■儿童实体瘤占儿童癌症的比例最高,是儿童死亡的主要原因之一。然而,其发病机制尚不清楚。
■探讨儿童实体恶性肿瘤的产前和围产期危险因素。
■我们连续招募了71名儿科患者(44名男孩和27名女孩;中位年龄,30个月),以2013年1月至2016年12月在我中心诊断和治疗的实体瘤为病例组。我们还招募了211名年龄和居住地匹配的健康儿童(与病例组的比例约为3:1)作为对照组。我们对这282名儿童的父母进行了问卷调查。对收集的数据进行单变量和多变量条件逻辑回归分析。
■确认的实体恶性肿瘤包括神经母细胞瘤(n=32),横纹肌肉瘤(n=18),视网膜母细胞瘤(n=7),肾肿瘤(n=3),和其他肿瘤(n=11)。单因素分析中儿童实体瘤的危险因素是父母的年龄,妊娠,奇偶校验,流产史,阴道出血,恶性肿瘤家族史,产前使用叶酸或补铁(P<0.05),多变量分析中的平差较高(赔率比[OR],2.482;95%置信区间[CI],1.521-4.048),恶性肿瘤家族史(OR,3.667;95%CI,1.679-8.009),和产前使用血液/铁补充剂(OR,2.882;95%CI,1.440-5.767)。相比之下,使用产前叶酸是保护性的(OR,0.334;95%CI,0.160-0.694)。
■有恶性肿瘤家族史,使用产前血液/铁补充剂,更高的平价是实体儿童肿瘤的危险因素,而使用产前叶酸是一个保护因素。
OBJECTIVE: Childhood solid tumors account for the highest proportion of childhood cancers and are one of the leading causes of death in childhood. However, their pathogenesis is unclear.
OBJECTIVE: To explore prenatal and perinatal risk factors for solid malignancies in children.
METHODS: We enrolled 71 consecutive pediatric patients (44 boys and 27 girls; median age, 30 months) with solid tumors who were diagnosed and treated at our center from January 2013 to December 2016 as the case group. We also enrolled 211 age- and residence-matched healthy children (ratio of approximately 3:1 with the case group) as the control group. We conducted a questionnaire-based survey with the parents of these 282 children. Univariate and multivariate conditional logistic regression analyses of the collected data were performed.
RESULTS: Confirmed solid malignancies included neuroblastoma (n = 32), rhabdomyosarcoma (n = 18), retinoblastoma (n = 7), renal tumors (n = 3), and other tumors (n = 11). Risk factors for solid childhood tumors in the univariate analysis were the parents\' age, gravidity, parity, abortion history, vaginal bleeding, family history of malignancy, and prenatal use of folic acid or hematinics/iron supplements (P < 0.05), and those in the multivariate analysis were higher parity (odds ratio [OR], 2.482; 95% confidence interval [CI], 1.521-4.048), family history of malignancy (OR, 3.667; 95% CI, 1.679-8.009), and prenatal use of hematinics/iron supplements (OR, 2.882; 95% CI, 1.440-5.767). In contrast, use of prenatal folic acid was protective (OR, 0.334; 95% CI, 0.160-0.694).
CONCLUSIONS: A family history of malignancy, use of prenatal hematinics/iron supplements, and higher parity are risk factors for solid childhood tumors, whereas use of prenatal folic acid is a protective factor.