Coffey Kate, Gaitskell Kezia, Beral Valerie, Canfell Karen, Green Jane, Reeves Gillian, Barnes Isobel
Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, UK.
Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales 2011, Australia.
Br J Cancer. 2016 Aug 23;115(5):599-606. doi: 10.1038/bjc.2016.165. Epub 2016 Jun 23.
Vulval cancer predominantly affects postmenopausal women. A smaller proportion of vulval cancers, particularly at older ages, are now thought to be associated with human papillomavirus infection than previously reported, but other risk factors have not been well examined in prospective cohort studies.
A total of 1.3 million women aged 49-65 years were followed for incident vulval cancer (ICD-10 C51). Adjusted Cox regression models were used to examine the relationship between reproductive and lifestyle factors and risk of vulval cancer.
There were 898 vulval cancers registered in the cohort over an average of 14 years of follow-up; 70% were squamous cell carcinomas. Past registration of cervical carcinoma in situ (RR 2.68; 95% CI 1.71-4.18; P<0.001), obesity (RR 1.71; 95% CI 1.44-2.04; P<0.0001), and menopause before the age of 50 years (RR 1.52; 95% CI 1.22-1.89; P<0.001) were associated with a significantly increased risk of subsequent vulval cancer.
Past cervical pre-cancer, obesity, and earlier age at menopause are associated with an increased risk of vulval cancer at older ages.
外阴癌主要影响绝经后女性。现在认为，与先前报道相比，较小比例的外阴癌，尤其是老年患者，与人乳头瘤病毒感染有关，但其他风险因素在前瞻性队列研究中尚未得到充分研究。
对总共130万名年龄在49至65岁之间的女性进行随访，以观察外阴癌（国际疾病分类第十版C51）的发病情况。采用校正后的Cox回归模型来研究生殖和生活方式因素与外阴癌风险之间的关系。
在平均14年的随访期内，该队列中登记了898例外阴癌；其中70%为鳞状细胞癌。既往宫颈原位癌登记（风险比2.68；95%置信区间1.71 - 4.18；P<0.001）、肥胖（风险比1.71；95%置信区间1.44 - 2.04；P<0.0001）以及50岁之前绝经（风险比1.52；95%置信区间1.22 - 1.89；P<0.001）与随后发生外阴癌的风险显著增加相关。
既往宫颈癌前病变、肥胖以及较早绝经年龄与老年外阴癌风险增加有关。
