A RETROSPECTIVE COHORT STUDY OF VASECTOMY AND PROSTATE-CANCER IN UNITED-STATES MEN
A RETROSPECTIVE COHORT STUDY OF VASECTOMY AND PROSTATE-CANCER IN UNITED-STATES MEN
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DOI：
10.1001/jama.269.7.878
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发表时间：
1993-02-17
影响因子：
120.7
通讯作者：
COLDITZ, GA
中科院分区：
文献类型：
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作者：
GIOVANNUCCI, E;TOSTESON, TD;COLDITZ, GA
客观。-研究输精管结扎术和前列腺癌之间的关系。回顾性队列研究。设置。-美国11个大州的护士丈夫。在1976年和1978年进行的问卷调查中，14607名参加护士健康研究的已婚女性报告说，输精管切除术是夫妇的避孕方式。1989年，我们联系了14607名妇女和14607名年龄匹配的参与者，他们的丈夫在1978年之前没有做过输精管切除术，以确定他们丈夫在1976年至1989年间的疾病状况。前列腺癌的诊断。结果。-在研究期间，从1976年到1989年，队列中诊断出96例新的前列腺癌病例。输精管切除术与前列腺癌风险增加相关（年龄校正相对风险为1.56; 95%可信区间为1.03 - 2.37; P= 0.04）。自输精管切除术后，前列腺癌的相对风险随时间推移而增加。在过去输精管切除术20年或更长时间的男性中，前列腺癌的相对风险为1.89（95%置信区间，1.14至3.14; P= 0.005），排除A期和B期病例后，相对风险为2.06（95%置信区间，0.95至4.43; P= 0.07）。当我们调整吸烟、饮酒、教育水平、身体质量指数和居住的地理区域时，输精管切除男性前列腺癌的风险升高持续存在。这些结果支持了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。输精管结扎术影响前列腺癌发生率的生物学机制可能与输精管结扎术后前列腺液分泌率降低有关，或者与输精管结扎术后对精子抗原的免疫反应有关，精子抗原可能与肿瘤相关抗原交叉反应并抑制肿瘤免疫监视机制。
Objective.-To examine the relationship between vasectomy and prostate cancer.Design.-Retrospective cohort study.Setting.-Husbands of nurses in 11 large states in the United States.Participants.-In questionnaires administered in 1976 and 1978, 14 607 married female participants of the Nurses' Health Study reported vasectomy as the couple's form of contraception. In 1989, we contacted these 14607 women and 14607 age-matched participants whose husbands had not had a vasectomy prior to 1978 to ascertain their husband's disease status between 1976 and 1989.Main Outcome Measure.-Diagnosis of prostate cancer.Results.-During the study period, from 1976 through 1989, 96 new cases of prostate cancer were diagnosed in the cohort. Vasectomy was associated with an increased risk of prostate cancer (age-adjusted relative risk, 1.56; 95% confidence interval, 1.03 to 2.37; P=.04). The relative risk of prostate cancer increased overtime since vasectomy. Among men who had their vasectomy 20 or more years in the past, the relative risk of prostate cancer was 1.89 (95% confidence interval, 1.14 to 3.14; P=.005), and after excluding stage A and B cases, the relative risk was 2.06 (95% confidence interval, 0.95 to 4.43; P=.07). This elevated risk of prostate cancer among vasectomized men persisted when we adjusted for 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. A biological mechanism whereby vasectomy influences the rate of prostate cancer may be related to a diminished secretory rate of prostatic fluid following vasectomy, or, alternatively, to the postvasectomy immune response to sperm antigens, which may cross-react with tumor-associated antigens and suppress tumor immunosurveillance mechanisms.