Chang Wei-Chun, Muo Chih-Hsin, Liang Ji-An, Sung Fung-Chang, Kao Chia-Hung
Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Gynecology and Obstetrics, China Medical University Hospital, Taichung, Taiwan.
Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
Eur J Oncol Nurs. 2015 Oct;19(5):473-8. doi: 10.1016/j.ejon.2015.02.006. Epub 2015 Mar 16.
This study was carried out to assess the risk of gynecological malignancy in colorectal cancer survivors using a population-based retrospective cohort study.
Using the National Health Insurance Research Database (NHIRD) of Taiwan, we identified 37,176 patients with colorectal cancer diagnosed in 1998-2009, aged 20 years and above, without other cancer history. We also randomly selected 148,700 women without any cancer in the comparison cohort, frequency matched by age and diagnosis date. Incidences and hazards of breast, cervix, endometrial and ovarian cancers were evaluated by 201l.
The overall incidence of the 4 types of gynecological cancer was 39.0% higher in colorectal cancer patients than in comparisons (2.99 vs. 2.14 per 1000 person-years) with an adjusted hazard ratio (HR) of 1.46 (95% confidence interval (CI) = 1.31-1.62). Breast cancer accounted for most subsequent cancer. The multivariable Cox method measured HR was the highest for endometrial cancer (3.40, 95% CI = 2.59-4.47) for the colorectal cohort relative to comparisons, followed by ovarian cancer and breast cancer, except cervix cancer. The risk of gynecological malignancies was apparently elevated for colorectal cancer survivors <50 years of age.
Follow-up measures are suggested for women with colorectal cancer for early detection and prevention of the subsequent gynecological malignancy.
本研究采用基于人群的回顾性队列研究，评估结直肠癌幸存者发生妇科恶性肿瘤的风险。
利用台湾国民健康保险研究数据库（NHIRD），我们确定了1998 - 2009年诊断的37176例年龄在20岁及以上、无其他癌症病史的结直肠癌患者。我们还在对照队列中随机选择了148700名无任何癌症的女性，按年龄和诊断日期进行频率匹配。到2011年评估乳腺癌、宫颈癌、子宫内膜癌和卵巢癌的发病率和风险。
结直肠癌患者中这4种妇科癌症的总体发病率比对照组高39.0%（每1000人年分别为2.99和2.14），调整后的风险比（HR）为1.46（95%置信区间（CI）= 1.31 - 1.62）。乳腺癌占后续癌症的大多数。多变量Cox方法测量的HR在结直肠癌队列中相对于对照组，子宫内膜癌最高（3.40，95% CI = 2.59 - 4.47），其次是卵巢癌和乳腺癌，但宫颈癌除外。年龄<50岁的结直肠癌幸存者发生妇科恶性肿瘤的风险明显升高。
建议对结直肠癌女性患者采取随访措施，以便早期发现和预防后续的妇科恶性肿瘤。
