肛门癌病因中的人乳头瘤病毒、吸烟及性行为

Human papillomavirus, smoking, and sexual practices in the etiology of anal cancer.

作者信息

Daling Janet R, Madeleine Margaret M, Johnson Lisa Godefroy, Schwartz Stephen M, Shera Katherine A, Wurscher Michelle A, Carter Joseph J, Porter Peggy L, Galloway Denise A, McDougall James K

机构信息

Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA.

出版信息

Cancer. 2004 Jul 15;101(2):270-80. doi: 10.1002/cncr.20365.

DOI:10.1002/cncr.20365

PMID:15241823

Abstract

BACKGROUND

The incidence of anal cancer has increased among both men (160%) and women (78%) from 1973 to 2000 in the U.S. The authors conducted a population-based case-control study of anal cancer to examine factors that may account for this increase.

METHODS

Men (n = 119 patients) and women (n = 187 patients) who were diagnosed with anal cancer between 1986 and 1998 in the Seattle area were ascertained through the local Surveillance, Epidemiology, and End Results registry. Control participants (n = 1700) were ascertained through random-digit telephone dialing. Participants were interviewed in person and provided blood samples. Archival tumor tissue was tested for human papilloma virus (HPV) DNA, and serum samples were tested for HPV type 16 (HPV-16).

RESULTS

Overall, 88% of tumors (all histologies) in the study were found to be positive for HPV. HPV-16 was the most frequent HPV type detected (73% of all tumors), followed by HPV-18 (6.9%), regardless of gender. However, 97.7% of tumors from men who were not exclusively heterosexual contained HPV DNA. The risk of anal cancer increased among men (odds ratio [OR], 5.3; 95% confidence interval [95% CI], 2.4-12.0) and women (OR, 11.0; 95% CI, 5.5-22.1) who had > or = 15 sexual partners during their lifetime. Among men who were not exclusively heterosexual and women, receptive anal intercourse was related strongly to the risk of anal cancer (OR, 6.8 [95% CI, 1.4-33.8] and OR, 2.2 [95% CI, 1.4-3.3], respectively). Current smokers among men and women were at particularly high risk for anal cancer, independent of age and other risk factors (OR, 3.9 [95% CI, 1.9-8.0] and OR, 3.8 [95% CI, 2.4-6.2], respectively).

CONCLUSIONS

The high proportion of tumors with detectable HPV suggests that infection with HPV is a necessary cause of anal cancer, similar to that of cervical cancer. Increases in the prevalence of exposures, such as cigarette smoking, anal intercourse, HPV infection, and the number of lifetime sexual partners, may account for the increasing incidence of anal cancer in men and women.

摘要

背景

1973年至2000年间，美国男性（增长160%）和女性（增长78%）的肛门癌发病率均有所上升。作者开展了一项基于人群的肛门癌病例对照研究，以探究可能导致这种增长的因素。

方法

通过当地的监测、流行病学和最终结果登记系统确定了1986年至1998年间在西雅图地区被诊断为肛门癌的男性（119例患者）和女性（187例患者）。通过随机数字拨号确定对照参与者（1700例）。对参与者进行了面对面访谈并采集了血样。对存档的肿瘤组织进行人乳头瘤病毒（HPV）DNA检测，对血清样本进行16型人乳头瘤病毒（HPV-16）检测。

结果

总体而言，研究中88%的肿瘤（所有组织学类型）HPV检测呈阳性。无论性别，HPV-16是最常检测到的HPV类型（占所有肿瘤的73%），其次是HPV-18（6.9%）。然而，并非完全异性恋的男性中97.7%的肿瘤含有HPV DNA。一生中拥有≥15个性伴侣的男性（比值比[OR]，5.3；95%置信区间[95%CI]，2.4 - 12.0）和女性（OR，11.0；95%CI，5.5 - 22.1）患肛门癌的风险增加。在并非完全异性恋的男性和女性中，接受肛交与患肛门癌的风险密切相关（分别为OR，6.8[95%CI，1.4 - 33.8]和OR，2.2[95%CI，1.4 - 3.3]）。男性和女性中的当前吸烟者患肛门癌的风险特别高，与年龄和其他风险因素无关（分别为OR，3.9[95%CI，1.9 - 8.0]和OR，3.8[95%CI，2.4 - 6.2]）。