Sturgeon S R, Hartge P, Silverman D T, Kantor A F, Linehan W M, Lynch C, Hoover R N
Environmental Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892.
Epidemiology. 1994 Mar;5(2):218-25. doi: 10.1097/00001648-199403000-00012.
Using data on 1,860 bladder cancer cases and 3,934 population-based controls from the National Bladder Cancer Study, we examined associations between suspected bladder cancer risk factors and tumor stage and grade. Employment in a high-risk occupation was associated with the entire clinical spectrum of bladder cancer rather than a particular tumor stage or grade. For example, relative risks (RR) were similar for noninvasive and invasive disease (1.5 and 1.6, respectively). Cigarette smoking also increased risk of the entire clinical spectrum of bladder cancer, but the more advanced the stage, the stronger the effect. For example, relative risks of noninvasive and invasive bladder cancer for current heavy smokers were 3.0 and 5.2, respectively. Cigarette smoking was associated with higher risk of low-grade than high-grade tumors, once stage of disease was taken into account. Compared with whites, nonwhites were at a lower risk of noninvasive bladder cancer (RR = 0.4) but at similar risk of invasive bladder cancer (RR = 1.1), a pattern indicating racial differences in health practices related to bladder cancer detection. History of urinary tract infections and bladder stones was associated with increasing relative risks for advanced tumor stage. Heavy artificial sweetener use was associated with higher-grade, poorly differentiated tumors. Coffee consumption and family history of bladder cancer were not consistently associated with tumor stage or grade. Overall, different clinical presentations of bladder cancer share most suspected bladder cancer risk factors, including employment in a high-risk occupation and cigarette smoking.
利用来自国家膀胱癌研究的1860例膀胱癌病例和3934例基于人群的对照的数据，我们研究了疑似膀胱癌风险因素与肿瘤分期及分级之间的关联。从事高风险职业与膀胱癌的整个临床谱相关，而非特定的肿瘤分期或分级。例如，非侵袭性和侵袭性疾病的相对风险（RR）相似（分别为1.5和1.6）。吸烟也会增加膀胱癌整个临床谱的风险，但分期越晚，影响越强。例如，当前重度吸烟者患非侵袭性和侵袭性膀胱癌的相对风险分别为3.0和5.2。一旦考虑疾病分期，吸烟与低级别肿瘤的风险高于高级别肿瘤相关。与白人相比，非白人患非侵袭性膀胱癌的风险较低（RR = 0.4），但患侵袭性膀胱癌的风险相似（RR = 1.1），这种模式表明在与膀胱癌检测相关的健康行为方面存在种族差异。尿路感染和膀胱结石病史与晚期肿瘤分期的相对风险增加相关。大量使用人工甜味剂与高级别、低分化肿瘤相关。咖啡消费和膀胱癌家族史与肿瘤分期或分级并无一致关联。总体而言，膀胱癌的不同临床表现具有大多数疑似膀胱癌风险因素，包括从事高风险职业和吸烟。
