台湾2型糖尿病患者子宫癌的年龄特异性风险及相关合并症
Age Specific Risks of Uterine Cancer in Type 2 Diabetes and Associated Comorbidities in Taiwan.
作者信息
Liu Hui-Shan, Chen Chin-Der, Lee Chung-Chen, Chen Yong-Chen, Cheng Wen-Fang
机构信息
Department of Obstetrics and Gynecology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City 242, Taiwan.
Data Science Center, College of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan.
出版信息
Cancers (Basel). 2022 Oct 7;14(19):4912. doi: 10.3390/cancers14194912.
Introduction: The global incidence of uterine cancer has increased substantially in recent decades. We evaluated if the trend of increasing prevalence of diabetes mellitus (DM) and obesity are attributed to the development of uterine cancer. Methods: Using data derived from the National Health Insurance database and Taiwan Cancer Registry, multivariate Cox proportional hazards regression models were adapted to analyze the risk factors of uterine cancer with potential confounding variables. Results: There were a total of 5,104,242 women aged 30−70 years enrolled in the study and 147,772 of them were diagnosed with DM during 2005−2007. In a total of 11 years of follow-up, 14,398 subjects were diagnosed with uterine cancer. An elevated risk of uterine cancer was observed in women with DM of all ages (HR 1.66, 95% CI 1.53−1.81, p < 0.0001). The effect of DM was highest at age 30−39 years (RR 3.05, 95% CI 2.35−3.96, p < 0.0001). In the group of <50 years old, DM patients had at least a twofold higher risk of developing uterine cancer (HR 2.39, 95% CI 2.09−2.74, p < 0.0001). Subjects among all ages diagnosed with polycystic ovary syndrome (PCOS) (HR 2.91, 95% CI 2.47−3.42, p < 0.0001), obesity (HR 2.13, 95% CI 1.88−2.41, p < 0.0001), and those undergoing hormone replacement therapy (HRT) (HR 1.60, 95% CI 1.33−1.93, p < 0.0001) were also positively associated with uterine cancer. Positive associations of hyperlipidemia (HR 1.33, 95% CI 1.22−1.46, p < 0.0001) and statin use (HR 1.27, 95% CI 1.12−1.44, p = 0.0002) on uterine cancer were only observed in subjects <50 years. On the contrary, hyperlipidemia was negatively associated with uterine cancer in subjects ≥50 years (HR 0.91, 95% CI: 0.84−0.98, p = 0.0122). Conclusions: DM is in general the most important risk factor for uterine cancer, especially in premenopausal women. Obesity, PCOS, HPL, statin use, and HRT were also associated with uterine cancer in subjects younger than 50 years. Premenopausal women with DM and respective comorbidities should be aware of the development of uterine cancer.
引言
近几十年来，全球子宫癌发病率大幅上升。我们评估了糖尿病（DM）患病率上升和肥胖趋势是否归因于子宫癌的发展。方法：利用来自国民健康保险数据库和台湾癌症登记处的数据，采用多变量Cox比例风险回归模型分析子宫癌的危险因素及潜在混杂变量。结果：本研究共纳入5104242名30至70岁的女性，其中147772人在2005 - 2007年期间被诊断为糖尿病。在总共11年的随访中，14398名受试者被诊断为子宫癌。各年龄段糖尿病女性患子宫癌的风险均升高（风险比[HR] 1.66，95%置信区间[CI] 1.53 - 1.81，p < 0.0001）。糖尿病的影响在30 - 39岁时最为显著（相对危险度[RR] 3.05，95% CI 2.35 - 3.96，p < 0.0001）。在年龄小于50岁的人群中，糖尿病患者患子宫癌的风险至少高出两倍（HR 2.39，95% CI 2.09 - 2.74，p < 0.0001）。各年龄段被诊断为多囊卵巢综合征（PCOS）（HR 2.91，95% CI 2.47 - 3.42，p < 0.0001）、肥胖（HR 2.13，95% CI 1.88 - 2.41，p < 0.0001）以及接受激素替代疗法（HRT）（HR 1.60，95% CI 1.33 - 1.93，p < 0.0001）的受试者也与子宫癌呈正相关。高脂血症（HR 1.33，95% CI 1.22 - 1.46，p < 0.0001）和使用他汀类药物（HR 1.27，95% CI 1.12 - 1.44，p = 0.0002）与子宫癌的正相关仅在年龄小于50岁的受试者中观察到。相反，在年龄≥50岁的受试者中，高脂血症与子宫癌呈负相关（HR 0.91，95% CI：0.84 - 0.98，p = 0.0122）。结论：总体而言，糖尿病是子宫癌最重要的危险因素，尤其是在绝经前女性中。肥胖、PCOS、HPL、使用他汀类药物和HRT在年龄小于50岁的受试者中也与子宫癌相关。绝经前患有糖尿病及相应合并症的女性应注意子宫癌的发生。
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