婴儿出生体重与儿童癌症风险：40000 例国际人群病例对照研究。
Infant birthweight and risk of childhood cancer: international population-based case control studies of 40 000 cases.
机构信息
Department of Paediatrics, Nuffield Department of Obstetrics and Gynaecology, National Perinatal Epidemiology Unit, Formerly of the Childhood Cancer Research Group, University of Oxford, Oxford, UK, Sanford Research Center, Sioux Falls, SD, USA, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA, Fred Hutchinson Cancer Research Center, Seattle, WA, USA, New York State Department of Health, Albany, NY, USA, Cancer Prevention Institute of California, Berkeley, CA, USA and Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA Department of Paediatrics, Nuffield Department of Obstetrics and Gynaecology, National Perinatal Epidemiology Unit, Formerly of the Childhood Cancer Research Group, University of Oxford, Oxford, UK, Sanford Research Center, Sioux Falls, SD, USA, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA, Fred Hutchinson Cancer Research Center, Seattle, WA, USA, New York State Department of Health, Albany, NY, USA, Cancer Prevention Institute of California, Berkeley, CA, USA and Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
Department of Paediatrics, Nuffield Department of Obstetrics and Gynaecology, National Perinatal Epidemiology Unit, Formerly of the Childhood Cancer Research Group, University of Oxford, Oxford, UK, Sanford Research Center, Sioux Falls, SD, USA, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA, Fred Hutchinson Cancer Research Center, Seattle, WA, USA, New York State Department of Health, Albany, NY, USA, Cancer Prevention Institute of California, Berkeley, CA, USA and Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA Department of Paediatrics, Nuffield Department of Obstetrics and Gynaecology, National Perinatal Epidemiology Unit, Formerly of the Childhood Cancer Research Group, University of Oxford, Oxford, UK, Sanford Research Center, Sioux Falls, SD, USA, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA, Fred Hutchinson Cancer Research Center, Seattle, WA, USA, New York State Department of Health, Albany, NY, USA, Cancer Prevention Institute of California, Berkeley, CA, USA and Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
出版信息
Int J Epidemiol. 2015 Feb;44(1):153-68. doi: 10.1093/ije/dyu265. Epub 2015 Jan 27.
BACKGROUND
High birthweight is an established risk factor for childhood leukaemia. Its association with other childhood cancers is less clear, with studies hampered by low case numbers.
METHODS
We used two large independent datasets to explore risk associations between birthweight and all subtypes of childhood cancer. Data for 16 554 cases and 53 716 controls were obtained by linkage of birth to cancer registration records across five US states, and 23 772 cases and 33 206 controls were obtained from the UK National Registry of Childhood Tumours. US, but not UK, data were adjusted for gestational age, birth order, plurality, and maternal age and race/ethnicity.
RESULTS
Risk associations were found between birthweight and several childhood cancers, with strikingly similar results between datasets. Total cancer risk increased linearly with each 0.5 kg increase in birthweight in both the US [odds ratio 1.06 (95% confidence interval 1.04, 1.08)] and UK [1.06 (1.05, 1.08)] datasets. Risk was strongest for leukaemia [USA: 1.10 (1.06, 1.13), UK: 1.07 (1.04, 1.10)], tumours of the central nervous system [USA: 1.05 (1.01, 1.08), UK: 1.07 (1.04, 1.10)], renal tumours [USA: 1.17 (1.10, 1.24), UK: 1.12 (1.06, 1.19)] and soft tissue sarcomas [USA: 1.12 (1.05, 1.20), UK: 1.07 (1.00, 1.13)]. In contrast, increasing birthweight decreased the risk of hepatic tumours [USA: 0.77 (0.69, 0.85), UK: 0.79 (0.71, 0.89) per 0.5 kg increase]. Associations were also observed between high birthweight and risk of neuroblastoma, lymphomas, germ cell tumours and malignant melanomas. For some cancer subtypes, risk associations with birthweight were non-linear. We observed no association between birthweight and risk of retinoblastoma or bone tumours.
CONCLUSIONS
Approximately half of all childhood cancers exhibit associations with birthweight. The apparent independence from other factors indicates the importance of intrauterine growth regulation in the aetiology of these diseases.
背景
高出生体重是儿童白血病的既定风险因素。其与其他儿童癌症的关联尚不明确，由于病例数量较少，研究受到阻碍。
方法
我们使用两个大型独立数据集来探讨出生体重与所有儿童癌症亚型之间的风险关联。通过在美国五个州的癌症登记记录与出生记录的链接，获得了 16554 例病例和 53716 例对照的数据；通过英国国家儿童肿瘤登记处获得了 23772 例病例和 33206 例对照的数据。美国的数据经过了胎龄、出生顺序、多胎、母亲年龄和种族/民族的调整，但英国的数据没有经过调整。
结果
我们发现出生体重与几种儿童癌症之间存在关联，两个数据集的结果非常相似。在美国[比值比 1.06（95%置信区间 1.04，1.08）]和英国[1.06（1.05，1.08）]，出生体重每增加 0.5 公斤，总癌症风险呈线性增加。白血病的风险最高[美国：1.10（1.06，1.13），英国：1.07（1.04，1.10）]，中枢神经系统肿瘤[美国：1.05（1.01，1.08），英国：1.07（1.04，1.10）]，肾肿瘤[美国：1.17（1.10，1.24），英国：1.12（1.06，1.19）]和软组织肉瘤[美国：1.12（1.05，1.20），英国：1.07（1.00，1.13）]。相比之下，出生体重增加会降低肝肿瘤的风险[美国：0.77（0.69，0.85），英国：0.79（0.71，0.89）]。高出生体重与神经母细胞瘤、淋巴瘤、生殖细胞瘤和恶性黑色素瘤的风险之间也存在关联。对于某些癌症亚型，出生体重与风险之间的关联是非线性的。我们没有观察到出生体重与视网膜母细胞瘤或骨肿瘤之间的关联。
结论
大约一半的儿童癌症与出生体重有关。这些疾病的发病机制与其他因素无关，表明宫内生长调节的重要性。
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