BMJ|丹麦全国性队列研究:妊娠时间与子宫内膜癌风险

           

BMJ|丹麦全国性队列研究:妊娠时间与子宫内膜癌风险






  子宫内膜癌是发达国家最常见的妇科癌症,在北美和欧洲的发病率与日俱增。女性子宫内膜癌的风险已经与足月怀孕的次数密切相关,尤其是第一次足月妊娠具有明显的保护效应。到目前为止,还不清楚这种保护性联系是由女性的生殖力、怀孕的累计月数,还是在妊娠期特定时间所发生的某些过程所驱动的。


妊娠期与子宫内膜癌风险降低的关系

  近期BMJ发表了一篇在丹麦进行的全国性队列研究,纳入对象为1935-2002年出生的所有丹麦女性,根据妊娠次数、类型和持续时间,使用对数线性泊松回归估计子宫内膜癌的相对风险(发生率比),针对妊娠期与子宫内膜癌风险降低的关系进行了分析和探讨。

  在2313332名丹麦妇女中,有3947650名怀孕,其中6743名妇女在57 347622人的随访中患上子宫内膜癌。在对年龄、月经周期和社会经济因素进行调整后,第一次怀孕显著降低了子宫内膜癌的风险,无论是以人工流产(调整相对风险0.53(95%CI 0.45 - 0.64)或分娩(0.66、0.61 - 0.72)告终。随后的每一次怀孕都与风险的进一步降低有关,无论是以人工流产(0.81、0.77至0.86)或分娩(0.86、0.84至0.89)告终。怀孕时间、怀孕年龄、自然流产、肥胖、产妇出生队列、生育力和社会经济因素并没有影响结果。


  这项研究表明,无论妊娠期是在怀孕后不久结束,还是在怀孕40周时结束,子宫内膜癌的风险都会降低。这种风险的降低可以用怀孕头几周内发生的一种生物过程来解释,因为终止于人工流产的妊娠与终止于分娩的妊娠具有类似的风险降低。研究结果支持早期妊娠过程在其中的主要作用,因为每次怀孕都与子宫内膜癌风险的降低有关,并且对不孕症的调整不能解释风险均等的影响。未来的研究非常重要,深入了解早期妊娠因素,可能有助于预防子宫内膜癌。



摘要原文

Objective 

To explore the association between pregnancy duration and risk of endometrial cancer.

Design 

Nationwide register based cohort study.

Setting 

Denmark.

Participants 

All Danish women born from 1935 to 2002.

Main outcome measures 

Relative risk (incidence rate ratio) of endometrial cancer by pregnancy number, type, and duration, estimated using log-linear Poisson regression.

Results 

Among 2 311 332 Danish women with 3 947 650 pregnancies, 6743 women developed endometrial cancer during 57 347 622 person years of follow-up. After adjustment for age, period, and socioeconomic factors, a first pregnancy was associated with a noticeably reduced risk of endometrial cancer, whether it ended in induced abortion (adjusted relative risk 0.53 (95% confidence interval 0.45 to 0.64) or childbirth (0.66, 0.61 to 0.72). Each subsequent pregnancy was associated with an additional reduction in risk, whether it ended in induced abortion (0.81, 0.77 to 0.86) or childbirth (0.86, 0.84 to 0.89). Duration of pregnancy, age at pregnancy, spontaneous abortions, obesity, maternal birth cohort, fecundity, and socioeconomic factors did not modify the results.

Conclusions 

The risk of endometrial cancer is reduced regardless of whether a pregnancy ends shortly after conception or at 40 weeks of gestation. This reduction in risk could be explained by a biological process occurring within the first weeks of pregnancy, as pregnancies ending in induced abortions were associated with similar reductions in risk as pregnancies ending in childbirth.



参考文献

HUSBY A, WOHLFAHRT J, MELBYE M. Pregnancy duration and endometrial cancer risk: nationwide cohort study[J]. BMJ, 2019:l4693.









Powered by 上海翼石信息科技有限公司 © 2001-2016 dayibian Inc.
沪ICP备12046386号-1