La Vecchia C, Franceschi S, Decarli A, Gallus G, Tognoni G
J Natl Cancer Inst. 1984 Sep;73(3):667-71.
The importance of the major risk factors for endometrial cancer in women of different ages was evaluated with the use of data from a hospital-based case-control study conducted in Milan, Italy, on 283 women with endometrial cancer and 566 age-matched controls. Current weight was related strongly to the risk of endometrial cancer both in younger (premenopausal) and in older women (with risk estimates for the heaviest categories of 20.3 and 7.7, respectively), thus confirming that obesity is the major cause of endometrial cancer in Northern Italy. Endometrial cancer risk appeared to be approximately proportional to the second power of body mass index. Early menarche and nulliparity were associated with an increased risk of endometrial cancer in premenopausal women, the point estimate for nulliparity rising to 35.1 (with lower confidence limit of 10.2) after adjustment for marital status. However, no association with these factors was evident in postmenopausal women. Combination oral contraceptives were used by 2 cases and 19 controls only [relative risk (RR) = 0.2, with 95% confidence interval = 0.1-0.8]. The use of noncontraceptive estrogens was associated with an elevated risk, which was greater in perimenopausal women (RR = 5.1 for greater than 2 yr of use), and decreased progressively with increasing time after menopause. Late menopause was also related to endometrial cancer. However, the risk estimates for late menopause apparently were more elevated in older women (greater than or equal to 65 yr) than in perimenopausal women. Most of the risk factors identified (excluding late menopause) apparently act on one of the later stages of the process of carcinogenesis, because the excess risk drops after cessation of exposure.
利用意大利米兰一项基于医院的病例对照研究的数据，评估了不同年龄女性子宫内膜癌主要危险因素的重要性。该研究纳入了283例子宫内膜癌女性患者和566例年龄匹配的对照。当前体重与年轻（绝经前）和老年女性的子宫内膜癌风险均密切相关（体重最重组别的风险估计值分别为20.3和7.7），从而证实肥胖是意大利北部子宫内膜癌的主要病因。子宫内膜癌风险似乎与体重指数的平方大致成正比。初潮早和未生育与绝经前女性子宫内膜癌风险增加相关，调整婚姻状况后，未生育的点估计值升至35.1（置信下限为10.2）。然而，在绝经后女性中未发现与这些因素有关联。仅2例病例和19例对照使用了复方口服避孕药[相对风险（RR）=0.2，95%置信区间=0.1 - 0.8]。使用非避孕雌激素与风险升高相关，在围绝经期女性中风险更高（使用超过2年的RR = 5.1），且绝经后随着时间推移风险逐渐降低。绝经晚也与子宫内膜癌有关。然而，绝经晚的风险估计值在老年女性（≥65岁）中似乎比在围绝经期女性中更高。所确定的大多数危险因素（不包括绝经晚）显然作用于致癌过程的后期阶段之一，因为停止接触后额外风险会下降。
