Larfors Gunnar, Lambert Paul C, Lambe Mats, Ekbom Anders, Cnattingius Sven
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
Cancer Epidemiol Biomarkers Prev. 2009 Mar;18(3):777-83. doi: 10.1158/1055-9965.EPI-08-0979. Epub 2009 Feb 24.
A growing body of evidence indicates that reproductive history influences survival in breast cancer, especially among women diagnosed during or shortly after a pregnancy. However, little is known about the underlying mechanisms. We hypothesized that increasing placental weight, as an indirect marker of exposure to elevated hormone levels during pregnancy, would be associated with reduced survival in breast cancer. A cohort of 1873 women with at least one pregnancy after January 1st, 1973, and a subsequent breast cancer diagnosis before the end of 1991 were followed up for death or emigration through 2006. Information on placental weight and potential confounding factors were collected from medical records and from nationwide registers, which resulted in data on placental weight in the most recent pregnancy before diagnosis for 1,057 cases. For each 100-gram increase in placental weight, the adjusted hazard ratio of death was 1.09 [95% confidence interval (CI), 0.99-1.19]. The association was stronger among primiparous women (adjusted hazard ratio, 1.26; 95% CI, 1.09-1.47), and among women diagnosed during pregnancy or within 2 years from last birth (adjusted hazard ratio, 1.30; 95% CI, 1.06-1.59). Increasing placental weight is associated with reduced breast cancer survival. These findings are consistent with the hypothesis that the reduced survival in breast cancer among women with a recent childbirth is linked to pregnancy hormone exposure.
越来越多的证据表明,生育史会影响乳腺癌患者的生存情况,尤其是在孕期或产后不久被诊断出乳腺癌的女性中。然而,其潜在机制却鲜为人知。我们推测,胎盘重量增加作为孕期接触高水平激素的一个间接指标,可能与乳腺癌患者生存率降低有关。我们对1873名女性进行了队列研究,这些女性在1973年1月1日之后至少有过一次怀孕,并在1991年底前被诊断出患有乳腺癌,随访至2006年,记录其死亡或移民情况。通过医疗记录和全国性登记系统收集了胎盘重量及潜在混杂因素的信息,最终获得了1057例患者在诊断前最近一次怀孕时的胎盘重量数据。胎盘重量每增加100克,校正后的死亡风险比为1.09 [95%置信区间(CI),0.99 - 1.19]。这种关联在初产妇中更强(校正后的风险比为1.26;95% CI,1.09 - 1.47),在孕期或最后一次分娩后2年内被诊断出乳腺癌的女性中也更强(校正后的风险比为1.30;95% CI,1.06 - 1.59)。胎盘重量增加与乳腺癌患者生存率降低有关。这些发现与近期分娩的女性乳腺癌生存率降低与孕期激素暴露有关的假设一致。