Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, Indiana.
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
Cancer Epidemiol Biomarkers Prev. 2021 Mar;30(3):499-506. doi: 10.1158/1055-9965.EPI-20-1373. Epub 2020 Dec 17.
Female hormones may play roles during renal cell carcinoma (RCC) carcinogenesis. The aims of this study were to investigate associations between hysterectomy, oophorectomy, and risk of RCC and to assess whether the associations were modified by exogenous estrogen, commonly used among women who have undergone hysterectomy.
Postmenopausal women ( = 144,599) ages 50-79 years at enrollment (1993-1998) in the Women's Health Initiative were followed for a mean of 15.9 years. Hysterectomy and oophorectomy were self-reported. Incident RCC cases were confirmed by physician review of medical records and pathology reports. Multivariable Cox proportional hazards modeling was used to estimate hazard ratios (HR) and 95% confidence intervals (CI), adjusting for potential confounders.
A total of 583 women developed RCC during follow-up. We observed that hysterectomy, regardless of oophorectomy status, was significantly associated with an increased risk of RCC (HR, 1.28; 95% CI, 1.03-1.60). The association appeared to be more pronounced in women with age at hysterectomy younger than 40 years (HR, 1.34; 95% CI, 1.01-1.80) or older than 55 years (HR, 1.52; 95% CI, 1.01-2.29). Oophorectomy was not significantly associated with risk of RCC. There was no evidence that exogenous estrogen use modified the association between hysterectomy and risk of RCC.
In this large prospective study, we showed that women with a history of hysterectomy had 28% increased risk of RCC, and this finding was not modified by exogenous hormone use.
If our findings are confirmed, women should be made aware of increased risk of RCC when considering hysterectomy.
女性激素可能在肾细胞癌（RCC）的发生中起作用。本研究的目的是探讨子宫切除术和卵巢切除术与 RCC 风险之间的关系，并评估这些关联是否因接受子宫切除术的女性常用的外源性雌激素而改变。
绝经后妇女（n=144599）年龄在 50-79 岁，于 1993-1998 年参加妇女健康倡议研究，随访平均 15.9 年。子宫切除术和卵巢切除术均为自我报告。通过医生审查病历和病理报告来确认 RCC 病例。多变量 Cox 比例风险模型用于估计危险比（HR）和 95%置信区间（CI），并调整潜在混杂因素。
在随访期间，共有 583 名妇女发生了 RCC。我们观察到，无论卵巢切除术状态如何，子宫切除术与 RCC 风险增加显著相关（HR，1.28；95%CI，1.03-1.60）。在子宫切除术年龄小于 40 岁（HR，1.34；95%CI，1.01-1.80）或大于 55 岁（HR，1.52；95%CI，1.01-2.29）的女性中，这种关联似乎更为明显。卵巢切除术与 RCC 风险无显著关联。没有证据表明外源性雌激素的使用改变了子宫切除术与 RCC 风险之间的关联。
在这项大型前瞻性研究中，我们发现有子宫切除术史的女性 RCC 风险增加 28%，而外源性激素的使用并没有改变这一发现。
如果我们的发现得到证实，女性在考虑子宫切除术时应意识到 RCC 风险增加。
