恶性肿瘤家族史与子宫内膜癌关系的流行病学研究

Epidemiologic study on the association of family history of cancer with the risk of endometrial cancer

目的 研究一级亲属恶性肿瘤家族史与子宫内膜癌的关系。方法 采用全人群病例对照研究的方法 ,收集1997年 1月～ 2 0 0 0年 6月诊断的 30～ 6 9岁 ,具有上海市区常住户口的子宫内膜癌病例及其对照一级亲属的恶性肿瘤家族史 ,分析恶性肿瘤史在病例与对照组一级亲属中的分布情况及其对子宫内膜癌发生的影响。结果 病例组中有较多的一级亲属患有恶性肿瘤 (调整OR =1 3,95 %CI 1 0～1 7) ,尤其是结肠直肠癌 (CRC) (调整OR 6 1,95 %CI 1 8～2 1 1)和子宫内膜癌 (调整OR 4 8,95 %CI 1 0～ 2 2 1)。调整年龄、一级亲属人数、体质指数 (BMI)、腰围臀围比 (WHR)、月经生育史和避孕药的使用、饮食等可能的混杂因素进行非条件Logistic回归分析发现 ,一级亲属中恶性肿瘤史、子宫内膜癌家庭史和CRC家族史的OR值仍有意义 ,且分别上升为1 4(95 %CI 1 1～ 1 9) ,5 2 (95 %CI 1 1～ 2 5 3)和 8 9(95 %CI 2 5～ 31 3) ,但家庭史和这些危险因素对子宫内膜癌的发生无交互作用。一级亲属中恶性肿瘤史、子宫内膜癌家庭史和CRC家族史的人群归因危险度分别为 9 5 %、1 6 %和3 2 %。结论 研究结果表明 ,子宫内膜癌具有明显的家族聚集性。子宫内膜癌和结肠直肠癌家族史是子宫内膜癌发生的独立的危险因素。

Objective To evaluate the assocaition of family histories of cancers among first degree relatives with the risk of endometrial cancer.Methods In a population based case control study conducted in urban Shanghai, in person interivews were completed for 497 cases newly diagnosed with endometrial cancer aged 30 to 69 from January 1997 to June 2000 and an equal number of controls frequency matched to cases on age, to examine the distributions of family histories of endometrial cancer,colorectum cancer and breast cancer in cases in cases and controls and their effects on endometrial cancer risk.Results Cases were much more likely than controls to have family histories of cancers among first degree relatives, especially for colorectum cancer and endometrial cnaer, with ORs after adjustment for age and education were 6.1(95% CI 1.8～21 1) and 4.8(95% CI 1.0～22.1), respectively.After additional adjustment for potential confounding variables such as number of first degree relatives, body mass index,waist to hip circumference ratio, ever using oral contraceptive, age of menarche,menopausal status, ever having a livebirth and ever having and abortion by using unconditional logistic regression,which was employed to estimate adjusted odds ratios and 95% confidence intervals, ORs for family histories of any cancer,endometrial cancer and colorectum cancer still remained significance and increased to 1.4 (95% CI, 1.1～1.9), 5.2 (95% CI 1.1～25.3) and 8.9(95% CI 2.5～31.3), respectively. Furthermore, PAR for family history of any cancer was 9.5% while for endometrial cancer and colorectum cancer were 1.6% and 3.2%. However,there were no interaction between family histories of cancers and other traditional risk factors to the risk of endometrial cancer.Conclusion Our study suggests that endometrial cancer is characterized with familial aggregation. Family histories of colorectum cancer and endometrial cancer in first degree relatives are independent risk factors to endometrial cancer.$$$$