Department of Epidemiology and Biostatistics, Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China.
Department of Nutrition, Harvard T.H. Chan School of Public Health, 667 Huntington Avenue, Kresge 906A, Boston, MA, 02115, USA.
BMC Med. 2021 Jan 28;19(1):18. doi: 10.1186/s12916-020-01895-1.
Sex hormones have been suggested to play a role in colorectal cancer (CRC), but their influence on early initiation of CRC remains unknown.
We retrospectively examined the associations with risk of CRC precursors, including conventional adenomas and serrated polyps, for plasma estrone, estradiol, free estradiol, testosterone, free testosterone, sex hormone-binding globulin (SHBG), and the ratio of estradiol to testosterone among 5404 postmenopausal women from the Nurses' Health Study I and II. Multivariable logistic regression was used to calculate the odds ratio (OR) and 95% confidence intervals (CI). Given multiple testing, P < 0.005 was considered statistically significant.
During 20 years of follow-up, we documented 535 conventional adenoma cases and 402 serrated polyp cases. Higher concentrations of SHBG were associated with lower risk of conventional adenomas, particularly advanced adenomas (multivariable OR comparing the highest to the lowest quartile, 0.40, 95% CI 0.24-0.67, P for trend < 0.0001). A nominally significant association was found for SHBG with lower risk of large serrated polyps (≥ 10 mm) (OR, 0.47, 95% CI 0.17-1.35, P for trend = 0.02) as well as free estradiol and free testosterone with higher risk of conventional adenomas (OR, 1.54, 95% CI 1.02-2.31, P for trend = 0.03 and OR, 1.33, 95% CI 0.99-1.78, P for trend = 0.03, respectively).
The findings suggest a potential role of sex hormones, particularly SHBG, in early colorectal carcinogenesis.
性激素被认为在结直肠癌（CRC）中发挥作用，但它们对 CRC 早期发生的影响尚不清楚。
我们回顾性地检查了血浆雌酮、雌二醇、游离雌二醇、睾酮、游离睾酮、性激素结合球蛋白（SHBG）以及雌二醇与睾酮比值与护士健康研究 I 和 II 中 5404 名绝经后妇女 CRC 前体（包括传统腺瘤和锯齿状息肉）风险之间的关联。多变量逻辑回归用于计算比值比（OR）和 95%置信区间（CI）。鉴于多次检验，P<0.005 被认为具有统计学意义。
在 20 年的随访期间，我们记录了 535 例传统腺瘤病例和 402 例锯齿状息肉病例。较高的 SHBG 浓度与传统腺瘤（特别是高级别腺瘤）的风险降低相关（最高四分位与最低四分位相比的多变量 OR，0.40，95%CI 0.24-0.67，P 趋势<0.0001）。SHBG 与较大锯齿状息肉（≥10mm）的风险降低之间存在显著关联（OR，0.47，95%CI 0.17-1.35，P 趋势=0.02），游离雌二醇和游离睾酮与传统腺瘤的风险增加相关（OR，1.54，95%CI 1.02-2.31，P 趋势=0.03 和 OR，1.33，95%CI 0.99-1.78，P 趋势=0.03，分别）。
这些发现表明性激素，特别是 SHBG，可能在结直肠早期癌变中发挥作用。
