欧洲癌症与营养前瞻性调查（EPIC）队列研究中的生殖因素与上皮性卵巢癌生存率
Reproductive factors and epithelial ovarian cancer survival in the EPIC cohort study.
作者信息
Bešević Jelena, Gunter Marc J, Fortner Renée T, Tsilidis Konstantinos K, Weiderpass Elisabete, Onland-Moret N Charlotte, Dossus Laure, Tjønneland Anne, Hansen Louise, Overvad Kim, Mesrine Sylvie, Baglietto Laura, Clavel-Chapelon Françoise, Kaaks Rudolf, Aleksandrova Krasimira, Boeing Heiner, Trichopoulou Antonia, Lagiou Pagona, Bamia Christina, Masala Giovanna, Agnoli Claudia, Tumino Rosario, Ricceri Fulvio, Panico Salvatore, Bueno-de-Mesquita H Bas, Peeters Petra H, Jareid Mie, Quirós J Ramón, Duell Eric J, Sánchez María-José, Larrañaga Nerea, Chirlaque María-Dolores, Barricarte Aurelio, Dias Joana A, Sonestedt Emily, Idahl Annika, Lundin Eva, Wareham Nicholas J, Khaw Kay-Tee, Travis Ruth C, Rinaldi Sabina, Romieu Isabelle, Riboli Elio, Merritt Melissa A
机构信息
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK.
Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany.
出版信息
Br J Cancer. 2015 Dec 1;113(11):1622-31. doi: 10.1038/bjc.2015.377. Epub 2015 Nov 10.
BACKGROUND
Reproductive factors influence the risk of developing epithelial ovarian cancer (EOC), but little is known about their association with survival. We tested whether prediagnostic reproductive factors influenced EOC-specific survival among 1025 invasive EOC cases identified in the European Prospective Investigation into Cancer and Nutrition (EPIC) study, which included 521,330 total participants (approximately 370,000 women) aged 25-70 years at recruitment from 1992 to 2000.
METHODS
Information on reproductive characteristics was collected at recruitment. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), and multivariable models were adjusted for age and year of diagnosis, body mass index, tumour stage, smoking status and stratified by study centre.
RESULTS
After a mean follow-up of 3.6 years (±3.2 s.d.) following EOC diagnosis, 511 (49.9%) of the 1025 women died from EOC. We observed a suggestive survival advantage in menopausal hormone therapy (MHT) users (ever vs never use, HR=0.80, 95% CI=0.62-1.03) and a significant survival benefit in long-term MHT users (⩾5 years use vs never use, HR=0.70, 95% CI=0.50-0.99, P(trend)=0.04). We observed similar results for MHT use when restricting to serous cases. Other reproductive factors, including parity, breastfeeding, oral contraceptive use and age at menarche or menopause, were not associated with EOC-specific mortality risk.
CONCLUSIONS
Further studies are warranted to investigate the possible improvement in EOC survival in MHT users.
背景
生殖因素会影响上皮性卵巢癌（EOC）的发病风险，但它们与生存率的关联却鲜为人知。我们在欧洲癌症与营养前瞻性调查（EPIC）研究中纳入的1025例浸润性EOC病例中，检验了诊断前生殖因素是否会影响EOC特异性生存率。该研究共纳入521,330名参与者（约370,000名女性），招募时间为1992年至2000年，年龄在25至70岁之间。
方法
在招募时收集生殖特征信息。采用Cox比例风险回归模型估计风险比（HR）和95%置信区间（CI），多变量模型根据年龄、诊断年份、体重指数、肿瘤分期、吸烟状况进行调整，并按研究中心分层。
结果
EOC诊断后平均随访3.6年（标准差±3.2），1025名女性中有511名（49.9%）死于EOC。我们观察到绝经激素治疗（MHT）使用者有生存优势（曾经使用与从未使用相比，HR = 0.80，95%CI = 0.62 - 1.03），长期MHT使用者（使用≥5年与从未使用相比）有显著生存获益（HR = 0.70，95%CI = 0.50 - 0.99，P（趋势）= 0.04）。在仅限于浆液性病例时，我们观察到MHT使用的类似结果。其他生殖因素，包括产次、母乳喂养、口服避孕药使用以及初潮或绝经年龄，与EOC特异性死亡风险无关。
结论
有必要进行进一步研究以调查MHT使用者中EOC生存率可能的改善情况。
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