中国女性三阴性乳腺癌发病相关因素的Meta分析

摘 要：［目的］ 探讨中国女性三阴性乳腺癌发病相关的危险因素和保护因素。［方法］ 检索Pubmed、Medline、Embase、Cochrane Library、CNKI、VIP和万方数据库收录的所有关于中国女性三阴性乳腺癌发病相关因素的病例对照研究,病例组要求是三阴性乳腺癌,对照组是非三阴性乳腺癌患者。发表时间截止至2017年5月1日。由2位研究者独立筛选文献、提取资料和评价纳入研究的质量,采用Stata 12.0软件进行Meta分析。［结果］ 20个病例对照研究入选,研究总病例数37 273例;病例组6732例,对照组30541例。Meta分析结果显示,初潮年龄、生产次数、体质指数（BMI）、吸烟、流产次数、饮酒、居住地区、生育年龄与三阴性乳腺癌发病无相关性;与非三阴性乳腺癌相比,发病年龄60岁以上者、绝经、肿瘤家族史、不哺乳、服用避孕药、无生育史是三阴性乳腺癌发病的高危因素。亚组分析结果显示：北方地区初潮年龄大于13岁是保护因素,家族史和年龄超过60岁是危险因素。南方地区结果显示不哺乳、家族史、服用避孕药为危险因素。［结论］ 与非三阴性乳腺癌相比,绝经、肿瘤家族史、不哺乳、服用避孕药、无生育史、发病年龄60岁以上者是三阴性乳腺癌发病的危险因素,但受纳入研究的数量和质量的限制,上述结论尚需要进行前瞻性研究予以证实。     

特殊型乳腺癌危险因素的研究

目的按不同病理类型分类探讨特殊型乳腺癌发病的危险因素,为乳腺癌的预防提供依据.方法对诊断为特殊型乳腺癌的患者进行1:2配比的病例对照研究,各因素的比值比和95%可信限的计算采用条件Logistic回归方法,连续变量的趋势检验采用X2检验法.结果单因素分析表明:乳腺炎病史、初产年龄(≥27岁)、初潮初产间隔(≥10年)、性格内向、生活事件总分、遇事忍受、乳腺癌家族史,Quet指数(≥37)、哺乳期奶量不足等因素可增加患特殊型乳腺癌的危险性;母乳喂养及初潮年龄(≥14岁)是保护因素.多因素分析结果表明:初产年龄大于等于27岁、初潮初产间隔大于等于10年、性格内向、生活事件总分及乳腺癌家族史是特殊型乳腺癌发生的危险因素,初潮年龄大于等于14岁是保护因素.结论初潮年龄、初产年龄、初潮初产间隔、精神心理因素、遗传因素等与特殊型乳腺癌的发生有明显的关系.     

乳腺癌危险性因素和保护性因素

乳腺癌在许多国家和地区已居女性恶性肿瘤发病的首位。其发病率呈现世界范围的增高,严重威胁着妇女的生命和健康。在大量乳腺癌病因学研究的基础上,本文试对它的危险因素和保护性因素作一下系统地分析。1乳腺癌的危险因素1.1月经和生育情况初潮年龄早,初潮与初产间隔长、月经周     

农村女性乳腺癌的病例对照研究

以唐山市郊区及县区新诊断的１０１例乳腺癌患者为对象，按性别、年龄、出生地、生活地等因素与相同数量的对照者进行１∶１配比的病例对照研究。在单因素分析中，筛选出绝经年龄迟、行经期长、初产年龄晚、体重大、良性乳腺疾病史及精神刺激为乳腺癌的危险因素。生育次数、总哺乳期、初潮年龄、初潮～初产间隔、初产～末产间隔、口服避孕药、吸烟、饮酒、文化程度、乳腺癌家族史等指标，未发现与乳腺癌有明显联系。将上述因素引入条件Ｌｏｇｉｓｔｉｃ回归模型进行多因素分析，结果与单因素分析一致。     

乳腺癌知识问答

研究发现与乳腺癌发病机会升高相关的因素,有一些是无法改变的,包括种族、性别、年龄增长、基因突变、乳腺癌家族史、自身乳腺癌病史、致密型乳腺、某些良性乳腺疾病史、行经期长（初潮早,绝经晚）和胸部放射治疗史等。还有一些是与生活相关的因素,改善后也许可以降低乳腺癌发病风险,包括首次生育年龄大、生育次数少、使用避孕药、绝经后激素替代治疗、哺乳时间短、酒精摄入过量、超重、肥胖和缺乏运动等。具有以上1个或多个因素并不意味着必然会得乳腺癌,只是发病机会较其他人增高。相反,不具有以上因素的也有可能发病。     

河南新乡地区女性乳腺癌危险因素的病例对照研究

目的　调查新乡地区女性乳腺癌危险因素 ,为确定高危人群、提出预防措施提供依据。方法　我们从 1992年 4月到 1997年 4月与中国医科院肿瘤医院合作开展了《中国大样本乳腺癌病例对照调查研究》 ,这 5年中对我院就诊的经我院病理证实的乳腺癌30 0例进行病例对照研究。研究其妇科史、药物史、吸烟史及饮食史、家族史、疾病史、染发史等。结果　在单因素分析中 ,达到显著性水平的危险因素为行经期≥ 35年、服用避孕药、良性乳腺疾病史、被动吸烟及常食用蜂王浆等 ,达到显著性水平的保护因素为哺乳及常食豆类食品。条件 (logistic)多元回归分析显示 :重要的有统计学显著意义的乳腺癌危险因素是良性乳腺疾病史、被动吸烟 ;重要保护性因素是常食豆制品及哺乳。结论　新乡地区女性乳腺癌重要危险因素为良性乳腺疾病史及被动吸烟     

河南新乡地区女性乳腺癌危险因素的病例对照研究

目的 调查新乡地区女性乳腺癌危险因素，为确定高危人群、提出预防措施提供依据。方法 我们从1992年4月到1997年4月与中国医科院肿瘤医院合作开展了《中国大样本乳腺癌病例对照调查研究》，这5年中对我院就诊的经我院病理证实的乳腺癌300例进行病例对照研究。研究其妇科史、药物史、吸烟史及饮食史、家族史、疾病史、染发史等。结果 在单因素分析中，达到显著性水平的危险因素为行经期≥35年、服用避孕药、良性乳腺疾病史、被动吸烟及常食用蜂王浆等，达到显著性水平的保护因素为哺乳及常食豆类食品。条件(1ogistic)多元回归分析显示：重要的有统计学显著意义的乳腺癌危险因素是良性乳腺疾病史、被动吸烟；重要保护性因素是常食豆制品及哺乳。结论 新乡地区女性乳腺癌重要危险因素为良性乳腺疾病史及被动吸烟。     

食管癌发病影响因素Meta分析

[目的]定量综合评价各种危险因素在食管癌发病中的作用.[方法]从<中国生物医学文献数据库(1994～2003)>和<中国期刊网>上,搜集研究食管癌危险因素的文献,利用随机模型进行Meta分析.[结果]检索到符合纳入标准的文章12篇.病例组2161人,对照组3813人.Meta分析结果显示:有食管癌家族史的人患食管癌比值比(ORDL)为2.45(1.66～3.62);食用腌制食品ORDL为1.87(1.55～2.26);吸烟ORDL为1.43(1.09～1.87);饮酒ORDL为2.16(1.55～2.99);喜欢吃烫食ORDL为2.41(1.95～2.98);经常食用蔬菜和水果是保护性因素,OR.为0.52(0.40～0.67).[结论]食管癌家族史、吃腌制食品、吸烟、饮酒、喜欢吃烫食均增加患食管癌的危险性,吃蔬菜和水果是保护性因素.     

应用分类树模型研究乳腺癌危险因素

目的应用分类树模型筛选乳腺癌的危险因素,并预测其发病风险,为乳腺癌的干预提供科学依据。方法用问卷调查及实验室检测等方式采集2010年7月至2012年6月就诊于黑龙江省牡丹江市第一、二人民医院及牡丹江医学院附属红旗医院的1023名女性的相关数据,利用分类树模型分析乳腺癌的影响因素,采取ROC曲线对模型进行评价。结果乳腺癌的危险因素为乳腺癌家族史、长期精神压抑、流产次数（≥3次）、初潮年龄（≤12岁）、平均行经时间（〉7d）、足月妊娠、乳腺良性疾病史、腰臀比（30．8）、职业和体质指数（325）,食用豆类食品（1周不少于2次）、体育锻炼和哺乳情况（母乳喂养）为乳腺癌发生的保护因素（P〈0．050）。结论利用分类回归树模型可以快速、有效的从众多数据中挖掘出影响乳腺癌发病的主要因素并预测人群乳腺癌的发病风险,在流行病学研究中具有较高的应用价值。     

女性乳腺癌发病危险因素的病例-对照研究

目的 通过病例-对照研究探索女性乳腺癌的危险因素,为制定乳腺癌预防措施提供科学依据.方法 选取1148例初诊的乳腺癌患者作为病例组,根据年龄和月经史按1:2频数匹配健康对照2229例,收集两组的人口学特征资料和体重指数(BMI)、治疗前雌二醇(E2)检测结果,采用单因素和多因素Logistic分析乳腺癌的危险因素.结果 病例组绝经患者占40.59%,对照组绝经者占39.08%.单因素分析中,妊娠、生育、流产、哺乳次数多,初潮年龄晚者,罹患乳腺癌风险降低(P<0.05);BMI越高,罹患乳腺癌的风险越高(P<0.05);而E2水平与罹患乳腺癌风险无关(P>0.05).非条件Logistic多元回归分析显示,初潮年龄、妊娠次数、生育次数均为保护因素.结论 女性乳腺癌发病与月经、生育史有关.妊娠或生育均为乳腺癌的保护因素,初潮年龄越早,罹患乳腺癌的风险越高.     

52例恶性上皮性卵巢肿瘤病例对照研究

目的：探讨恶性上皮卵巢肿瘤发生的影响因素。方法：应用１：１配对病例对照研究,收集３所医院妇科收治的恶性上皮性卵巢肿瘤患者５２例作为病例组,收集同期住院的非妇产科,非肿瘤,与激素无关的其他女性患者５２例作为对照组,两组间同性别、同民族、一对内年龄相关不过５岁,对所得资料进行单因素条件Ｌｏｇｉｓｔｉｃ回归分析及多元条件Ｌｏｇｉｓｔｉｃ回归分析。结果有恶性肿瘤家族史,暴露于滑石粉为上皮性卵巢癌主要的危险     

卵巢上皮癌的预后影响因素分析

目的:探讨卵巢上皮癌预后的影响因素.方法:回顾分析自2005年1月至2010年12月在陕西省肿瘤医院收治的292例卵巢上皮癌患者的临床资料.采用Kaplan-Meier法分析生存时间,应用Log-rank法进行组别间生存率差异检验,采用OR值对各因素间进行危险度分析.结果:年龄、手术分期、组织学类型、病理分化程度、肿瘤细胞减灭术后残余瘤的大小以及术后化疗疗程数是卵巢上皮癌的预后生存指标.以FIGOⅠ期患者的死亡风险为1,则Ⅱ期、Ⅲ期、Ⅴ期的死亡风险分别为Ⅰ期的3倍、14.7倍、21.8倍;以术后残余瘤直径≤2cm患者的死亡风险为l,则残余瘤直径＞2cm的患者的死亡风险为残余瘤直径≤2cm患者的死亡风险的80.7倍;化疗疗程数＜6疗程的死亡风险为≥6疗程的2.3倍.以高分化患者的死亡风险为l,则中、低分化的死亡风险分别为高分化的2.4倍、3.8倍.结论:FIGO分期,首次肿瘤细胞减灭术后残余瘤的大小、化疗疗程数、病理分化程度是卵巢上皮癌的独立预后因素.因此尽力做到早诊断、早治疗,术后辅以正规、足程的化疗是提高卵巢上皮癌生存率的关键.     

Hormonal risk factors and invasive epithelial ovarian cancer risk by parity

Background:

Recent studies have suggested that several ovarian cancer risk factors differ by parity status, but these findings have not been confirmed. We evaluated whether known risk factors of ovarian cancer differ between nulliparous and parous women using data from two large prospective cohorts.

Methods:

Data from the National Institutes of Health-AARP Diet and Health Study and the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial were combined for this analysis. Cox regression models were used to estimate associations with ovarian cancer risk. Risk heterogeneity by parity status was assessed using likelihood-ratio tests.

Results:

Among the 125 437 women included in the analysis, there were 16 589 (13%) nulliparous women and 108 848 (87%) parous women. Of the 623 women diagnosed with invasive epithelial ovarian cancer, 102 (16%) were nulliparous and 521 (84%) were parous. While parity reduced ovarian cancer risk, no differences were found for other risk factors by parity. Among ever users of hormone therapy, body mass index suggestively increased the risk of ovarian cancer by 1.5-fold in nulliparous but not parous women (P-heterogeneity=0.08).

Conclusion:

While nulliparous women have higher ovarian cancer risk than parous women, our findings suggest that the relative effects of most other risk factors do not differ by parity.     

影响上皮性卵巢癌术后复发的相关危险因素

目的:探讨影响上皮性卵巢癌术后复发的危险因素。方法:对近年来我院收治的上皮性卵巢癌患者171例进行回顾性分析,其中随访资料完整者91例为研究对象。91例患者中,术后复发33例为复发组,随访未复发的58例为对照组,比较两组患者临床特征、手术情况、病理类型及术后治疗方案有无差别,并采用Logistic回归方法对影响术后复发的独立危险因素进行分析。结果:单因素分析显示:临床分期(P=0.00)、病理类型(P=0.03)、腹水肿瘤细胞阳性(P=0.02)和术后化疗大于4个周期(P=0.03)与上皮性卵巢癌患者术后复发有关。Logistic回归分析显示晚期 (Ⅲ/Ⅳ)(OR=4.22,P=0.01)和腹水肿瘤细胞阳性(OR=2.81,P=0.03)是影响上皮性卵巢癌术后复发的独立危险因素。结论:腹水中肿瘤细胞阳性的晚期上皮性卵巢癌患者是术后复发的高危人群,应加强术后辅助治疗,降低复发风险。     

Risk of ovarian cancer in the United States in relation to anthropometric measures: does the association depend on menopausal status?

Objective: To elucidate the association between anthropometric measures and ovarian cancer risk. Methods: From a population-based study of 563 cases of ovarian cancer and 523 controls we recorded weight, both at index age and age 18, and height using an in-person questionnaire, and used these to calculate body mass index (BMI). Multivariate logistic regression was used to calculate the exposure odds ratios, adjusted for established risk factors, stratified, in turn, by menopausal status and histologic type of ovarian cancer. Results: Height, weight, and BMI were unrelated to risk for ovarian cancer in the total group of cases and controls. After stratification by menopausal status, weight and BMI were associated positively with risk among premenopausal women, but did not affect risk postmenopausally. High BMI, weight, and height were most strongly related to risk of serous borderline cancer, particularly among premenopausal women. The association did not appear to be confined only to those overweight women with gynecologic problems such as irregular periods or ovarian cysts. Conclusions: Weight and BMI are positively related to premenopausal ovarian cancer risk in this population-based case–control study. This association is particularly noted for serous borderline tumors. This may suggest the importance of endocrine factors, which are altered in overweight women, such as insulin or androgens.     

Incessant ovulation, mucin 1 immunity, and risk for ovarian cancer.

BACKGROUND: Risk for ovarian cancer correlates directly with "ovulatory years or cycles" estimated from time not pregnant, breast-feeding, or using oral contraceptives. Recently, we reported that several factors known to reduce ovarian cancer risk may operate by inducing antibodies against mucin 1 (MUC1), a glycoprotein overexpressed in ovarian cancer. Conversely, other events might increase risk by interfering with the development of protective immunity. In this study, we examined whether the total number of ovulatory cycles decreases the likelihood of anti-MUC1 antibodies and provides an immune basis for the association between "incessant ovulation" and ovarian cancer risk. METHODS: From 1998 to 2003, we enrolled 668 epithelial ovarian cancer cases and 721 controls residing in eastern Massachusetts or New Hampshire, collected information on menstrual and reproductive events, and obtained blood samples from controls to measure anti-MUC1 antibodies. Using logistic regression, we calculated odds ratios to evaluate the influence of reproductive factors, including the estimated lifetime number of ovulatory cycles on ovarian cancer risk and on the presence of MUC1 antibodies in controls. RESULTS: Overall, we observed that early age at first birth, cycle lengths >or=30 days, and oral contraceptive use increased the likelihood of having anti-MUC1 antibodies. Estimated ovulatory cycles were correlated positively with ovarian cancer risk and inversely with the presence of anti-MUC1 antibodies among controls ages 46 to 60 years. CONCLUSIONS: These data suggest that suppression of MUC1-specific immunity should be considered as an additional explanation for the observation that ovarian cancer risk increases with the lifetime number of ovulatory cycles.     

Cancer incidence in the first-degree relatives of ovarian cancer patients.

Cancer incidence was studied among 3072 first-degree relatives of 559 unselected ovarian cancer patients. Among cohort members there were 306 cancer cases. The overall cancer incidence was not increased: the standardised incidence ratio (SIR) in males was 0.9 (95% confidence interval 0.8-1.1) and in females 1.0 (0.8-1.1). The female relatives had a significantly increased risk for ovarian cancer (SIR 2.8, 1.8-4.2). The excess was attributable to sisters only (SIR 3.7, 2.3-5.7). The relative risk for ovarian cancer among sisters decreased both by increasing age of the sister and by increasing age at diagnosis of the index patient: the SIRs were 7.3 (1.5-21.4), 4.5 (1.6-9.8) and 3.1 (1.7-5.4) for sisters of index patients diagnosed in age < 45, 45-54 and 55-75 years respectively. The age dependency of the risk supports the role of genetic factors in familial ovarian cancer. Although the risk of ovarian cancer among sisters from families with breast cancer (SIR 9.2, 3.7-19.0) was significantly higher than among sisters from families with no breast cancer patients (SIR 2.9, 1.6-4.8, rate ratio 3.1, P < 0.05), the excess was not solely attributable to coaggregation of breast and ovarian cancer. Among the 27 families with two or more ovarian cancers, only sisters were affected in 24 families, which might implicate recessive inheritance or shared environmental factors influencing ovarian cancer risk in sisters.     

Facteurs de risques professionnels du cancer de l’ovaire. Revue de la littérature

The aim of this work was to review the available literature on occupational risk factors associated with ovarian cancer. A PubMed search was performed using an algorithm with the following search terms: ovary, ovarian, exposure, work, occupation. Relevant articles were selected through assessment of titles and abstracts as well as through the reference lists of related articles. A total of 54 studies were selected for this review, including 17 studies on asbestos exposure and risk of ovarian cancer and, 16 studies on other occupational factors (5 cohort studies and 11 case control studies). An increased risk of ovarian cancer has been reported for several occupations (teachers, administration employees, nurses, religious workers) and various industrial sectors (biomedical research, telephony industry, hairdresser and beautician, printing factories) with inconsistent results. Moreover, in many of these studies, individual risk factors of ovarian cancers were not considered. Despite methodological limitations of published studies, a significantly increased risk for ovarian cancer associated with asbestos exposure have been consistently reported.     

Caffeine, alcohol, smoking, and the risk of incident epithelial ovarian cancer

BACKGROUND: Smoking, caffeine, and alcohol intake are all potentially modifiable factors that have an unclear association with ovarian cancer risk. Therefore, the associations between these exposures and ovarian cancer risk were prospectively examined among 110,454 women in the Nurses' Health Study (NHS) for the smoking analyses and 80,253 women for the dietary analyses. METHODS: Women completed biennial questionnaires assessing ovarian cancer risk factors beginning in 1976, with food frequency questionnaires administered every 2 to 4 years starting in 1980. For the smoking analyses, 737 confirmed cases of epithelial ovarian cancer were identified and for the dietary aims, 507 cases were identified through June 1, 2004. RESULTS: Compared with never-smokers, neither current nor past smoking was associated with ovarian cancer risk overall; however, both were associated with mucinous tumors (n = 69; rate ratio [RR], past = 2.02 [95% confidence interval (CI), 1.15-3.55]; RR, current = 2.22 [95% CI, 1.16-4.24]). A modest inverse association between caffeine intake and ovarian cancer risk was observed (RR, top vs bottom quintile = 0.80; 95% CI, 0.60-1.07 [P = .03]), which was strongest for women who had never used either oral contraceptives (RR = 0.65; 95% CI, 0.46-0.92 [P for heterogeneity = .02]) or postmenopausal hormones (RR = 0.57; 95% CI, 0.36-0.91 [P for heterogeneity = .13]). Alcohol was not associated with ovarian cancer risk. CONCLUSIONS: The results of the current study suggest that cigarette smoking may only increase the risk for mucinous ovarian tumors, and alcohol intake was not associated with risk. However, an inverse association was observed between caffeine intake and ovarian cancer risk, particularly in women not using hormones; this finding merits further study.