A PROSPECTIVE COHORT STUDY OF VASECTOMY AND PROSTATE-CANCER IN UNITED-STATES MEN
A PROSPECTIVE COHORT STUDY OF VASECTOMY AND PROSTATE-CANCER IN UNITED-STATES MEN
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DOI：
10.1001/jama.269.7.873
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发表时间：
1993-02-17
影响因子：
120.7
通讯作者：
WILLETT, WC
中科院分区：
文献类型：
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作者：
GIOVANNUCCI, E;ASCHERIO, A;WILLETT, WC
目的.-前瞻性地研究输精管结扎术和前列腺癌之间的关系。设计.-队列研究。设置.-美国的卫生专业人员（牙医、兽医、整骨医生、验光师、药剂师和足病医生）。参与者。-卫生专业人员随访研究中有 10055 名男性成员，年龄 40 至 75 岁，曾接受过输精管结扎术，37 800 名在 1986 年进入研究时尚未进行输精管结扎术的成员。这些参与者提供了包括饮食在内的各种生活方式变量的详细信息。主要结果测量。-前列腺癌的诊断。结果。-在 1986 年至 1990 年间，在最初未诊断出癌症的参与者中诊断出了 300 例新的前列腺癌病例。输精管结扎术与前列腺癌风险升高相关（年龄调整相对风险，1.66；95% 置信区间，1.25 至 2.21；P=.0004）。在排除 21 例 A1 期病例后，这种升高的风险仍然存在（年龄调整相对风险，1.56；95% 置信区间，1.15 至 2.11；P=.004）。在过去至少 22 年（1965 年之前）进行过输精管切除术的男性中，患前列腺癌的风险甚至更高（相对风险，1.85；95% 置信区间，1.26 至 2.72；P=.002）。接受输精管结扎术的男性中这种风险升高似乎并不是由检测偏差引起的，并且当我们控制饮食、体力活动水平、吸烟、饮酒、教育水平、体重指数和居住地理区域时，这种风险仍然存在。结论。-这些结果支持其他流行病学研究的证据，即输精管结扎术会增加前列腺癌的风险。各种流行病学研究结果的一致性、输精管结扎术后风险随着时间的推移而增加、明显缺乏混杂因素或偏倚以及输精管结扎术后前列腺生理变化的存在表明这种关联可能是因果关系。
Objective.-To examine prospectively the relationship between vasectomy and prostate cancer.Design.-Cohort study.Setting.-Health professionals (dentists, veterinarians, osteopaths, optometrists, pharmacists, and podiatrists) in the United States.Participants.-There were 10055 male members of the Health Professionals Follow-up Study, aged 40 to 75 years, who had had a vasectomy, and 37 800 members who had not had a vasectomy at the time of study entry in 1986. These participants had provided detailed information on various life-style variables including diet.Main Outcome Measure.-Diagnosis of prostate cancer.Results.-Between 1986 and 1990, 300 new cases of prostate cancer were diagnosed in participants who were initially free of diagnosed cancer. Vasectomy was associated with an elevated risk of prostate cancer (age-adjusted relative risk, 1.66; 95% confidence interval, 1.25 to 2.21; P=.0004). This elevated risk persisted after excluding 21 stage A1 cases (age-adjusted relative risk, 1.56; 95% confidence interval, 1.15 to 2.11; P=.004). Among men who had their vasectomy at least 22 years in the past (before 1965), the risk of prostate cancer was even higher (relative risk, 1.85; 95% confidence interval, 1.26 to 2.72; P=.002). This elevated risk among men with vasectomy did not appear to be caused by detection bias and persisted when we controlled for diet, level of physical activity, smoking, alcohol consumption, educational level, body mass index, and geographical area of residence.Conclusions.-These results support evidence from other epidemiologic studies that vasectomy increases risk of prostate cancer. The consistency of results among various epidemiologic studies, the increase of risk over time following vasectomy, the apparent lack of confounding or bias, and the existence of physiological changes in the prostate following vasectomy suggest that the association may be causal.