聚丙烯网片用于中段尿道悬吊术后的癌症风险。

Cancer Risk After Midurethral Sling Surgery Using Polypropylene Mesh.

机构信息

Stockholm Urogynecological Clinic and the Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden; the Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; the Department of Women's Health, University of Texas Austin Dell Medical School, Austin, Texas; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria; and the Department of Obstetrics and Gynecology, MedStar Washington Hospital Center/Georgetown University School of Medicine, Washington, DC.

出版信息

Obstet Gynecol. 2018 Mar;131(3):469-474. doi: 10.1097/AOG.0000000000002496.

DOI:10.1097/AOG.0000000000002496

PMID:29420401

Abstract

OBJECTIVE

To assess whether there is any association between the implantation of synthetic polypropylene mesh slings for the treatment of stress urinary incontinence (SUI) and risk of cancer.

METHODS

We performed a nationwide cohort study based on the general female population in Sweden. All women entered the observational period as unexposed on January 1, 1997, and contributed person-time as unexposed unless they underwent a midurethral sling procedure for SUI, after which they contributed person-time as exposed until first occurrence of any cancer, death, emigration, or end of the observational period (December 31, 2009). Occurrence of primary cancer was ascertained from the Cancer Register. Hazard ratios (HRs) with 95% CIs were calculated by Cox proportional hazards regression.

RESULTS

The final study population included 5,385,186 women, including 20,905 exposed, encompassing a total of 44,012,936 person-years at risk. Other than an inverse association with rectal cancer (HR 0.5, 95% CI 0.3-0.8), there were no significant differences in risk between exposed and unexposed women for pelvic organ cancers including ovarian (HR 0.8, 95% CI 0.5-1.2), endometrial (HR 1.1, 95% CI 0.8-1.4), cervical (HR 0.4, 95% CI 0.2-1.0), bladder, and urethra (HR 0.7, 95% CI 0.4-1.2). No significant association was observed between exposed women and primary cancer in any organ system when compared with unexposed women. The relative risk for cancer after exposure showed little variation over time except for an inverse overall correlation within the first 4 years of surgery (HR 0.7, 95% CI 0.7-0.8). The incidence rates per 100,000 person-years (95% CIs) for exposed vs unexposed women were 20.5 (14.3-29.5) vs 21.0 (20.6-21.5) for rectal cancer, 25.5 (18.4-35.3) vs 19.8 (19.4-20.2) for ovarian cancer, 65.0 (53.0-79.8) vs 33.1 (32.6-33.7) for endometrial cancer, 5.7 (2.8-11.3) vs 11.9 (11.6-12.2) for cervical cancer, and 19.1 (13.1-27.8) vs 13.3 (13.0-13.7) for bladder and urethra cancer.

CONCLUSION

Our results suggest that midurethral polypropylene sling surgery for SUI is not associated with an increased cancer risk later in life.

摘要

目的

评估治疗压力性尿失禁（SUI）的合成聚丙烯网片吊带植入与癌症风险之间是否存在关联。

方法

我们基于瑞典普通女性人群进行了一项全国性队列研究。所有女性于 1997 年 1 月 1 日进入观察期，作为未暴露人群，除非她们接受了治疗 SUI 的中尿道吊带手术，此后她们作为暴露人群参与研究，直到首次发生任何癌症、死亡、移民或观察期结束（2009 年 12 月 31 日）。通过癌症登记处确定原发性癌症的发生情况。通过 Cox 比例风险回归计算危险比（HR）及其 95%置信区间（CI）。

结果

最终的研究人群包括 5385186 名女性，其中 20905 名暴露于该治疗，共包含 44012936 人年的风险暴露时间。除了与直肠癌呈负相关（HR 0.5，95%CI 0.3-0.8）外，暴露与未暴露女性在包括卵巢癌（HR 0.8，95%CI 0.5-1.2）、子宫内膜癌（HR 1.1，95%CI 0.8-1.4）、宫颈癌（HR 0.4，95%CI 0.2-1.0）、膀胱癌和尿道癌（HR 0.7，95%CI 0.4-1.2）在内的盆腔器官癌症风险方面无显著差异。与未暴露女性相比，暴露女性在任何器官系统中均未观察到与原发性癌症的显著关联。暴露后癌症的相对风险随时间变化不大，除了手术前 4 年内的总体相关性呈负相关（HR 0.7，95%CI 0.7-0.8）外。每 100000 人年的发病率（95%CI），暴露女性与未暴露女性相比分别为：直肠癌 20.5（14.3-29.5）vs 21.0（20.6-21.5）、卵巢癌 25.5（18.4-35.3）vs 19.8（19.4-20.2）、子宫内膜癌 65.0（53.0-79.8）vs 33.1（32.6-33.7）、宫颈癌 5.7（2.8-11.3）vs 11.9（11.6-12.2）、膀胱癌和尿道癌 19.1（13.1-27.8）vs 13.3（13.0-13.7）。