carcinoma was followed by an increased risk of developing endometrial carcinoma, and the risks of developing many other malignancies also were increased after women were diagnosed with endometrial carcinoma, including intestinal malignancies, renal cell carcinoma, bladder carcinoma, squamous cell skin carcinoma, connective tissue malignancies, and leukemia. When ovarian endometrioid histology was diagnosed synchronously with primary endometrial carcinoma, the SIR was 140; when endometrial carcinoma was the subsequent neoplasm, the SIR was 87. A small familial component was found in the cooccurrence of endometrial carcinoma and ovarian carcinoma.
The current data show a strong clustering of endometrial carcinomas and ovarian carcinomas, particularly involving tumors of endometrioid morphology. The patterns of second neoplasms also suggest that hereditary nonpolyposis colorectal carcinoma may contribute to the association between endometrial and ovarian malignancies. Increased risks for connective tissue tumors and leukemia may signal a response to treatment, and an increased risk for squamous cell skin carcinoma may signal a depressed immune function.
关于女性被诊断为子宫内膜癌和卵巢癌后后续肿瘤的基于人群的数据有限，尤其是关于特定组织学肿瘤类型的数据。
利用瑞典全国性的包含1020万人的家庭癌症数据库，其中包括19128例浸润性子宫内膜癌和19440例卵巢癌，计算第二原发性癌的标准化发病比（SIRs）和95%置信区间（95% CIs）。针对特定的随访期计算SIRs。还使用了组织病理学类型的数据。
在11个部位发现女性被诊断为子宫内膜癌后后续恶性肿瘤增多。同步或异时性卵巢癌的SIR最高（SIR，55.77；95% CI，48.82 - 63.43），小肠癌的SIR也较高（SIR，14.71；95% CI，4.64 - 34.59）。原发性卵巢癌之后发生子宫内膜癌的风险增加，女性被诊断为子宫内膜癌后发生许多其他恶性肿瘤的风险也增加，包括肠道恶性肿瘤、肾细胞癌、膀胱癌、鳞状细胞皮肤癌、结缔组织恶性肿瘤和白血病。当卵巢子宫内膜样组织学与原发性子宫内膜癌同时诊断时SIR为140；当子宫内膜癌为后续肿瘤时，SIR为87。在子宫内膜癌和卵巢癌的同时发生中发现了较小的家族性因素。
目前的数据显示子宫内膜癌和卵巢癌有很强的聚集性，尤其是涉及子宫内膜样形态的肿瘤。第二肿瘤的模式还表明遗传性非息肉病性结直肠癌可能与子宫内膜和卵巢恶性肿瘤之间的关联有关。结缔组织肿瘤和白血病风险增加可能表明对治疗的反应，鳞状细胞皮肤癌风险增加可能表明免疫功能低下。
