Richiardi Lorenzo, Akre Olof, Montgomery Scott M, Lambe Mats, Kvist Ulrik, Ekbom Anders
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. lorenzo.richiardi@ meb.ki.se
J Natl Cancer Inst. 2004 Jan 21;96(2):145-7. doi: 10.1093/jnci/djh012.
Previous studies have suggested an association between subfertility and testicular cancer by using fecundity and semen characteristics to measure fertility. The occurrence of twinning in offspring may be used to investigate male reproductive health, because dizygotic twinning is reduced by male subfertility. We therefore assessed number of children and offspring twinning rates among 4592 Swedish patients with testicular cancer and 12 254 control subjects. Before diagnosis, case patients had a decreased number of children (for testicular cancer, odds ratio [OR] = 0.71, 95% confidence interval [CI] = 0.62 to 0.81; at least three children compared with no children), with a lower frequency of dizygotic twinning (for unlike-sex twins, OR for the father having testicular cancer = 0.49, 95% CI = 0.22 to 1.08). The ratio of unlike-sex to same-sex twins was 0.22 among children of case patients and 0.66 among children of control subjects (adjusted P =.03, two-sided Wald test). We also found an increased occurrence of twinning after diagnosis, probably attributable to treatment for iatrogenic subfertility. Our study strongly supports evidence of an association between subfertility and the subsequent risk for testicular cancer.
以往的研究通过使用生育力和精液特征来衡量生育能力，提示了亚生育力与睾丸癌之间的关联。后代中双胎妊娠的发生情况可用于研究男性生殖健康，因为男性亚生育力会降低异卵双胎妊娠的发生率。因此，我们评估了4592例瑞典睾丸癌患者和12254例对照者的子女数量及后代双胎妊娠率。在诊断前，病例组患者的子女数量减少（对于睾丸癌，比值比[OR]=0.71，95%置信区间[CI]=0.62至0.81；与无子女相比，至少有三个子女），异卵双胎妊娠的频率较低（对于不同性别的双胞胎，父亲患睾丸癌的OR=0.49，95%CI=0.22至1.08）。病例组患者子女中不同性别与同性别双胞胎的比例为0.22，对照组患者子女中该比例为0.66（校正P=0.03，双侧Wald检验）。我们还发现诊断后双胎妊娠的发生率增加，这可能归因于医源性亚生育力的治疗。我们的研究有力地支持了亚生育力与随后患睾丸癌风险之间存在关联的证据。
