前瞻性队列研究不孕与癌症发病情况。
A prospective cohort study of infertility and cancer incidence.
机构信息
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
出版信息
Fertil Steril. 2023 Jul;120(1):134-142. doi: 10.1016/j.fertnstert.2023.02.028. Epub 2023 Feb 25.
OBJECTIVE
To investigate the association between infertility and the incidence of invasive cancer.
DESIGN
Prospective cohort study (1989-2015).
SETTING
Not applicable.
PATIENT(S): A total of 103,080 women aged 25-42 years in the Nurses' Health Study II who were cancer-free at baseline (1989).
INTERVENTION(S): The infertility status (failure to conceive after 1 year of regular, unprotected sex) and causes of infertility were self-reported at baseline and biennial follow-up questionnaires.
MAIN OUTCOME MEASURE(S): Cancer diagnosis was confirmed through medical record review and classified as obesity-related (colorectal, gallbladder, kidney, multiple myeloma, thyroid, pancreatic, esophageal, gastric, liver, endometrial, ovarian, and postmenopausal breast) or non-obesity-related (all other cancers). We fit the Cox proportional-hazards models to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of the association between infertility and cancer incidence.
RESULT(S): During 2,149,385 person-years of follow-up, 26,208 women reported a history of infertility, and we documented 6,925 incident invasive cancer cases. After adjusting for body mass index and other risk factors, women who reported infertility had a higher risk of developing cancer than gravid women without a history of infertility (HR, 1.07; 95% CI, 1.02-1.13). This association was stronger among obesity-related cancers (HR, 1.13; 95% CI, 1.05-1.22; vs. non-obesity-related cancers, HR, 0.98; 95% CI, 0.91-1.06) and, in particular, obesity-related reproductive cancers (postmenopausal breast, endometrial, and ovarian cancers; HR, 1.17; 95% CI, 1.06-1.29) and was stronger among women who first reported infertility earlier in life (≤25 years, HR, 1.19; 95% CI, 1.07-1.33; 26-30 years, HR, 1.11; 95% CI, 0.99-1.25; >30 years, HR, 1.07; 95% CI, 0.94-1.22; P trend < .001).
CONCLUSION(S): A history of infertility may be associated with the risk of developing obesity-related reproductive cancers; further study is needed to elucidate the underlying mechanisms.
目的
探讨不孕与侵袭性癌症发病的相关性。
设计
前瞻性队列研究（1989-2015 年）。
地点
不适用。
患者
护士健康研究 II 中年龄在 25-42 岁之间、基线时无癌症（1989 年）的 103080 名女性。
干预
不孕状况（规律无保护性生活 1 年后仍未怀孕）和不孕原因在基线和每两年一次的随访问卷中进行自我报告。
主要观察指标
癌症诊断通过病历复查确定，并分为肥胖相关癌症（结直肠癌、胆囊癌、肾癌、多发性骨髓瘤、甲状腺癌、胰腺癌、食管癌、胃癌、肝癌、子宫内膜癌、卵巢癌和绝经后乳腺癌）和非肥胖相关癌症（所有其他癌症）。我们使用 Cox 比例风险模型估计不孕与癌症发病风险之间的风险比（HR）和 95%置信区间（CI）。
结果
在 2149385 人年的随访期间，26208 名女性报告有不孕史，我们记录了 6925 例侵袭性癌症病例。调整体重指数和其他危险因素后，与从未不孕的孕妇相比，报告不孕的女性癌症发病风险更高（HR，1.07；95%CI，1.02-1.13）。这种关联在肥胖相关癌症中更强（HR，1.13；95%CI，1.05-1.22；vs. 非肥胖相关癌症，HR，0.98；95%CI，0.91-1.06），特别是肥胖相关生殖系统癌症（绝经后乳腺癌、子宫内膜癌和卵巢癌；HR，1.17；95%CI，1.06-1.29），并且在更早报告不孕的女性中更强（≤25 岁，HR，1.19；95%CI，1.07-1.33；26-30 岁，HR，1.11；95%CI，0.99-1.25；>30 岁，HR，1.07；95%CI，0.94-1.22；P 趋势<.001）。
结论
不孕史可能与肥胖相关生殖系统癌症的发病风险相关；需要进一步研究阐明潜在机制。
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