Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, United States.
Cancer Epidemiol. 2012 Dec;36(6):e359-65. doi: 10.1016/j.canep.2012.08.002. Epub 2012 Aug 25.
We conducted a large registry-based study in California to investigate the association of perinatal factors and childhood leukemia with analysis of two major subtypes, acute lymphocytic leukemia (ALL) and acute myeloid leukemia (AML).
We linked California cancer and birth registries to obtain information on 5788 cases and 5788 controls matched on age and sex (1:1). We examined the association of birth weight, gestational age, birth and pregnancy order, parental ages, and specific conditions during pregnancy and risk of total leukemia, ALL and AML using conditional logistic regression, with adjustment for potential confounders.
The odds ratio (OR) per 1000 g increase in birth weight was 1.11 for both total leukemia and ALL. The OR were highest for babies weighing ≥ 4500 g with reference < 2500 g: 1.59 (95% CI: 1.05-2.40) and 1.70 (95% CI: 1.08-2.68) for total leukemia and ALL, respectively. For AML, increase in risk was also observed but the estimate was imprecise due to small numbers. Compared to average-for-gestational age (AGA), large-for-gestational age (LGA) babies were at slightly increased risk of total childhood leukemia (OR = 1.10) and both ALL and AML (OR = 1.07 and OR = 1.13, respectively) but estimates were imprecise. Being small-for-gestational age (SGA) was associated with reduced risk of childhood leukemia (OR = 0.81, 95% CI: 0.67-0.97) and ALL (OR = 0.77, 95% CI: 0.63-0.94), but not AML. Being first-born was associated with decreased risk of AML only (OR = 0.70; 95% CI: 0.53-0.93). Compared to children with paternal age <25 years, children with paternal age between 35 and 45 years were at increased risk of total childhood leukemia (OR = 1.12; 95% CI: 1.04-1.40) and ALL (OR = 1.23; 95% CI: 1.04-1.47). None of conditions during pregnancy examined or maternal age were associated with increased risk of childhood leukemia or its subtypes.
Our results suggest that high birth weight and LGA were associated with increased risk and SGA with decreased risk of total childhood leukemia and ALL, being first-born was associated with decreased risk of AML, and advanced paternal age was associated with increased risk of ALL. These findings suggest that associations of childhood leukemia and perinatal factors depend highly on subtype of leukemia.
我们在加利福尼亚州进行了一项大型基于登记的研究，旨在调查围产期因素和儿童白血病与两种主要亚型（急性淋巴细胞白血病[ALL]和急性髓细胞白血病[AML]）的分析之间的关联。
我们将加利福尼亚癌症和出生登记处联系起来，以获取 5788 例病例和 5788 名年龄和性别相匹配的对照者（1:1）的信息。我们使用条件逻辑回归检查出生体重、胎龄、出生和妊娠顺序、父母年龄以及妊娠期间特定情况与总白血病、ALL 和 AML 风险之间的关联，同时调整了潜在混杂因素。
出生体重每增加 1000 克，总白血病和 ALL 的比值比（OR）分别为 1.11。对于体重≥4500 克的婴儿（参考体重<2500 克），OR 最高：总白血病和 ALL 分别为 1.59（95%CI：1.05-2.40）和 1.70（95%CI：1.08-2.68）。对于 AML，虽然也观察到风险增加，但由于数量较少，估计值不太准确。与平均胎龄（AGA）相比，大于胎龄（LGA）的婴儿患儿童期总白血病（OR=1.10）和 ALL（OR=1.07 和 OR=1.13）的风险略有增加，但估计值不太准确。小于胎龄（SGA）与儿童白血病（OR=0.81，95%CI：0.67-0.97）和 ALL（OR=0.77，95%CI：0.63-0.94）的风险降低有关，但与 AML 无关。与第一胎相比，仅 AML 的风险降低（OR=0.70；95%CI：0.53-0.93）。与父亲年龄<25 岁的儿童相比，父亲年龄在 35 至 45 岁之间的儿童患儿童期总白血病（OR=1.12；95%CI：1.04-1.40）和 ALL（OR=1.23；95%CI：1.04-1.47）的风险增加。研究期间检查的任何妊娠情况或母亲年龄与儿童白血病或其亚型的风险增加无关。
我们的研究结果表明，高出生体重和 LGA 与总儿童白血病和 ALL 的风险增加有关，而 SGA 与风险降低有关，第一胎与 AML 的风险降低有关，而父亲年龄较大与 ALL 的风险增加有关。这些发现表明，儿童白血病与围产期因素之间的关联高度依赖于白血病的亚型。
