Sherman M E, Sturgeon S, Brinton L A, Potischman N, Kurman R J, Berman M L, Mortel R, Twiggs L B, Barrett R J, Wilbanks G D
Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Mod Pathol. 1997 Oct;10(10):963-8.
We performed a multi-institutional, incident case-control study of 328 endometrioid and 26 serous carcinomas to assess whether risk factors and circulating hormone levels in women with serous carcinoma differ from the expected profile for endometrial carcinoma We also evaluated exposures potentially related to endometrial cancer risk, anthropometric measurements, and circulating levels of sex hormones and related carrier proteins. Histopathologic specimens were reviewed without knowledge of the other data. As expected, a statistically significant association was observed for high body mass index (BMI) (relative risk, 3.5) and use of menopausal estrogens (relative risk, 2.4) in the endometrioid carcinoma cases, whereas serous carcinomas were not strongly associated with these factors. Smoking and oral contraceptive use decreased risk for both tumor types. For five of six sex hormones tested, age-adjusted mean serum levels in patients with serous carcinoma were significantly lower than those in women with endometrioid carcinoma. After adjustment for BMI, these differences were narrowed, but levels of albumin-bound estradiol and estrone remained significantly lower in the serous cases. Age and BMI-adjusted levels of sex hormone-binding globulin were significantly higher in patients with serous carcinoma than in women with endometrioid carcinomas. In conclusion, risk factors and sex hormone levels in patients with uterine serous carcinoma seem to differ from those in women with endometrioid carcinoma, suggesting that there may be at least two different pathways of endometrial carcinogenesis.
我们开展了一项多机构的病例对照研究，纳入328例子宫内膜样癌和26例浆液性癌患者，以评估浆液性癌女性患者的危险因素和循环激素水平是否与子宫内膜癌的预期特征不同。我们还评估了可能与子宫内膜癌风险相关的暴露因素、人体测量指标以及性激素和相关载体蛋白的循环水平。在不知晓其他数据的情况下对组织病理学标本进行了复查。正如预期的那样，在子宫内膜样癌病例中，观察到高体重指数（BMI）（相对风险为3.5）和使用绝经后雌激素（相对风险为2.4）之间存在统计学显著关联，而浆液性癌与这些因素的关联并不强烈。吸烟和使用口服避孕药会降低这两种肿瘤类型的发病风险。在所检测的六种性激素中的五种中，浆液性癌患者经年龄调整后的平均血清水平显著低于子宫内膜样癌女性患者。在对BMI进行调整后，这些差异有所缩小，但浆液性癌病例中白蛋白结合雌二醇和雌酮的水平仍然显著较低。浆液性癌患者经年龄和BMI调整后的性激素结合球蛋白水平显著高于子宫内膜样癌女性患者。总之，子宫浆液性癌患者的危险因素和性激素水平似乎与子宫内膜样癌女性患者不同，这表明子宫内膜癌的发生可能至少存在两种不同途径。
