Cancer risk among parous women following assisted reproductive technology.
Cancer risk among parous women following assisted reproductive technology.
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DOI：
10.1093/humrep/dev124
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发表时间：
2015-08
期刊：
影响因子：
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通讯作者：
Storeng R
中科院分区：
文献类型：
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作者：
Reigstad MM;Larsen IK;Myklebust TÅ;Robsahm TE;Oldereid NB;Omland AK;Vangen S;Brinton LA;Storeng R
与未接受辅助生殖技术 (ART) 分娩的女性相比，接受辅助生殖技术 (ART) 分娩的女性患癌症的风险是否增加？如果不进行校正，结果表明 ART 后分娩的女性总体癌症风险会增加，中枢神经系统癌症风险会增加 50%，但在校正多项分析后，结果并不显着。关于 ART 涉及的激素治疗对后续癌症风险影响的研究提供了不一致的结果，并且也有人认为不孕本身可能是一个促成因素。一个以人口为基础的队列由在挪威医疗出生登记处登记并在 1984 年 1 月 1 日至 2010 年 12 月 31 日期间分娩的所有妇女组成（n = 812 986）。通过与挪威癌症登记处的联系来识别癌症。研究对象从观察期内第一次怀孕开始一直到第一次癌症、死亡、移居或2010年12月31日为止进行随访。在总研究人群中（n = 806 248），16 525人在ART后生下了孩子。 Cox 回归分析计算了风险比 (HR) 和 95% 置信区间 (CI)，比较了 ART 女性和非 ART 女性之间的癌症风险；适用于整体癌症、宫颈癌、卵巢癌、子宫癌、中枢神经系统 (CNS)、结直肠癌和甲状腺癌以及恶性黑色素瘤。共有 22 282 名队列成员被诊断患有癌症，其中 338 名是 ART 女性，21 944 名非 ART 女性。结果显示，七分之一的接受 ART 女性的风险较高。中枢神经系统癌症的 HR 为 1.50 (95% CI 1.03–2.18)，在专门接受 IVF（无 ICSI）的患者中，HR 为 1.83 (95% CI 1.22–2.73)。总体癌症风险分析得出的 HR 为 1.16（95% CI 1.04-1.29）。在随访结束时仅生育一胎的女性中，卵巢癌的 HR 为 2.00 (95% CI 1.08–3.65)，对于入组时未生育的女性，HR 为 1.80 (95% CI 1.04–3.11)。然而，在校正多重分析后，所有发现都变得不显着。在调整多项分析后，整体癌症和中枢神经系统癌症风险升高的结果失去了意义，这意味着该研究的一个重要局限性。随访时间相对较短，尤其是对于 ART 女性。此外，由于该队列相对年轻，因此很少发生癌症，特别是对于一些较罕见的癌症形式，例如子宫癌。无法根据不同的不孕原因进行风险评估。根据本研究的结果，应进一步研究中枢神经系统和卵巢癌的风险，并鼓励对所有接受 ART 治疗的患者进行持续监测。我们的研究结果可能仅适用于 ART 后分娩的女性，而 ART 后仍未生育的女性的风险仍有待评估。该研究由挪威国家妇女健康咨询单位资助。所有作者均声称不存在竞争利益。
Do women who give birth after assisted reproductive technology (ART) have an increased risk of cancer compared with women who give birth without ART? Without correction, the results indicate an increase in overall cancer risk, as well as a 50% increase in risk of CNS cancer for women giving birth after ART, however the results were not significant after correcting for multiple analyses. Studies regarding the effects of hormonal treatments involved with ART on subsequent cancer risk have provided inconsistent results, and it has also been suggested that infertility itself could be a contributory factor. A population-based cohort consisting of all women registered in the Medical Birth Registry of Norway as having given birth between 1 January 1984 and 31 December 2010 was assembled (n = 812 986). Cancers were identified by linkage to the Cancer Registry of Norway. Study subjects were followed from start of first pregnancy during the observational period until the first cancer, death, emigration, or 31 December 2010. Of the total study population (n = 806 248), 16 525 gave birth to a child following ART. Cox regression analysis computed hazard ratios (HR) and 95% confidence intervals (CI) comparing cancer risk between ART women and non-ART women; for overall cancer, and for cervical, ovarian, uterine, central nervous system (CNS), colorectal and thyroid cancers, and for malignant melanoma. A total of 22 282 cohort members were diagnosed with cancer, of which 338 were ART women and 21 944 non-ART women. The results showed an elevated risk in one out of seven sites for ART women. The HR for cancer of the CNS was 1.50 (95% CI 1.03– 2.18), and among those specifically subjected to IVF (without ICSI) the HR was 1.83 (95% CI 1.22–2.73). Analysis of risk of overall cancer gave an HR of 1.16 (95% CI 1.04–1.29). Among those who had delivered only one child by the end of follow-up, the HR for ovarian cancer was 2.00 (95% CI 1.08–3.65), and for those nulliparous at entry the HR was 1.80 (95% CI 1.04–3.11). However, all findings became non-significant after correcting for multiple analyses. The results of elevated risk of overall cancer and CNS cancer lost significance when adjusting for multiple analyses, implying an important limitation of the study. The follow-up time was relatively short, especially for ART women. In addition, as the cohort was relatively young, there were few incident cancers, especially for some rarer cancer forms, such as uterine cancer. Risk assessments according to different causes of infertility could not be done. In light of the findings in the present study, further studies should be made on risk of CNS and ovarian cancer, and continued monitoring of all those treated with ART is encouraged. Our findings may only be generalizable to women who give birth after ART, and the risk for women who remain nulliparous after ART remains to be assessed. The study was funded by the Norwegian National Advisory Unit on Women's Health. All authors claim no competing interests.