Association of urinary cadmium and arsenic with gynecological cancers:Results from NHANES 2003—2018  

尿镉和砷与妇科癌症的相关性:基于NHANES 2003—2018数据分析

作　　者：JIANG Yuanna WANG Jie HE Zhouxiao XIANG Xuanang YANG Ruichen WANG Qian CAO Lanqin 姜元娜;王婕;何周晓;向轩昂;杨瑞琛;王前;曹兰琴(中南大学湘雅医院妇产科,长沙410008;国家卫健委肿瘤蛋白质组学重点实验室,长沙410008;中南大学湘雅医院消化内科,长沙410008)

机构地区：[1]Department of Obstetrics and Gynecology,Xiangya Hospital,Central South University,Changsha 410008 [2]National Health Commission Key Laboratory of Cancer Proteomics(Xiangya Hospital,Central South University),Changsha 410008 [3]Department of Gastroenterology,Xiangya Hospital,Central South University,Changsha 410008,China

出　　处：《中南大学学报(医学版)》2025年第1期23-35,共13页Journal of Central South University :Medical Science

基　　金：supported by the Science and Technology Innovation Program of Hunan Province,China(2020SK2073).

摘　　要：Objective:Previous studies have demonstrated that the metals cadmium and arsenic exhibit estrogen-like effects and may influence the occurrence and development of gynecological tumors.This study aims to explore the association between urinary cadmium and arsenic levels and the prevalence of gynecologic cancers using data from the National Health and Nutrition Examination Survey(NHANES).Methods:Data from female participants in NHANES 2003—2018 were analyzed.Using R software,datasets(DEMO,BMX,etc.)were merged,and complete cases were retained by intersecting row names,yielding a total of 2999 participants.After applying strict exclusion criteria,2802 participants were included:83 with gynecologic cancer(cancer group)and 2719 without(control group).Demographic,reproductive health,and urinary cadmium and arsenic data were collected.Binary Logistic regression models were employed to assess associations between urinary cadmium and arsenic levels and gynecologic cancer risk.Results:High urinary cadmium and arsenic levels were risk factors for gynecologic cancers,with odds ratios(ORs)of 1.623(95%CI 1.217 to 2.166)and 1.003(95%CI 1.001 to 1.005),respectively.After propensity score matching(PSM),the trend remained;cadmium was still a statistically significant risk factor with an OR of 2.182(95%CI 1.343 to 3.545),while arsenic’s association,though not statistically significant,still trended toward risk(OR=1.004,95%CI 0.999 to 1.009).Subgroup analyses showed that both cadmium and arsenic were risk factors for ovarian cancer(OR=1.745,95%CI 1.178 to 2.586 and OR=1.005,95%CI 1.002 to 1.008,respectively);these associations persisted after PSM.Additionally,cadmium increased the risk of endometrial cancer(OR=1.617,95%CI 1.109 to 2.356).Conclusion:Exposure to cadmium and arsenic is associated with an increased risk of ovarian and endometrial cancers.These findings suggest that reducing environmental exposure to heavy metals such as cadmium and arsenic may help prevent certain gynecologic cancers.目的:既往研究表明,金属镉、砷具有雌激素效应,对妇科肿瘤的发生、发展具有一定影响。本研究通过分析美国国家健康与营养调查(National Health and Nutrition Examination Survey,NHANES)的数据,探讨尿液中镉和砷水平与妇科恶性肿瘤发病率之间的关系。方法:利用NHANES 2003至2018年期间的数据,以女性参与者为研究人群,通过R语言合并数据集(DEMO、BMX等指标),按行名取交集保留完整数据,最终纳入2999例。根据严格的排除指标,锁定2802例为研究对象,其中将83例妇科癌症患者作为肿瘤组,将2719例未患妇科癌症的患者作为对照组。收集的数据包括人口学信息、生殖健康状况、尿液中镉和砷水平等变量。通过二元Logistic回归模型分析尿液中镉和砷水平与不同妇科癌症发生的关系。结果:高尿镉和尿砷水平是患妇科肿瘤的危险因素,其比值比(odds ratio,OR)分别为1.623(95%CI 1.217~2.166)和1.003(1.001~1.005);经倾向性匹配(propensity score matching,PSM)后,总体趋势不变,尿镉依旧是患妇科肿瘤的危险因素,且具有统计学意义,其OR为2.182(95%CI 1.343~3.545);尿砷水平与患妇科肿瘤之间虽不具有统计学意义,但整体趋向危险,其OR为1.004(95%CI 0.999~1.009)。进一步区分尿镉和尿砷水平对各妇科肿瘤的影响,尿镉和尿砷均为促进卵巢癌发生的风险因素,其OR分别为1.745(95%CI 1.178~2.586)和1.005(95%CI 1.002~1.008);经PSM后,趋势保持不变。此外,尿镉也会增加子宫内膜癌发生的风险,OR为1.617(95%CI 1.109~2.356)。结论:镉和砷的暴露与卵巢癌和子宫内膜癌的发病风险增加有关,此发现为卵巢癌和子宫内膜癌的预防提供了新的思路,即减少镉、砷等重金属的暴露可降低部分妇科肿瘤的患病风险。

关 键 词：gynecologic cancer urinary cadmium urinary arsenic ovarian cancer endometrial cancer 

分 类 号：R737.3[医药卫生—肿瘤]