Abstract：
OBJECTIVE: Uterine sarcomas are a rare group of uterine malignancies. Due to the low incidence and changes in uterine sarcoma classification, risk factors are not well characterized. Our objective was to evaluate risk factors for uterine sarcoma and compare risk factors between uterine sarcoma, malignant mixed Mullerian tumors (MMMTs), and type I endometrial carcinomas.
METHODS: This nested case-control study utilized linked data from population-based medical birth and cancer registries in Denmark, Finland, Norway, and Sweden. Up to 10 controls were matched on country and birth year for each uterine cancer case. Using multivariable adjusted multinomial logistic regression, estimates of the associations between pregnancy-related factors and risk of uterine sarcoma, MMMTs, and type I endometrial carcinomas were determined.
RESULTS: Having a very-low-birth-weight infant (< 1500 vs. 2500-3999 g: OR [95% CI] 2.83 [1.61-4.96]) was associated with an increased risk of uterine sarcoma. Whereas, having a more recent pregnancy was associated with reduced risks of MMMT (< 10 vs. ≥ 30 years: 0.66 [0.20-2.23]) and type 1 endometrial carcinomas (0.35 [0.30-0.41]) but not uterine sarcomas (1.33 [0.90-1.98], p-heterogeneity < 0.01).
CONCLUSIONS: Our study provides evidence that risk factors for uterine sarcoma and MMMT, previously grouped with uterine sarcomas, vary substantially. Additionally, MMMT and type I endometrial carcinomas are more similar than uterine sarcoma in that pregnancy complications like gestational hypertension and preeclampsia were associated with reduced risks of both but not uterine sarcoma, suggesting different etiologies.
METHODS: This nested case-control study utilized linked data from population-based medical birth and cancer registries in Denmark, Finland, Norway, and Sweden. Up to 10 controls were matched on country and birth year for each uterine cancer case. Using multivariable adjusted multinomial logistic regression, estimates of the associations between pregnancy-related factors and risk of uterine sarcoma, MMMTs, and type I endometrial carcinomas were determined.
RESULTS: Having a very-low-birth-weight infant (< 1500 vs. 2500-3999 g: OR [95% CI] 2.83 [1.61-4.96]) was associated with an increased risk of uterine sarcoma. Whereas, having a more recent pregnancy was associated with reduced risks of MMMT (< 10 vs. ≥ 30 years: 0.66 [0.20-2.23]) and type 1 endometrial carcinomas (0.35 [0.30-0.41]) but not uterine sarcomas (1.33 [0.90-1.98], p-heterogeneity < 0.01).
CONCLUSIONS: Our study provides evidence that risk factors for uterine sarcoma and MMMT, previously grouped with uterine sarcomas, vary substantially. Additionally, MMMT and type I endometrial carcinomas are more similar than uterine sarcoma in that pregnancy complications like gestational hypertension and preeclampsia were associated with reduced risks of both but not uterine sarcoma, suggesting different etiologies.
摘要：
目的：子宫肉瘤是一种罕见的子宫恶性肿瘤。由于子宫肉瘤的低发病率和分类的变化，风险因素没有得到很好的表征。我们的目的是评估子宫肉瘤的危险因素，并比较子宫肉瘤之间的危险因素。恶性混合苗勒管肿瘤（MMMTs），和I型子宫内膜癌.
方法：这项巢式病例对照研究利用了丹麦基于人群的医疗出生和癌症登记处的关联数据，芬兰,挪威,和瑞典。每个子宫癌病例在国家和出生年份匹配多达10个对照。使用多变量调整多项逻辑回归，估计妊娠相关因素与子宫肉瘤风险之间的关联，MMMT,并确定了I型子宫内膜癌。
结果：有一个极低出生体重的婴儿（<1500vs.2500-3999g：OR[95%CI]2.83[1.61-4.96]）与子宫肉瘤风险增加相关。然而,最近怀孕与MMMT风险降低相关(<10vs.≥30年：0.66[0.20-2.23]）和1型子宫内膜癌（0.35[0.30-0.41]），但不是子宫肉瘤（1.33[0.90-1.98]，p异质性<0.01)。
结论：我们的研究提供了证据，表明子宫肉瘤和MMMT的危险因素，先前与子宫肉瘤分组，差异很大。此外,MMMT和I型子宫内膜癌比子宫肉瘤更相似，因为妊娠高血压和先兆子痫等妊娠并发症与子宫肉瘤的风险降低有关，但与子宫肉瘤无关。提示不同的病因。
方法：这项巢式病例对照研究利用了丹麦基于人群的医疗出生和癌症登记处的关联数据，芬兰,挪威,和瑞典。每个子宫癌病例在国家和出生年份匹配多达10个对照。使用多变量调整多项逻辑回归，估计妊娠相关因素与子宫肉瘤风险之间的关联，MMMT,并确定了I型子宫内膜癌。
结果：有一个极低出生体重的婴儿（<1500vs.2500-3999g：OR[95%CI]2.83[1.61-4.96]）与子宫肉瘤风险增加相关。然而,最近怀孕与MMMT风险降低相关(<10vs.≥30年：0.66[0.20-2.23]）和1型子宫内膜癌（0.35[0.30-0.41]），但不是子宫肉瘤（1.33[0.90-1.98]，p异质性<0.01)。
结论：我们的研究提供了证据，表明子宫肉瘤和MMMT的危险因素，先前与子宫肉瘤分组，差异很大。此外,MMMT和I型子宫内膜癌比子宫肉瘤更相似，因为妊娠高血压和先兆子痫等妊娠并发症与子宫肉瘤的风险降低有关，但与子宫肉瘤无关。提示不同的病因。
