男性因素不孕症与睾丸癌风险有关


  March 3, 2009 — 根据一项发表于2月23日内科学志的研究结果显示,有男性因素不孕症的男士们,发展成睾丸癌的风险比较高。
  
  旧金山加州大学Thomas J. Walsh医师与其同事写到,相较于一般大众,寻求不孕症治疗的男性,睾丸癌的风险被认为是较高的。这目前并未在美国大型群众资料库中进行确认。这项研究在美国一群群众中探索男性不孕症与接下来发生睾丸癌风险之间的关系。
  
  这项研究共收纳51,461对夫妇,他们于1967年到1998年间在加州15个不孕症中心接受不孕症评估,另外22,562位确认的男性伴侣与加州癌症注册试验相连结。透过监视流行病学与最终结果计画,研究团队将这群群众中睾丸癌与年龄相仿的一般大众进行比较。以Cox比例风险回归模式来确定有无男性因素不孕症男士发生睾丸癌的风险。
  
  男性因素不孕症以世界卫生组织精液分析异常结果临床表征来确认。
  
  总共有34件过去被诊断罹患不孕症的病理学确认男性睾丸癌病例。寻求不孕症治疗的男性,之后发生睾丸癌的风险(标准化发生率比值[SIR]为1.3;95%信赖区间为0.9-1.9)是已知男性因素不孕症男士的近一倍(标准化发生率比值[SIR]为2.8;95%信赖区间为1.5-4.8)。
  
  多变项分析显示,有男性因素不孕症的男士发生睾丸癌的风险几乎是没有此状况男士的三倍(危险比值为2.8;95%信赖区间为1.3-6.0)。
  
  研究作者们写到,有男性因素不孕症的男士接下来发生睾丸癌的风险上升,代表不孕症与睾丸癌之间存在著共同致病因素。
  
  这项研究的限制包括可能未评量的干扰因素,以及缺乏有关隐睾症相关的数据,这是另一个造成不孕症与睾丸癌的潜在原因。
  
  研究者们写到,不孕症与睾丸癌之间的关连已经被证实是生物学上与临床上可行的。更重要的,男性因素不孕症睾丸生殖细胞癌之间的关连应该刺激之后的研究,将重点放在这个族群生殖细胞健康不良的生物学。
  
  国家儿童健康机构与人类发展及加州泌尿学基金会赞助这项研究。研究作者们表示没有相关资金上往来。

Male Factor Infertility Linked to Risk for Testicular Cancer

By Laurie Barclay, MD
Medscape Medical News

March 3, 2009 — Men with male factor infertility have an increased risk for the subsequent development of testicular cancer, according to the results of a study reported in the February 23 issue of the Archives of Internal Medicine.

"The risk of testicular cancer is thought to be higher among men seeking infertility treatment compared with the general population," write Thomas J. Walsh, MD, MS, from University of California–San Francisco and colleagues. "Confirmation of this risk in a large US cohort of at-risk patients is lacking. This study explored the association between male infertility and subsequent development of testicular cancer in a US-based cohort."

The study cohort consisted of 51,461 couples evaluated for infertility from 1967 to 1998 at 15?California infertility centers. Data from 22,562 identified male partners were linked to the California Cancer Registry. Using the Surveillance Epidemiology and End Results program, the investigators compared the incidence of testicular cancer in this cohort vs an age-matched, general-population sample. A Cox proportional hazards regression model allowed determination of the risk for testicular cancer in men with and without male factor infertility.

Male factor infertility was determined by the clinical presentation with abnormal semen analysis variables as defined by World Health Organization criteria.

There were 34 cases of histologically confirmed testicular cancer in men who had been previously diagnosed with infertility. The risk for the subsequent development of testicular cancer was increased in men seeking infertility treatment (standardized incidence ratio [SIR], 1.3; 95% confidence interval [CI], 0.9 - 1.9), with more than double the increased risk in men with known male factor infertility (SIR, 2.8; 95% CI, 1.5 - 4.8).

Multivariable analysis showed that men with male factor infertility were nearly 3 times more likely to have testicular cancer vs men without this condition (hazard ratio, 2.8; 95% CI, 1.3 - 6.0).

"Men with male factor infertility have an increased risk of subsequently developing testicular cancer, suggesting the existence of common etiologic factors for infertility and testicular cancer," the study authors write.

Limitations of this study include possible unmeasured confounding and lack of data concerning cryptorchidism, which is another potential cause of infertility and testicular cancer.

"The association between infertility and testicular cancer has been shown to be biologically and clinically feasible," the study authors write. "More importantly, the association between male infertility and testicular germ cell cancer should stimulate further research that focuses on the etiology of poor germ cell health in these populations."

The National Institute of Child Health and Human Development and the California Urology Foundation supported this study. The study authors have disclosed no relevant financial relationships.

Arch Intern Med. 2009;169:351-356.

    
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