HISTORY OF CIRCUMCISION, MEDICAL CONDITIONS, AND SEXUAL-ACTIVITY AND RISK OF PENILE CANCER
HISTORY OF CIRCUMCISION, MEDICAL CONDITIONS, AND SEXUAL-ACTIVITY AND RISK OF PENILE CANCER
复制标题
DOI：
10.1093/jnci/85.1.19
复制
发表时间：
1993-01-06
影响因子：
10.3
通讯作者：
DALING, JR
中科院分区：
文献类型：
--
作者：
MADEN, C;SHERMAN, KJ;DALING, JR
背景资料：流行病学证据表明，缺乏新生儿包皮环切术是阴茎癌的最大风险因素，但性传播疾病在阴茎癌病因中的作用仍不清楚。目的：为了进一步阐明阴茎癌的危险因素，我们研究了包皮环切术，个人特征和习惯（如吸烟），性传播疾病，过去的性活动和阴茎的医疗条件的作用。方法：在西部华盛顿州和不列颠哥伦比亚省进行了一项以人群为基础的病例对照研究。我们采访了110名男性阴茎癌诊断从1979年1月至1990年7月和355名对照组的一般人群，频率匹配的情况下，受试者的年龄和诊断日期。应用聚合酶链反应（PCR）检测67例肿瘤组织中人乳头瘤病毒（HPV）DNA。69例病例受试者和208例对照受试者的血液检查结果可用于研究。统计学显著性结果：与出生时接受过包皮环切术的男性相比，从未接受过包皮环切术的男性患阴茎癌的风险高出3.2倍，而在新生儿期后接受包皮环切术的男性则高出3.0倍。目前吸烟者的风险是从不吸烟者的2.8倍。报告有生殖器疣病史的男性的风险是报告无此类病史的男性的5.9倍。在67例HPV DNA检测的肿瘤中，49%呈阳性;这些阳性肿瘤中的大多数（70%）是16型，与肛门生殖器癌有关。与报告的阴茎皮疹或阴茎撕裂病史相关的相对风险（RR）分别为9.4和3.9。在出生时未行包皮环切术的男性中，与包皮垢和包皮回缩困难相关的RR分别为2.1和3.5。28%的病例受试者报告了30个或更多的性伴侣，而对照组受试者仅为10%，HPV阳性肿瘤的男性更有可能报告更多的性伴侣。结论：这些结果表明，缺乏新生儿包皮环切术和潜在的并发症与阴茎癌有关。此外，阴茎的医疗条件，性活动，HPV感染和吸烟可能会增加阴茎癌的风险。意义：一项更大的研究将允许检查包皮环切术，HPV感染和吸烟作为危险因素的相互关系。
Background: Epidemiological evidence suggests lack of neonatal circumcision as the strongest risk factor for penile cancer, but the role of sexually transmitted diseases in the etiology of penile cancer has remained unclear. Purpose: To further clarify risk factors for penile cancer, we examined the role of circumcision, personal characteristics and habits (such as smoking), sexually transmitted diseases, past sexual activity, and medical conditions of the penis. Methods: A population-based, case-control study was conducted in western Washington state and in the province of British Columbia. We interviewed 110 men with penile cancer diagnosed from January 1979 to July 1990 and 355 control subjects from the general population, frequency matched to case subjects on age and date of diagnosis. Tumor tissue from 67 case subjects was tested for human papillomavirus (HPV) DNA by polymerase chain reaction. Results of blood tests from 69 case subjects and 208 control subjects were available for study. Statistically Significant Results: Relative to men circumcised at birth, the risk for penile cancer was 3.2 times greater among men who were never circumcised and 3.0 times greater among men who were circumcised after the neonatal period. For current smokers, the risk was 2.8 times that of men who never smoked. The risk among men reporting a history of genital warts was 5.9 times that of men reporting no such history. Of 67 tumors tested for HPV DNA, 49% were positive; the majority of these positive tumors (70%) were type 16, which has been associated with anogenital carcinoma. Relative risks (RRs) associated with a reported history of penile rash or penile tear were 9.4 and 3.9, respectively. Among men not circumcised at birth, RRs associated with presence of smegma and difficulty in retracting the foreskin were 2.1 and 3.5, respectively. Twenty-eight percent of case subjects, compared with only 10% of control subjects, reported 30 or more sexual partners, and men with HPV-positive tumors were more likely to report a greater number of sexual partners. Conclusions: These results suggest that the absence of neonatal circumcision and potential resulting complications are associated with penile cancer. Additionally, medical conditions of the penis, sexual activity, infection with HPV, and smoking may increase the risk for penile cancer. Implications: A larger study would allow examination of interrelationships of circumcision, infection with HPV, and smoking as risk factors.