美国国立卫生研究院-美国退休人员协会饮食与健康研究中结直肠癌女性患者的生殖与激素因素及死亡率
Reproductive and hormonal factors and mortality among women with colorectal cancer in the NIH-AARP Diet and Health Study.
作者信息
Arem H, Park Y, Felix A S, Zervoudakis A, Brinton L A, Matthews C E, Gunter M J
机构信息
Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD 20892, USA.
Division of Public Health Sciences, Washington University School of Medicine in St. Louis, 660 S. Euclid Avenue, Campus Box 8100, St Louis, MO 63110, USA.
出版信息
Br J Cancer. 2015 Jul 28;113(3):562-8. doi: 10.1038/bjc.2015.224. Epub 2015 Jun 23.
BACKGROUND
Although use of menopausal hormone therapy (MHT) and some reproductive factors have been associated with colorectal cancer (CRC) risk, relations between these factors and survival after CRC diagnosis are unclear.
METHODS
Among 2053 post-menopausal women diagnosed with incident CRC in the NIH-AARP Diet and Health Study, we calculated hazard ratios (HRs) and 95% confidence intervals (CIs) using multivariable Cox proportional hazards regression to test associations between oral contraceptive (OC) use, menarche age, age at first birth, parity, menopausal age, and MHT use with all-cause and CRC-specific mortality.
RESULTS
There were 759 deaths (332 CRC-related deaths) over a median follow-up of 7.7 years. We observed no statistically significant associations between OC use, menarche age, age at first birth, parity, menopausal age, and mortality. Compared with never MHT use, former use was not associated with mortality, but we found an inverse association among baseline current users, for both all-cause (HR=0.79, 95% CI 0.66-0.94) and CRC mortality (0.76, 0.59-0.99).
CONCLUSION
Future studies should further focus on the mechanisms by which exogenous oestrogen exposure might affect tumour progression and CRC survival.
背景
尽管绝经激素治疗（MHT）的使用和一些生殖因素与结直肠癌（CRC）风险相关，但这些因素与CRC诊断后的生存之间的关系尚不清楚。
方法
在NIH-AARP饮食与健康研究中确诊为偶发性CRC的2053名绝经后女性中，我们使用多变量Cox比例风险回归计算风险比（HRs）和95%置信区间（CIs），以检验口服避孕药（OC）使用、初潮年龄、首次生育年龄、产次、绝经年龄和MHT使用与全因死亡率和CRC特异性死亡率之间的关联。
结果
在中位随访7.7年期间，有759人死亡（332例与CRC相关的死亡）。我们观察到OC使用、初潮年龄、首次生育年龄、产次、绝经年龄与死亡率之间无统计学显著关联。与从未使用MHT相比，既往使用与死亡率无关，但我们发现基线时当前使用者中存在反向关联，全因死亡率（HR=0.79，95%CI 0.66-0.94）和CRC死亡率（0.76，0.59-0.99）均如此。
结论
未来的研究应进一步关注外源性雌激素暴露可能影响肿瘤进展和CRC生存的机制。
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