Boissiere Jaye, Thomas Samantha M, Gu Yueqi, Linhart Sarah, March Lauren, Berchuck Andrew, Davidson Brittany, Rossi Emma, Havrilesky Laura, Secord Angeles Alvarez
Duke School of Medicine, Durham, NC, USA.
Department of Biostatistics & Bioinformatics, Duke School of Medicine, Durham, NC, USA.
Gynecol Oncol Rep. 2025 Jul 12;60:101801. doi: 10.1016/j.gore.2025.101801. eCollection 2025 Aug.
Prior research demonstrated a 2.27-fold increase in uterine cancer mortality among North Carolinians living near hog concentrated animal feeding operations (CAFOs). Endometrial cancer (EC) accounts for 90% of uterine cancer cases. Mutation and abnormal expression of the gene is a frequent causative alteration in aggressive forms ECs. We investigated whether increased proximity to hog CAFOs was associated with abnormal p53 expression, aggressive histologic subtypes, and increased mortality.
Patients with a pathologic diagnosis of EC were enrolled into the study between 2019 and 2024. Demographic and clinicopathologic data were abstracted from the electronic health record. Unadjusted survival was estimated with the Kaplan-Meier method with log-rank tests. Cox proportional hazards models were used to estimate associations between residing in a county classified as having CAFOs or no CAFOs, serous and carcinosarcoma EC subtypes, abnormal p53 expression, and survival.
Of the 278 enrolled participants, the median age was 70.5 years, and 40.6 % resided in a CAFO county at the time of EC diagnosis. There was no association between abnormal p53 expression (46.9 % vs 51.5 %, p = 0.45), serous histology (27.4 % vs 35.2 %, p = 0.39), or carcinosarcoma subtype (12.4 % vs 10.3 %, p = 0.39) and residence in a CAFO vs non-CAFO county. Unadjusted overall survival rates were similar between those in counties with and without CAFOs (log-rank p = 0.62).
This study did not demonstrate an association between CAFO county status and abnormal p53 expression or aggressive histologic subtypes. Further studies are warranted to investigate the causes of previously established mortality differences in uterine cancer patients by CAFO proximity.
先前的研究表明，居住在北卡罗来纳州养猪集中式动物饲养场（CAFO）附近的居民子宫癌死亡率增加了2.27倍。子宫内膜癌（EC）占子宫癌病例的90%。该基因的突变和异常表达是侵袭性子宫内膜癌的常见致病改变。我们调查了与养猪CAFO距离增加是否与p53异常表达、侵袭性组织学亚型及死亡率增加有关。
2019年至2024年期间，将病理诊断为EC的患者纳入研究。从电子健康记录中提取人口统计学和临床病理数据。采用Kaplan-Meier法和对数秩检验估计未调整的生存率。使用Cox比例风险模型估计居住在被分类为有CAFO或无CAFO的县、浆液性和癌肉瘤EC亚型、p53异常表达与生存率之间的关联。
在278名纳入的参与者中，中位年龄为70.5岁，40.6%的人在EC诊断时居住在有CAFO的县。p53异常表达（46.9%对51.5%，p = 0.45）、浆液性组织学（27.4%对35.2%，p = 0.39）或癌肉瘤亚型（12.4%对10.3%，p = 0.39）与居住在有CAFO与无CAFO的县之间无关联。有CAFO和无CAFO的县的未调整总生存率相似（对数秩p = 0.62）。
本研究未证明CAFO县状况与p53异常表达或侵袭性组织学亚型之间存在关联。有必要进一步研究，以调查先前确定的子宫癌患者因与CAFO的距离不同而导致死亡率差异的原因。
