PARITY, AGE AT FIRST CHILDBIRTH, AND RISK OF OVARIAN-CANCER
PARITY, AGE AT FIRST CHILDBIRTH, AND RISK OF OVARIAN-CANCER
复制标题
DOI：
10.1016/s0140-6736(94)90749-8
复制
发表时间：
1994-11-05
期刊：
影响因子：
168.9
通讯作者：
JANSON, PO
中科院分区：
文献类型：
--
作者：
ADAMI, HO;HSIEH, CC;JANSON, PO
增加产次与卵巢癌风险降低相关，但尚不清楚这种关联是否适用于不同的组织病理学类型和交界性肿瘤。此外，时间关系知之甚少，第一次生育年龄的可能作用仍然是明确的。我们调查了这些问题的病例对照研究嵌套在一个全国性队列的妇女出生于1925年和1960年之间在Sweden.During随访至1984年，3486浸润性卵巢癌（2992上皮，330间质，149生殖细胞，15未分类）和510肿瘤的边缘恶性。每例妇女选择5名年龄匹配的个体（共19 980名）。在同时调整胎次和首次生育年龄后，增加胎次与所有浸润性癌症相对风险的显著一致下降相关（每增加一胎的比值比为0.81 [95% CI 0.77-0.85]），上皮癌（0.81 [0.77-0.86]）、间质癌（0.84 [0.72-0.98]）和生殖细胞癌（0.71 [0.48-1.05]），但交界性肿瘤的下降幅度较小（0.92 [0.81-1.04]）。首次生育年龄每增加5岁，卵巢癌风险降低约10（优势比0.89 [0.84-0.94]上皮癌，0.92 [0.77-1.10]间质癌，0.92 [0.65-1.32]生殖细胞癌，由于我们的发现不能轻易地用持续排卵或高血清促性腺激素浓度的理论来解释，因此需要新的病因学假说。卵巢中发生恶性转化的细胞的妊娠依赖性清除可以解释卵巢癌的生殖风险因素。
Increasing parity is associated with a reduction in the risk of ovarian cancer, but it is not clear whether this association applies to different histopathological types and to borderline tumours. Moreover, the temporal relations are poorly understood, and the possible role of age at first birth remains unequivocal. We have investigated these issues in a case-control study nested in a nationwide cohort of women born between 1925 and 1960 in Sweden.During follow-up until 1984, 3486 invasive ovarian cancers (2992 epithelial, 330 stromal, 149 germ-cell, 15 not classifiable) and 510 tumours of borderline malignant were diagnosed. 5 individually age-matched (total 19 980) were selected for each case woman. After simultaneous adjustment for parity and age at first birth, increasing parity was associated with a pronounced consistent decrease in relative risk of all invasive cancers (odds ratio for each additional birth 0.81 [95% Cl 0.77-0.85]), epithelial cancer (0.81 [0.77-0.86]), stromal cancer (0.84 [0.72-0.98]), and germ-cell cancer (0.71 [0.48-1.05]), but a less consistent decrease for borderline tumours (0.92 [0.81-1.04]). The risk of ovarian cancer decreased by about 10% for each 5-year increment in age at first childbirth (odds ratios 0.89 [0.84-0.94] epithelial cancer, 0.92 [0.77-1.10] stromal cancer, 0.92 [0.65-1.32] germ-cell cancer, 0.93 [0.80-1.09] borderline tumours).Because our findings cannot be readily explained by theories invoking incessant ovulation or high serum concentrations of gonadotropins, new aetiological hypotheses are needed. Pregnancy-dependent clearance from the ovaries of cells that have undergone malignant transformation could explain the reproductive risk factors for ovarian cancer.