美国护士大型前瞻性队列研究中的子宫内膜异位症与卵巢癌和子宫内膜癌风险
Endometriosis and risk of ovarian and endometrial cancers in a large prospective cohort of U.S. nurses.
作者信息
Poole Elizabeth M, Lin Wayne T, Kvaskoff Marina, De Vivo Immaculata, Terry Kathryn L, Missmer Stacey A
机构信息
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Ave, 3rd Floor, Boston, MA, USA.
Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
出版信息
Cancer Causes Control. 2017 May;28(5):437-445. doi: 10.1007/s10552-017-0856-4. Epub 2017 Mar 15.
PURPOSE
Endometriosis is associated with ovarian cancer, but the relation with endometrial cancer is unclear. Prior studies generally were retrospective and had potential limitations, including use of self-reported endometriosis, failure to account for delays between symptom onset and endometriosis diagnosis, and changes in risk factors post-endometriosis diagnosis. We evaluated whether these limitations obscured a weak association with endometrial cancer and the extent to which these limitations impacted associations with ovarian cancer.
METHODS
Cox proportional hazards regression models were used to assess associations between endometriosis and cancer risk, evaluating the impacts of self-reported vs. laparoscopically confirmed endometriosis, delayed diagnosis, and post-endometriosis diagnosis changes in risk factor exposures on relative risk estimates.
RESULTS
Over 18 years of follow-up, we identified 228 ovarian and 166 endometrial cancers among 102,025 and 97,109 eligible women, respectively. Self-reported endometriosis was associated with ovarian cancer [relative risk (RR): 1.81; 95% confidence interval (CI): 1.26-2.58]; this association was stronger for laparoscopically confirmed endometriosis (HR: 2.14; 95% CI 1.45-3.15). No association was observed with endometrial cancer (self-report RR: 0.78; 95% CI 0.42-1.44; laparoscopic-confirmation RR: 0.76; 95% CI 0.35-1.64). Accounting for diagnosis delays or post-endometriosis diagnosis changes in risk factors had a little impact.
CONCLUSIONS
This study adds to the evidence that endometriosis is not strongly linked to endometrial cancer risk and that the association with ovarian cancer is robust to misclassification, diagnostic delay, and changes in exposures post-endometriosis diagnosis. Our analysis suggests that confounding and misclassification do not obscure a weak association for endometrial cancer risk, although our results should be replicated.
目的
子宫内膜异位症与卵巢癌相关，但与子宫内膜癌的关系尚不清楚。既往研究通常为回顾性研究，存在潜在局限性，包括使用自我报告的子宫内膜异位症、未考虑症状出现与子宫内膜异位症诊断之间的延迟，以及子宫内膜异位症诊断后危险因素的变化。我们评估了这些局限性是否掩盖了与子宫内膜癌的微弱关联，以及这些局限性对与卵巢癌关联的影响程度。
方法
采用Cox比例风险回归模型评估子宫内膜异位症与癌症风险之间的关联，评估自我报告与腹腔镜确诊的子宫内膜异位症、诊断延迟以及子宫内膜异位症诊断后危险因素暴露变化对相对风险估计值的影响。
结果
在18年的随访中，我们在102,025名和97,109名符合条件的女性中分别确定了228例卵巢癌和166例子宫内膜癌。自我报告的子宫内膜异位症与卵巢癌相关[相对风险（RR）：1.81；95%置信区间（CI）：1.26 - 2.58]；腹腔镜确诊的子宫内膜异位症的这种关联更强（HR：2.14；95%CI 1.45 - 3.15）。未观察到与子宫内膜癌的关联（自我报告RR：0.78；95%CI 0.42 - 1.44；腹腔镜确诊RR：0.76；95%CI 0.35 - 1.64）。考虑诊断延迟或子宫内膜异位症诊断后危险因素的变化影响较小。
结论
本研究补充了证据，表明子宫内膜异位症与子宫内膜癌风险没有强烈关联，并且与卵巢癌的关联对错误分类、诊断延迟以及子宫内膜异位症诊断后暴露的变化具有稳健性。我们的分析表明，混杂和错误分类并未掩盖与子宫内膜癌风险的微弱关联，但我们的结果应予以重复验证。
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