Department of Global Public Health and Primary Care, University of Bergen, N-5020 Bergen, Norway.
Pediatrics. 2013 Nov;132(5):e1265-75. doi: 10.1542/peds.2013-1317. Epub 2013 Oct 28.
The etiology of childhood cancers is largely unknown. Studies have suggested that birth characteristics may be associated with risk. Our goal was to evaluate the risk of childhood cancers in relation to fetal growth.
We conducted a case-control study nested within Nordic birth registries. The study included cancer cases diagnosed in Denmark, Finland, Norway, and Sweden among children born from 1967 to 2010 and up to 10 matched controls per case, totaling 17,698 cases and 172,422 controls. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were derived from conditional logistic regression.
Risks of all childhood cancers increased with increasing birth weight (P trend ≤ .001). Risks of acute lymphoid leukemia and Wilms tumor were elevated when birth weight was >4000 g and of central nervous system tumors when birth weight was >4500 g. Newborns large for gestational age were at increased risk of Wilms tumor (OR: 2.1 [95% CI: 1.2-3.6]) and connective/soft tissue tumors (OR: 2.1 [95% CI: 1.1-4.4]). In contrast, the risk of acute myeloid leukemia was increased among children born small for gestational age (OR: 1.8 [95% CI: 1.1-3.1]). Children diagnosed with central nervous system tumors at <1 year of age had elevated risk with increasing head circumference (P trend < .001). Those with head circumference >39 cm had the highest risk (OR: 4.7 [95% CI: 2.5-8.7]).
In this large, Nordic population-based study, increased risks for several childhood tumors were associated with measures of fetal growth, supporting the hypothesis that tumorigenesis manifesting in childhood is initiated in utero.
儿童癌症的病因在很大程度上尚不清楚。有研究表明，出生特征可能与风险相关。我们的目标是评估儿童癌症与胎儿生长的关系。
我们进行了一项嵌套在北欧出生登记处的病例对照研究。该研究包括在丹麦、芬兰、挪威和瑞典出生的儿童中诊断出的癌症病例，这些儿童出生于 1967 年至 2010 年之间，每个病例最多有 10 个匹配对照，总计 17698 例病例和 172422 个对照。比值比（OR）和 95%置信区间（95%CI）由条件逻辑回归得出。
所有儿童癌症的风险随着出生体重的增加而增加（趋势 P≤.001）。当出生体重超过 4000 克时，急性淋巴细胞白血病和威尔姆斯瘤的风险增加，当出生体重超过 4500 克时，中枢神经系统肿瘤的风险增加。巨大儿患威尔姆斯瘤（OR：2.1[95%CI：1.2-3.6]）和结缔组织/软组织肿瘤（OR：2.1[95%CI：1.1-4.4]）的风险增加。相反，出生体重不足的儿童患急性髓细胞白血病的风险增加（OR：1.8[95%CI：1.1-3.1]）。<1 岁时被诊断为中枢神经系统肿瘤的儿童，头围越大（趋势 P<.001），风险越高。头围>39 厘米的儿童风险最高（OR：4.7[95%CI：2.5-8.7]）。
在这项大型的北欧基于人群的研究中，几种儿童肿瘤的风险增加与胎儿生长的测量值有关，这支持了肿瘤发生在儿童期的假说，即该肿瘤在子宫内就已开始。
