Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan.
Cancer. 2015 Feb 1;121(3):441-7. doi: 10.1002/cncr.28952. Epub 2014 Dec 22.
Preclinical studies have demonstrated antitumor effects of bisphosphonates. The objective of the current study was to determine the effect of exposure to bisphosphonate on the incidence of endometrial cancer.
The authors used data from the National Cancer Institute's Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial, which collected data on all cancers. In year 5, all participants were asked to complete a self-administered supplemental questionnaire (SQX) that included questions regarding bone medication use. For women without a cancer diagnosis at the time of the SQX, the authors identified whether a woman reported current or former use of a nitrogenous bisphosphonate (NBP), defined as ever-use, and compared them with women never exposed to an NBP. Women with missing information were excluded as were women who reported undergoing a hysterectomy. Incidence rates and rate ratios were calculated with 95% confidence intervals (95% CIs). Cox proportional hazard ratios were also calculated and adjusted for covariates.
A total of 29,254 women were included in the current analysis; an additional 77 cases of endometrial cancer have been diagnosed since the SQX. The incidence rate for endometrial cancer among women exposed to NBPs was 8.7 per 10,000 person-years versus 17.7 per 10,000 person-years among never-exposed women (rate ratio, 0.49; 95% CI, 0.30-0.80). The effect was similar after adjusting for all the covariates in the Cox proportional hazards analysis, with a hazard ratio of 0.56 (95% CI, 0.34-0.93).
The results of the current study suggest that use of NBPs may have a protective effect on the incidence of endometrial cancer. However, additional studies are needed that include other potential confounders and a larger sample.
临床前研究已经证明双膦酸盐具有抗肿瘤作用。本研究的目的是确定接触双膦酸盐对子宫内膜癌发病率的影响。
作者使用了美国国家癌症研究所前列腺癌、肺癌、结直肠癌和卵巢癌（PLCO）癌症筛查试验的数据，该试验收集了所有癌症的数据。在第 5 年，所有参与者都被要求完成一份自我管理的补充问卷（SQX），其中包括关于骨药物使用的问题。对于在 SQX 时没有癌症诊断的女性，作者确定了女性是否报告了当前或过去使用氮双膦酸盐（NBP），定义为曾经使用，并将其与从未接触过 NBP 的女性进行了比较。排除信息缺失的女性和报告接受过子宫切除术的女性。用 95%置信区间（95%CI）计算发病率和比率比。还计算了 Cox 比例风险比，并进行了协变量调整。
共有 29254 名女性纳入本分析；自 SQX 以来，又诊断出 77 例子宫内膜癌。暴露于 NBP 的女性中子宫内膜癌的发病率为每 10000 人年 8.7 例，而从未暴露于 NBP 的女性中为每 10000 人年 17.7 例（比率比，0.49；95%CI，0.30-0.80）。在 Cox 比例风险分析中调整所有协变量后，效果相似，风险比为 0.56（95%CI，0.34-0.93）。
本研究结果表明，使用 NBP 可能对子宫内膜癌的发病率有保护作用。然而，需要进一步的研究，包括其他潜在的混杂因素和更大的样本。
