Daniels Julie L, Pan I-Jen, Olshan Andrew F, Breslow Norman E, Bunin Greta R, Ross Julie A
Department of Epidemiology, University of North Carolina, Chapel Hill, NC 27599-7435, USA.
Cancer Causes Control. 2008 Dec;19(10):1103-10. doi: 10.1007/s10552-008-9174-1. Epub 2008 May 29.
Previous epidemiologic studies have suggested that various pregnancy and birth characteristics may be associated with Wilms tumor, a childhood kidney tumor. We evaluated obstetric events and birth characteristics in relation to Wilms tumor using data from a large North American case-control study. Mothers of 521 children with Wilms tumor and 517 controls, frequency matched on child's age and geographic region, provided information about their labor and delivery history and their children's birth characteristics through a detailed computer-assisted telephone interviews. Most obstetric factors were not associated with Wilms tumor, but modest associations were observed for labor induction (OR: 1.4, 95% Confidence Interval (CI): 1.1, 1.8), prenatal vaginal infection (OR: 1.8, 95% CI: 1.2, 2.8), and upper respiratory infection (OR: 1.5, 95% CI: 1.0, 2.4). Low (<2500 g) and high (>4500 g) birth weight and preterm delivery (<37 weeks completed gestation) were associated with an elevated risk of Wilms tumor, as was neonatal respiratory problems. The association for high birth weight was present only among children with perilobar nephrogenic rests (OR: 2.1, 95% CI: 1.2, 3.9), possibly distinguishing a specific association among a biologically distinct subgroup of Wilms tumor cases. The results of this large study did not support many of the earlier findings of smaller studies. However, additional investigations of the effects of certain obstetric and birth characteristics among more refined tumor subgroups may further our understanding of these factors in relation to Wilms tumor.
以往的流行病学研究表明，各种妊娠和出生特征可能与儿童肾肿瘤——肾母细胞瘤有关。我们利用一项大型北美病例对照研究的数据，评估了与肾母细胞瘤相关的产科事件和出生特征。521例肾母细胞瘤患儿的母亲和517名对照者（根据孩子年龄和地理区域进行频率匹配），通过详细的计算机辅助电话访谈，提供了她们的分娩史和孩子的出生特征信息。大多数产科因素与肾母细胞瘤无关，但引产（比值比：1.4，95%置信区间：1.1, 1.8）、产前阴道感染（比值比：1.8，95%置信区间：1.2, 2.8）和上呼吸道感染（比值比：1.5，95%置信区间：1.0, 2.4）存在适度关联。低出生体重（<2500克）和高出生体重（>4500克）以及早产（妊娠<37周）与肾母细胞瘤风险升高相关，新生儿呼吸问题也与之相关。高出生体重的关联仅存在于有叶周肾源性残留的儿童中（比值比：2.1，95%置信区间：1.2, 3.9），这可能在生物学上不同的肾母细胞瘤病例亚组中区分出一种特定关联。这项大型研究的结果不支持许多早期小型研究的发现。然而，对某些产科和出生特征在更精细肿瘤亚组中的影响进行进一步调查，可能会加深我们对这些因素与肾母细胞瘤关系的理解。
