A Prospective Evaluation of Endogenous Sex Hormone Levels and Colorectal Cancer Risk in Postmenopausal Women
A Prospective Evaluation of Endogenous Sex Hormone Levels and Colorectal Cancer Risk in Postmenopausal Women
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DOI：
10.1093/jnci/djv210
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发表时间：
2015-10-01
影响因子：
10.3
通讯作者：
Gunter, Marc J.
中科院分区：
文献类型：
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作者：
Murphy, Neil;Strickler, Howard D.;Gunter, Marc J.
背景：在观察性研究中，绝经后激素治疗的使用与结直肠癌风险降低相关。然而，内源性性性激素在绝经后妇女结直肠癌发展中的作用尚不确定。大肠癌风险与循环中雌二醇、雌酮、游离雌激素水平的关系（生物活性）雌二醇，对1203名绝经后妇女进行了一项巢式病例对照研究，测定了孕酮和性激素结合球蛋白（SHBG（401例病例患者和802例年龄和种族/民族匹配的对照患者）参加了妇女健康倡议临床试验（WHI-CT），这些患者没有被分配到单独的雌激素或联合雌激素加孕酮干预组。我们使用多变量调整的条件逻辑回归模型，其中包括已确定的结直肠癌风险因素。所有统计检验均为双侧检验。比较极端四分位数，雌酮（比值比[OR]（q4-q1）= 0.44，95%置信区间[CI] = 0.28 - 0.68，P趋势= .001），游离雌二醇（ORq 4-q1 = 0.43，95% CI = 0.27至0.69，P趋势= .0001）和总雌二醇（ORq 4-q1 = 0.58，95% CI = 0.38至0.90，P趋势= .08）与结直肠癌风险呈负相关。SHBG水平与结直肠癌的发生呈正相关（OR[q4-q1] = 2.30，95%CI = 1.51至3.51，P趋势
Background: Postmenopausal hormone therapy use has been associated with lower colorectal cancer risk in observational studies. However, the role of endogenous sex hormones in colorectal cancer development in postmenopausal women is uncertain.Methods: The relation of colorectal cancer risk with circulating levels of estradiol, estrone, free (bioactive) estradiol, progesterone and sex hormone-binding globulin (SHBG) was determined in a nested case-control study of 1203 postmenopausal women (401 case patients and 802 age and race/ethnicity-matched control patients) enrolled in the Women's Health Initiative Clinical Trial (WHI-CT) who were not assigned to the estrogen-alone or combined estrogen plus progestin intervention groups. We used multivariable-adjusted conditional logistic regression models that included established colorectal cancer risk factors. All statistical tests were two-sided.Results: Comparing extreme quartiles, estrone (odds ratio [OR](q4-q1) = 0.44, 95% confidence interval [CI] = 0.28 to 0.68, P-trend = .001), free estradiol (ORq4-q1 = 0.43, 95% CI = 0.27 to 0.69, P-trend = .0001), and total estradiol (ORq4-q1 = 0.58, 95% CI = 0.38 to 0.90, P-trend = .08) were inversely associated with colorectal cancer risk. SHBG levels were positively associated with colorectal cancer development (OR[q4-q1] = 2.30, 95% CI = 1.51 to 3.51, P-trend