绝经前子宫内膜癌的危险因素分析

[目的]分析绝经前子宫内膜癌的危险因素,为临床诊治提供参考依据.[方法] 2006年1月至2010年12月间因阴道出血就诊的绝经前患者1 283例,其中子宫内膜正常1 239例,子宫内膜癌44例;收集两组病例的临床资料,采用Logistic回归分析危险因素的危险度.[结果]多因素Logistic回归分析显示多囊卵巢综合征(PCOS)患者患子宫内膜癌风险是非PCOS的28.594倍(95％CI为11.983～73.407).糖尿病者患有子宫内膜癌的风险是非糖尿病患者的43.965倍(95％CI为11.783～164.041).三苯氧胺(TAM)使用史者患子宫内膜癌的风险是无TAM使用史的65.074倍(95％CI为8.993～476.172).肿瘤家族史者患子宫内膜癌的风险是无肿瘤家族史患者的67.797倍(95％CI为9.622～377.687).[结论]PCOS、糖尿病、TAM使用史和肿瘤家族史是子宫内膜癌的危险因素.针对危险因素采取防治措施对预防子宫内膜癌发病有着一定的价值.     

恶性肿瘤家族史与子宫内膜癌关系的流行病学研究

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－2000年6月诊断的30－69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％CI1．0－1．7）,尤其是结肠直肠癌（CRC）（调整OR6．1,95％CI1．8－21．1）和子宫内膜癌（调整OR4．8,95％CI1．0－22．1）。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、子宫内膜癌家施行史和CRC家族史的OR值仍有意义,且分别上升为1．4（95％CI1．1－1．9）,5．2（95％CI1．1－25．3）和8．9（95％CI2．5－31．3）,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,子宫呐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。     

他莫西芬与子宫内膜癌——关于他莫西芬治疗的乳腺癌患者发生子宫内膜癌的回顾性研究

研究他莫西芬（Ｔａｍｏｘｉｆｅｎ，ＴＡＭ）治疗乳腺癌而发生子宫内膜癌的危险性及其病理特征。根据统计中心提供资料，查阅病历确认日本国立癌中心中央病院自１９６２年５月开院至１９９５年１２月间收治的２５例发生于乳腺癌后的子宫内膜癌病例。２５例中１３例因乳腺癌接受过ＴＡＭ治疗。１９９０年前２５年间仅发生９例，占同期收治子宫内膜癌总数的２．１％，而１９９０年后的５年中发生１６例，占同期收治的子宫内膜癌总数的７％，其中１３例接受过ＴＡＭ治疗。ＴＡＭ组中组织学８４．６％属低度恶性（ｇｒａｄｅ１～２），与非ＴＡＭ组中８３．３％相近。闭经后或有恶性肿瘤家族史者易受ＴＡＭ作用发生子宫内膜癌。ＴＡＭ增加了子宫内膜癌的发病危险，ＴＡＭ组子宫内膜癌的病理类型及恶性度与非ＴＡＭ组相同     

妇科癌症患者患结直肠癌危险增加

美国印第安纳大学Ｒｅｘ报告 ,某些妇科癌症患者发生结直肠癌的危险增加。Ｒｅｘ等对１９７４年～１９９５年间流行病学及最后结果监测数据库进行了回顾性分析 ,研究纳入１０１７３４例患宫颈癌、子宫内膜癌或卵巢癌的白人及非洲籍女性患者。随访证实患宫颈癌妇女以后发生结直肠癌的危险没有增加。而对于子宫内膜癌患者 ,５０岁以前确诊者发生结直肠癌的危险显著增加（ＲＲ为３ ３９）。卵巢癌患者 ,５０岁以前确诊者发生结直肠癌的危险也显著增加（ＲＲ为３ ６７） ;５０岁～６４岁之间确诊者发生结直肠癌的危险也稍有增加（ＲＲ为１ ５２…     

海淀区子宫内膜癌危险因素病例对照研究

[目的]探讨子宫内膜癌发生的危险因素.[方法]收集2001～2002年海淀区户籍的在北京各大医院就诊并经病理证实为子宫内膜癌的患者临床资料70例.在同一社区人群按照1：3病例对照配比原则进行,对照组进行系统的妇科体检,调查资料进行条件单因素和多因素Logistic分析.[结果]对照组体检确诊子宫内膜癌1例,从对照组剔除.条件单因素Logistic分析显示：职业、肥胖、月经初潮年龄、绝经年龄、不规则阴道出血、子宫内膜异位症为子宫内膜癌的高危因素.多因素Logistic分析显示：绝经年龄、阴道不规则出血是其危险因素.[结论]重视高危因素,对高危人群定期进行妇科检查,可及早诊断和预防癌症的发生.     

CYP17 MspA1Ⅰ基因多态性和月经生育史与子宫内膜癌关系的病例对照研究

目的 研究细胞色素CYP17 MspA1 Ⅰ基因多态性与子宫内膜癌发生的关系。方法采用Taqmam特异性等位基因鉴别方法,对832例子宫内膜癌患者和781例正常对照者的CYP17MspA1 Ⅰ基因多态性进行分析。以非条件Logistic回归模型计算各种基因型发生子宫内膜癌的比数比（OR）及其95％置信区间（CI）。结果 在781例正常对照组中,CYP17 MspA1 Ⅰ位点A1／A1、A1／A2、A2／A2等3种基因型的频率分别为17．8％、49．3％和32．9％。无论绝经与否,CYP17MspA1 Ⅰ基因型与子宫内膜癌的发生均无关,但在携带A2等位基因且未绝经的女性中,怀孕次数多者发生子宫内膜癌的危险降低（OR=0．66,95％ CI 0．44～0．99）。在绝经后女性中,怀孕次数〉2或行经年数≤32年且具有A2等位基因者发生子宫内膜癌的危险降低（OR=0．68,95％CI 0．47～0．99;OR=0．54,95％CI 0．37～0．81）。结论CYP17MspA1 Ⅰ基因多态性单独存在可能与上海市区女性子宫内膜癌的发生无关。     

年轻妇女子宫内膜癌临床分析

目的 探讨年轻妇女子宫内膜癌的临床病理特征、诊治方法及预后.方法 回顾性分析我院收治的45岁以下年轻妇女子宫内膜癌21例资料.结果 本组21例占同期收治子宫内膜癌的13.9%,与以往资料相比,患者有年轻化趋势;≤40岁者和41～45岁者在临床分期、细胞分化、病理类型及肌层浸润深度方面比较差异无统计学意义(P>0.05);21例均行手术治疗,术后随访6个月～15年,其中失访2例,死亡2例,复发3例.结论 45岁以下年轻妇女子宫内膜癌临床期别较早,病理类型主要为子宫内膜样腺癌,分段诊刮是其诊断的有效方法,治疗以手术为主,对合并高危因素者辅以放、化疗.     

子宫内膜癌患者大剂量孕激素治疗后妊娠结局的影响因素分析

目的 分析子宫内膜癌患者大剂量孕激素治疗后妊娠结局的影响因素.方法 选取80例早期子宫内膜癌患者,给予大剂量孕激素治疗,记录患者的妊娠结局,采用多因素Logistic回归分析大剂量孕激素治疗的早期子宫内膜癌患者妊娠结局的影响因素.结果 给予80例早期子宫内膜癌患者大剂量孕激素治疗后,缓解率为97.50％.78例缓解患者中,离异、未婚及无迫切生育需求25例,有生育需求53例,其中未妊娠25例,妊娠28例,生育21例,生育率39.62％;活产21例,活产率为75.00％.单因素分析结果显示,合并不孕症、产次﹥2次、激素治疗前子宫内膜厚度﹤7 mm、经济水平低的早期子宫内膜癌患者妊娠率分别低于未合并不孕症、产次≤2次、激素治疗前子宫内膜厚度≥7 mm、经济水平高的患者,差异均有统计学意义(P﹤0.05).多因素Logistic回归分析,结果显示,产次﹥2次、合并不孕症、经济水平低均是影响有生育需求的早期子宫内膜癌患者妊娠结局的独立危险因素(P﹤0.05),激素治疗前子宫内膜厚度不是影响有生育需求的早期子宫内膜癌患者妊娠结局的因素(P﹥0.05).结论 产次﹥2次、合并不孕症、经济水平低均是影响有生育需求的早期子宫内膜癌患者妊娠结局的独立危险因素.     

血脂异常与子宫内膜癌的相关性分析

目的:回顾性分析子宫内膜癌患者中血脂代谢异常发病情况并探讨血脂代谢异常与子宫内膜癌发病风险的相关性。方法:收集2010年至2014年就诊于新疆医科大学第一附属医院的未经过放疗及化疗的且 经病理确诊为雌激素依赖型子宫内膜癌的病例81例。另以子宫内膜正常组,子宫内膜增生组作为对照组、各组分别56例,收集患者和对照者一般资料,既往史,月经史,婚育史,用药史,家族史(包括家族肿瘤史),生化血脂结果,病理结果。结果:子宫内膜正常组、子宫内膜增生组、子宫内膜癌组三组在发病年龄、月经状态、孕产情况、糖尿病发病情况、肿瘤家族史、PCOS/甲减发病率、HRT/TAM使用情况之间差异无统计学意义（P＞0.05）;子宫内膜癌组的体重指数（BMI）、甘油三酯（TG）、总胆固醇（TC）、高血压发病率均高于子宫内膜正常组、增生组,差异有统计学意义（P＜0.05）;子宫内膜癌组的高密度脂蛋白（HDL）明显低于子宫内膜正常组、增生组,差异有统计学意义（P<0.05）。 结论:子宫内膜癌患者的BMI、TG、TC、HDL及高血压发病率明显高于非子宫内膜癌患者,血脂异常很可能是子宫内膜癌发生的关键因素,有望高血脂将可能作为尽早识别子宫内膜癌高危人群的预警指标。     

子宫内膜癌卵巢转移的高危因素及预后分析

目的：研究子宫内膜癌患者发生卵巢转移的高危因素及其预后。方法：回顾性分析1960年9月～2001年8月有手术病理资料和随访记录的764例子宫内膜癌患者的临床资料。结果：764例子宫内膜癌患者中发生卵巢转移者23例，发生率为3．01％。单因素分析发现子宫内膜癌患者无卵巢转移组与卵巢转移组比较，肌层浸润深度、腹水细胞学、细胞分级、宫颈转移、宫旁转移、阴道转移、榆卵管转移和淋巴转移等方面存在显著差异。多元回归显示宫旁转移、腹水细胞学、肌层浸润深度是子宫内膜癌卵巢转移的独立危险因素。子宫内膜癌卵巢转移患者5年生存率低于无卵巢转移者，复发率高于无卵巢转移者。结论：宫旁转移、腹水细胞学阳性和肌层浸润深度是宫内膜癌卵巢转移的独立危险因素。子宫内膜癌卵巢转移患者预后差。     

Lactation, lactation suppression hormones and breast cancer

One hundred and fifty-four parous women with pathologically confirmed newly diagnosed breast cancer in National Taiwan University Hospital were selected as the case group. Three hundred and eighty-six parous inpatient controls were individually matched for each case by age and date of admission. Information was collected from questionnaire interview and medical record. Effects of lactation and lactation suppression hormone were assessed with conditional logistic regression analysis. In univariate analysis, lactation had a weak protective effect, after adjusting for educational level, body mass index, family history of breast cancer, reproductive factors, oral contraceptive and lactation suppression hormone use, the weak negative associations changed to weak positive ones. The use of lactation suppression hormone was consistently associated with a higher breast cancer risk. The major confounders between lactation and breast cancer risk were parity and age at first full-term birth. Lower breast cancer risks were found in high parity - long lactation, and in younger ages at first full-term birth - long lactation groups. The differences among different lactation lengths within each parity and age at first full-term birth category were small. The protective effects disappeared after adjusting for other potential confounders. The results of this study questions the independent protective effect of lactation in a population having both a variable duration of lactation and rapid socioeconomic change. The role of lactation suppression hormones needs further study.     

The association between lactation and breast cancer in an international case-control study: A re-analysis by menopausal status

In the large, hospital-based, international case-control study of breast cancer conducted by MacMahon and colleagues in the 1960s, no protective effect of lactation was observed. However, more recent reports have suggested that such an association may be limited to pre-menopausal women. Therefore, a re-analysis of the data from that original study was performed by menopausal status and with control for additional breast-cancer risk factors since identified. Overall, data from 4,671 parous pre-menopausal and 7,200 parous post-menopausal women were analyzed, from 7 different sites representing areas of high risk (Glamorgan, Wales; Boston, USA), moderate risk (Athens, Greece; Slovenia, ex-Yugoslavia; São Paolo, Brazil), and low risk (Tokyo, Japan; Taipei, Taiwan) of breast cancer. No significant effect of lactation was found for pre-menopausal or post-menopausal women from the high-, moderate-, or low-risk areas; the center-adjusted, combined odds ratio (OR) for having breast-fed was 1.05 (95% confidence interval, 0.86–1.29) among pre-menopausal and 1.04 (0.88–1.24) among post-menopausal women. Moreover, examination of cumulative duration of lactation did not support an inverse association between breast cancer and increased length of total breast-feeding. In conclusion, re-analysis of these data, by menopausal status and adjusting for age at first parity, age at menarche, age at menopause, body-mass index and years of schooling, did not reveal a protective effect of lactation or duration of lactation against breast-cancer occurrence among the pre-menopausal, parous women. Int. J. Cancer 71:166–169, 1997. © 1997 Wiley-Liss, Inc.     

A case-control study of lactation and cancer of the breast.

We have examined the relation of lactation, by total duration, with breast cancer risk among pre- and post-menopausal women. In a hospital-based case-control study conducted in Athens (1989-91), involving 820 patients with confirmed breast cancer and 795 orthopaedic patient controls and 753 hospital visitor controls, logistic regression was used to analyse the data controlling for demographic, nutritional and reproductive factors, including parity and age at any birth. Among post-menopausal women, there was no association between breastfeeding and breast cancer risk, but among premenopausal women those who has breastfed for > or = 24 months had an odds ratio of 0.50 (95% confidence interval 0.23-1.41). A reduction of the odds ration was also evident among premenopausal women who had breastfed between 12 and 23 months (odds ratio 0.70; 95% confidence interval 0.34-1.60). In conjunction with several other recent reports these results support the hypothesis that breastfeeding of prolonged duration may reduce the risk of breast cancer among premenopausal women but not among post-menopausal women. The biology underlying this different effect remains unknown, and the practical implication of the finding is a marginal importance.     

Breastfeeding and Ovarian Cancer Risk: a Systematic Review and Meta-analysis of 40 Epidemiological Studies

The present systematic review and meta-analysis was conducted to assess any association between breastfeeding and the risk of ovarian cancer. A systematic search of published studies was performed in PUBMED and EMBASE and by reviewing reference lists from retrieved articles through March 2013. Data extraction was conducted independently by two authors. Pooled relative risk ratios were calculated using random-effect models. Totals of 5 cohort studies and 35 case-control studies including 17,139 women with ovarian cancer showed a30% reduced risk of ovarian cancer when comparing the women who had breastfed with those who had never breastfed (pooled RR = 0.70, 95% CI: 0.64-0.76; p = 0.00), with significant heterogeneity in the studies (p = 0.00;I2 = 76.29%). A significant decreasd in risk of epithelial ovarian cancer was also observed (pooled RR = 0.68, 95% CI: 0.61-0.76). When the participants were restricted to only parous women, there was a slightly attenuated but still significant risk reduction of ovarian cancer (pooled RR = 0.76, 95% CI: 0.69-0.83). For total breastfeeding duration, the pooled RRs in the < 6 months, 6-12 months and > 12 months of breastfeeding subgroups were 0.85 (95% CI: 0.77-0.93), 0.73 (95% CI: 0.65-0.82) and 0.64 (95%CI: 0.56-0.73), respectively. Meta-regressionof total breastfeeding duration indicated an increasing linear trend of risk reduction of ovarian cancer with the increasing total breastfeeding duration (p = 0.00). Breastfeeding was inversely associated with the risk of ovarian cancer, especially long-term breastfeeding duration that demonstrated a stronger protective effect.     

Effect of lifetime lactation on breast cancer risk: a Korean women's cohort study

The objective of our study was to examine the effect of lifetime lactation on breast cancer risk among premenopausal women. The data were from a prospective cohort study with a follow-up period of 6 years in Korea (1995-2000). The cohort was composed of 110,604 premenopausal parous Korean women, aged 20 years and older, who received health insurance from the Korea Medical Insurance Corporation and who had medical evaluations in 1992 and 1994. Multivariate Cox proportional hazard models were tested, controlling for age, age at menarche, number of children, age at first pregnancy, oral contraceptive use, smoking, exercise and obesity. At baseline, 57,440 (51.9%) reported breastfeeding and 4,584 (4.1%) reported breastfeeding more than 24 months. From 1995-2000, 360 incident cases of breast cancer (61.8/100,000 person-years) occurred. Compared to parous women who had no history of lactation, a period of lactation of 13-24 months decreased the risk of breast cancer (RR, 0.7; 95% CI, 0.5-1.1), and this risk was decreased even further for those who breastfed for more than 24 months (RR, 0.6; 95% CI, 0.3-1.0). There was a clear trend of decreasing breast cancer risk with the duration of lactation (p for trend <0.001). In conclusion, our study of a large Korean cohort provides additional empirical evidence to current theoretical conjecture that lactation decreases the risk of breast cancer among premenopausal women.     

Socioeconomic status, lactation and breast cancer risk of parous women in Taiwan

The objective of this study was to evaluate effects of socioeconomic status and lactation on breast cancer of parous women in Taiwan. A total of 102 parous incident cases of female breast cancer in Taipei City were recruited from National Cancer Registry. Another 102 community parous controls individually matched with each case on residential area and age (within five years) were randomly selected from household registration profiles. Socioeconomic status including ethnic group, schooling years, family income, and religion, reproductive risk factors, lactation and body size risk factors for breast cancer were collected from a structured questionnaire interview. Conditional logistic regression was used to estimate the multivariate-adjusted odds ratio of each risk factor. Family income was positively and significantly associated with breast cancer, showing a significant dose-response trend. High parity above three showed a significant protective effect. There was a prominent protective effect from breast feeding. The longer the duration, the smaller the risk of breast cancer. The protective effect of breast feeding was significant only in women who had more than three deliveries.     

Lactation and the risk of breast cancer

Some factors are suggested to have an association with an increased risk of breast cancer, which are called risk factors. Lactation is one of the risk factors that still needs to be studied because of conflicting findings in epidemiological studies and also uncertainty regarding biologic plausibility. Our objective was to study the relationship between lactation and the risk of breast cancer. A pair of unmatched case control studies was held among parous women at Dr. Soetomo Hospital (general hospital) and some private hospitals in the Surabaya municipality. There are 219 (51.9%) cases and 203 (48.1%) controls analyzed in this study. Age, age at menarche, regular menstruation and number of parity between both groups are not statistical different. When we divided the age at menarche (below 13), it was statistically different. The cases consisted of more women with menarche below 13 (p = 0.00038). Other factors showing statistical differences in the risk of breast cancer between case and control are age at first delivery, family history of breast cancer and age at menopause. Women who have lactated (more than 4-month duration of breast feeding) show a "protective effect" against breast cancer, OR 0.57 (95% CI 0.33-0.99). However, there was no clear duration of lactation and the risk of breast cancer. Logistic regression analysis showed that lactation was not any independent factor. Lactation exerts a "protective effect" against breast cancer. However, the duration of lactation did not show an influence in reducing the risk of breast cancer, and logistic regression analysis did not show that lactation was an independent factor in the risk of breast cancer.     

Prolonged lactation reduces ovarian cancer risk in Chinese women.

To investigate the effect of lactation on the risk of ovarian cancer for Chinese women, a case-control study was conducted in Hangzhou, capital of Zhejiang province, China. Cases were 275 patients with histologically confirmed epithelial ovarian cancer. Controls were 623 women without neoplasm. All participants were parous women who had given at least one live birth and had been residents of Zhejiang province for at least 10 years. Information was collected using a validated and reliable questionnaire on total months of lactation, number of children breastfed, and average duration of lactation per child. Multivariate logistic regression models were used to assess the association between ovarian cancer risk and lactation variables, accounting for age, locality, full-term pregnancy, oral contraceptive use and family history of the cancer. The adjusted odds ratios were 0.51 (95% confidence interval (CI) 0.3-0.9) and 0.44 (95% CI 0.2-0.9) respectively for women with over 12 months of lactation and at least three children breastfed, compared with those with 4 months or less lactation and one child breastfed. The corresponding dose-response relationships were also significant (P<0.05). Therefore, prolonged lactation could reduce the risk of ovarian cancer for Chinese women.     

Oral contraceptive and IUD use and endometrial cancer: a population-based case-control study in Shanghai, China

Oral contraceptive (OC) and intrauterine device (IUD) use have been shown to be protective factors for endometrial cancer in several epidemiological studies; however, few studies have been conducted in Chinese populations. We evaluated the association between OC and IUD use and endometrial cancer risk in a population-based case-control study among Chinese women in Shanghai, China. The study included 1,204 newly diagnosed endometrial cancer cases and 1,212 age frequency-matched healthy controls. Logistic regression models were used to estimate adjusted odds ratios (OR) and their 95% confidence intervals (95% CI). In our study population, 18.5% cases and 24.9% controls reported having ever used OCs with an OR of 0.75 (95% CI, 0.60-0.93), after adjusting for known risk or protective factors for endometrial cancer. The risk of endometrial cancer decreased with long-term use of OCs with the OR for more than 72 months of use being 0.50 (95% CI, 0.30-0.85). The effect of OC use remained 25 or more years after cessation of use; the associated OR was 0.57 (95% CI = 0.42-0.78) as compared to nonusers. Similarly, fewer cases than controls had ever used IUD, with the multivariable adjusted OR being 0.53 (95% CI = 0.43-0.65). A reduction in risk was observed regardless the duration of use or age at first and last use. These results suggest that OC and IUD use may confer long-term protection against endometrial cancer.     

Breastfeeding and risk of ovarian cancer in two prospective cohorts

Objective To describe the association between breastfeeding and ovarian cancer risk in two prospective cohorts. Materials & methods We pooled data from the Nurses’ Health Study and Nurses’ Health Study II. There were 391 cases of epithelial ovarian cancer diagnosed among 149,693 parous women with up to 16 years of follow-up. Data were analyzed using multivariate Cox proportional hazards models, controlling for age, parity, duration of oral contraceptive use, tubal ligation, and age at menarche. Results Ever breastfeeding was associated with a non-significant reduction in ovarian cancer risk compared with never breastfeeding (RR = 0.86, 95% CI 0.70–1.06); the median duration of breastfeeding among women who breastfed was nine months. Breastfeeding of 18 or more months was associated with a significant decrease in ovarian cancer risk compared to never breastfeeding (RR = 0.66, 95% CI 0.46–0.96). For each month of breastfeeding the relative risk decreased by 2% (RR = 0.98 per month, 95% CI 0.97–1.00). Conclusions These data support a linear inverse association between breastfeeding and risk of epithelial ovarian cancer.