儿童中枢神经系统肿瘤的危险因素：一项病例对照研究的新发现。
Risk factors for central nervous system tumors in children: New findings from a case-control study.
作者信息
Ramis Rebeca, Tamayo-Uria Ibon, Gómez-Barroso Diana, López-Abente Gonzalo, Morales-Piga Antonio, Pardo Romaguera Elena, Aragonés Nuria, García-Pérez Javier
机构信息
Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), Madrid, Spain.
出版信息
PLoS One. 2017 Feb 17;12(2):e0171881. doi: 10.1371/journal.pone.0171881. eCollection 2017.
BACKGROUND
Central nervous system tumors (CNS) are the most frequent solid tumor in children. Causes of CNS tumors are mainly unknown and only 5% of the cases can be explained by genetic predisposition. We studied the effects of environmental exposure on the incidence of CNS tumors in children by subtype, according to exposure to industrial and/or urban environment, exposure to crops and according to socio-economic status of the child.
METHODS
We carried out a population-based case-control study of CNS tumors in Spain, covering 714 incident cases collected from the Spanish Registry of Childhood Tumors (period 1996-2011) and 4284 controls, individually matched by year of birth, sex, and autonomous region of residence. We built a covariate to approximate the exposure to industrial and/or urban environment and a covariate for the exposure to crops (GCI) using the coordinates of the home addresses of the children. We used the 2001 Census to obtain information about socio-economic status (SES). We fitted logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (95%CIs).
RESULTS
The results for all CNS tumors showed an excess risk (OR = 1.37; 95%CI = 1.09-1.73) for SES, i.e., children living in the least deprived areas had 37% more risk of CNS tumor than children living in the most deprived areas. For GCI, an increase of 10% in crop surface in the 1-km buffer around the residence implied an increase of 22% in the OR (OR = 1.22; 95%CI = 1.15-1.29). Children living in the intersection of industrial and urban areas could have a greater risk of CNS tumors than children who live outside these areas (OR = 1.20; 95%CI = 0.82-1.77). Living in urban areas (OR = 0.90; 95%CI = 0.65-1.24) or industrial areas (OR = 0.96; 95%CI = 0.81-1.77) did not seem to increase the risk for all CNS tumors together. By subtype, Astrocytomas, Intracranial and intraspinal embryonal tumors, and other gliomas showed similar results.
CONCLUSION
Our results suggest that higher socioeconomic status and exposure to crops could increase the risk of CNS tumors in children.
背景
中枢神经系统肿瘤（CNS）是儿童中最常见的实体瘤。CNS肿瘤的病因主要不明，仅有5%的病例可由遗传易感性解释。我们根据儿童对工业和/或城市环境的暴露、对农作物的暴露以及社会经济地位，按亚型研究了环境暴露对儿童CNS肿瘤发病率的影响。
方法
我们在西班牙开展了一项基于人群的CNS肿瘤病例对照研究，纳入了从西班牙儿童肿瘤登记处收集的714例新发病例（1996 - 2011年期间）以及4284例对照，对照按出生年份、性别和居住自治区进行个体匹配。我们利用儿童家庭住址的坐标构建了一个近似工业和/或城市环境暴露的协变量以及一个农作物暴露（全球癌症发病率，GCI）的协变量。我们使用2001年人口普查获取社会经济地位（SES）信息。我们拟合逻辑回归模型以估计比值比（OR）和95%置信区间（95%CI）。
结果
所有CNS肿瘤的结果显示，SES存在超额风险（OR = 1.37；95%CI = 1.09 - 1.73），即生活在最不贫困地区的儿童患CNS肿瘤的风险比生活在最贫困地区的儿童高37%。对于GCI，居住地址周围1公里缓冲区内农作物种植面积增加10%意味着OR增加22%（OR = 1.22；95%CI = 1.15 - 1.29）。生活在工业和城市区域交界处的儿童患CNS肿瘤的风险可能比生活在这些区域之外的儿童更高（OR = 1.20；95%CI = 0.82 - 1.77）。生活在城市地区（OR = 0.90；95%CI = 0.65 - 1.24）或工业地区（OR = 0.96；95%CI = 0.81 - 1.77）似乎并未使所有CNS肿瘤的风险共同增加。按亚型分析，星形细胞瘤、颅内和脊髓内胚胎性肿瘤以及其他胶质瘤显示出相似结果。
结论
我们的结果表明，较高的社会经济地位和对农作物的暴露可能会增加儿童患CNS肿瘤的风险。
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