Schwartz S M, Weiss N S, Daling J R, Gammon M D, Liff J M, Watt J, Lynch C F, Newcomb P A, Armstrong B K, Thompson W D
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
Cancer. 1996 Feb 15;77(4):717-24. doi: 10.1002/(sici)1097-0142(19960215)77:4<717::aid-cncr18>3.0.co;2-3.
We analyzed data from a population-based, multi-center, case-control study to determine whether the occurrence of histologic types of uterine sarcoma is related to exogenous hormone use and/or to two correlates of endogenous estrogens: excess weight and cigarette smoking.
One hundred sixty-seven women with newly-diagnosed uterine sarcoma (56 leiomyosarcoma, 85 mixed mullerian tumors, and 26 endometrial stromal sarcomas) were interviewed by telephone regarding possible risk factors for these neoplasms, For comparison, 208 women identified at random from the general population of the study areas were interviewed as controls.
Use of oral contraceptives was positively associated with the risk of leiomyosarcoma (odds ratios [OR] = 1.7, 95% confidence interval [CI] = 0.7, 4.1), primarily among women who last used these medications 15 or more years prior to diagnosis. Use of noncontraceptive estrogens was directly associated with the risk of mixed mullerian tumors, but only among recent and long-term users of these medications. Women in the highest quantile of body mass index (> or = 27.5 kg/m2) one year prior to diagnosis were at increased risk of each type of uterine sarcoma (leiomyosarcoma, OR = 2.5, 95% CI = 1.1, 5.7; mixed mullerian tumors, OR = 2.9, 95% CI = 1.3, 6.7; stromal sarcoma, OR = 3.5, 95% CI = 1.1, 10.9). Women who had ever smoked cigarettes were at reduced risk of leiomyosarcoma (OR = 0.6, 95% CI = 0.3, 1.1) and stromal sarcoma (OR = 0.5, 95% CI = 0.2, 1.2), but the relationship was not more pronounced among heavy smokers; no association with smoking was observed with mixed mullerian tumors.
Several of these findings parallel those from studies of endometrial carcinoma and may indicate a role for unopposed estrogen in the etiology of histologic types of uterine sarcoma.
我们分析了一项基于人群的多中心病例对照研究的数据，以确定子宫肉瘤组织学类型的发生是否与外源性激素使用和/或内源性雌激素的两个相关因素：超重和吸烟有关。
通过电话采访了167名新诊断为子宫肉瘤的女性（56例平滑肌肉瘤、85例混合性苗勒管肿瘤和26例子宫内膜间质肉瘤），询问这些肿瘤可能的危险因素。作为对照，从研究区域的普通人群中随机挑选了208名女性进行采访。
口服避孕药的使用与平滑肌肉瘤风险呈正相关（比值比[OR]=1.7，95%置信区间[CI]=0.7，4.1），主要发生在诊断前15年或更久以前最后使用这些药物的女性中。非避孕雌激素的使用与混合性苗勒管肿瘤风险直接相关，但仅在这些药物的近期和长期使用者中。诊断前一年体重指数处于最高四分位数（≥27.5kg/m²）的女性患每种类型子宫肉瘤（平滑肌肉瘤，OR=2.5，95%CI=1.1，5.7；混合性苗勒管肿瘤，OR=2.9，95%CI=1.3，6.7；间质肉瘤，OR=3.5，95%CI=1.1，10.9）的风险增加。曾经吸烟的女性患平滑肌肉瘤（OR=0.6，95%CI=0.3，1.1）和间质肉瘤（OR=0.5，95%CI=0.2，1.2）的风险降低，但在重度吸烟者中这种关系并不更明显；未观察到吸烟与混合性苗勒管肿瘤有关。
这些发现中有几项与子宫内膜癌研究的结果相似，可能表明无对抗雌激素在子宫肉瘤组织学类型的病因学中起作用。
