Yang H P, Cook L S, Weiderpass E, Adami H-O, Anderson K E, Cai H, Cerhan J R, Clendenen T V, Felix A S, Friedenreich C M, Garcia-Closas M, Goodman M T, Liang X, Lissowska J, Lu L, Magliocco A M, McCann S E, Moysich K B, Olson S H, Petruzella S, Pike M C, Polidoro S, Ricceri F, Risch H A, Sacerdote C, Setiawan V W, Shu X O, Spurdle A B, Trabert B, Webb P M, Wentzensen N, Xiang Y-B, Xu Y, Yu H, Zeleniuch-Jacquotte A, Brinton L A
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA.
University of New Mexico, Albuquerque, NM 87131, USA.
Br J Cancer. 2015 Mar 3;112(5):925-33. doi: 10.1038/bjc.2015.24. Epub 2015 Feb 17.
Nulliparity is an endometrial cancer risk factor, but whether or not this association is due to infertility is unclear. Although there are many underlying infertility causes, few studies have assessed risk relations by specific causes.
We conducted a pooled analysis of 8153 cases and 11 713 controls from 2 cohort and 12 case-control studies. All studies provided self-reported infertility and its causes, except for one study that relied on data from national registries. Logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI).
Nulliparous women had an elevated endometrial cancer risk compared with parous women, even after adjusting for infertility (OR=1.76; 95% CI: 1.59-1.94). Women who reported infertility had an increased risk compared with those without infertility concerns, even after adjusting for nulliparity (OR=1.22; 95% CI: 1.13-1.33). Among women who reported infertility, none of the individual infertility causes were substantially related to endometrial cancer.
Based on mainly self-reported infertility data that used study-specific definitions of infertility, nulliparity and infertility appeared to independently contribute to endometrial cancer risk. Understanding residual endometrial cancer risk related to infertility, its causes and its treatments may benefit from large studies involving detailed data on various infertility parameters.
未生育是子宫内膜癌的一个风险因素，但这种关联是否归因于不孕尚不清楚。尽管存在多种潜在的不孕原因，但很少有研究按具体原因评估风险关系。
我们对来自2项队列研究和12项病例对照研究的8153例病例和11713例对照进行了汇总分析。除一项依赖国家登记数据的研究外，所有研究均提供了自我报告的不孕情况及其原因。采用逻辑回归估计调整后的比值比（OR）和95%置信区间（CI）。
即使在调整不孕因素后，未生育女性患子宫内膜癌的风险仍高于已生育女性（OR = 1.76；95% CI：1.59 - 1.94）。报告不孕的女性与无不孕问题的女性相比，即使在调整未生育因素后，风险也有所增加（OR = 1.22；95% CI：1.13 - 1.33）。在报告不孕的女性中，任何一种个体不孕原因与子宫内膜癌均无显著关联。
基于主要为自我报告的不孕数据（使用特定研究的不孕定义），未生育和不孕似乎独立地增加了子宫内膜癌风险。了解与不孕及其原因和治疗相关的残余子宫内膜癌风险，可能受益于涉及各种不孕参数详细数据的大型研究。
