Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK.
Ann Oncol. 2015 Aug;26(8):1635-48. doi: 10.1093/annonc/mdv142. Epub 2015 Mar 19.
Greater body mass index (BMI) has been convincingly related to increased endometrial cancer risk, however, whether adiposity earlier in life or abdominal fatness is an independent risk factor and whether weight gain or greater height increases the risk is not clear.
As part of the Continuous Update Project of the World Cancer Research Fund International, we conducted a systematic review and meta-analysis of prospective studies of the association between anthropometric measures and endometrial cancer risk and searched PubMed and several other databases up to February 2015. Summary relative risks (RRs) were calculated using a random-effects model.
Thirty prospective studies of BMI and endometrial cancer risk with 22 320 cases among 6 445 402 participants were included. The summary RR for a 5-unit increment was 1.54 [95% confidence interval (CI) 1.47-1.61, I(2) = 81%]. Although the test for non-linearity was significant, Pnon-linearity < 0.0001, and the curve was steeper within the overweight and obese BMI ranges, there was evidence of increased risk even within the high normal BMI range. The summary RR was 1.45 (95% CI 1.28-1.64, I(2) = 76%) per 5 BMI units for BMI in young adulthood, 1.18 (95% CI 1.14-1.23, I(2) = 67%) per 5 kg increase of weight, and 1.16 (95% CI 1.12-1.20, I(2) = 51%) per 5 kg of weight gained between young adulthood and study baseline, 1.27 (95% CI 1.17-1.39, I(2) = 71%) per 10 cm increase in waist circumference, 1.21 (95% CI 1.13-1.29, I(2) = 0%) per 0.1-unit increment in waist-to-hip ratio and 1.30 (95% CI 1.19-1.41, I(2) = 0%) per 10-cm increase in hips circumference. The summary RR was 1.15 (95% CI 1.09-1.22, I(2) = 61%) for a 10-cm increase in height.
All measures of adiposity were associated with increased risk of endometrial cancer, and in addition increasing height was associated with increased risk.
较大的体重指数（BMI）与子宫内膜癌风险的增加有令人信服的关系，然而，生命早期的肥胖或腹部肥胖是否是一个独立的危险因素，以及体重增加或身高增加是否会增加风险尚不清楚。
作为世界癌症研究基金会国际持续更新项目的一部分，我们对前瞻性研究进行了系统回顾和荟萃分析，这些研究调查了人体测量指标与子宫内膜癌风险之间的关系，并在 2015 年 2 月前检索了 PubMed 和其他几个数据库。使用随机效应模型计算了汇总相对风险（RR）。
纳入了 30 项 BMI 与子宫内膜癌风险的前瞻性研究，共纳入 6445402 名参与者中的 22320 例病例。5 个单位 BMI 增加的汇总 RR 为 1.54（95%置信区间 1.47-1.61，I2=81%）。虽然非线性检验有统计学意义（P<0.0001），并且超重和肥胖 BMI 范围内的曲线更陡峭，但即使在高正常 BMI 范围内也有证据表明风险增加。在年轻成年时，每 5 个 BMI 单位的 BMI 为 1.45（95%置信区间 1.28-1.64，I2=76%），体重每增加 5kg 为 1.18（95%置信区间 1.14-1.23，I2=67%），在年轻成年和研究基线之间体重增加 5kg 为 1.16（95%置信区间 1.12-1.20，I2=51%），腰围每增加 10cm 为 1.27（95%置信区间 1.17-1.39，I2=71%），腰围臀围比每增加 0.1 单位为 1.21（95%置信区间 1.13-1.29，I2=0%），臀部周长每增加 10cm 为 1.30（95%置信区间 1.19-1.41，I2=0%），身高增加 10cm 为 1.15（95%置信区间 1.09-1.22，I2=61%）。
所有肥胖指标都与子宫内膜癌风险增加相关，此外，身高增加也与风险增加相关。
