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Perinatal risk factors for Wilms tumor in a Swedish national cohort

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Abstract

Perinatal risk factors including high birth weight have been associated with Wilms tumor in case–control studies. However, these findings have seldom been examined in large cohort studies, and the specific contributions of gestational age at birth and fetal growth remain unknown. We conducted the largest population-based cohort study to date consisting of 3,571,574 persons born in Sweden in 1973–2008, followed up for Wilms tumor incidence through 2009 to examine perinatal risk factors. There were 443 Wilms tumor cases identified in 66.3 million person-years of follow-up. After adjusting for gestational age and other perinatal factors, high fetal growth was associated with increased risk of Wilms tumor among girls (hazard ratio per 1 standard deviation (SD), 1.36; 95 % CI 1.20–1.54; P < 0.001), but not boys (1.10; 95 % CI 0.97–1.25; P = 0.14) (P interaction = 0.02). Among girls, high fetal growth was associated with disease onset before age 5 years (odds ratio per 1 SD, 1.47; 95 % CI 1.28–1.69; P < 0.001), but not beyond (1.00; 95 % CI 0.76–1.31; P = 0.99). No clear associations were found for gestational age at birth or other perinatal factors. In this large cohort study, high fetal growth was associated with Wilms tumor before age 5 years among girls. These findings suggest that early-life growth factor pathways for Wilms tumor may be more common among girls than boys. Further elucidation of these mechanisms may reveal better targets for prevention or treatment of specific subtypes of Wilms tumor.

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Abbreviations

CI:

Confidence interval

aHR:

Adjusted hazard ratio

aOR:

Adjusted odds ratio

IGF2:

Insulin-like growth factor 2

SD:

Standard deviation

WT1:

Wilms tumor 1

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Acknowledgments

This work was supported by the National Cancer Institute at the National Institutes of Health (Grant number R03CA171017); the Swedish Research Council; and ALF project Grant, Lund, Sweden. The funding agencies had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Medicine, Stanford University, 211 Quarry Road, Suite 405, MC 5985, Palo Alto, CA, 94304-1426, USA

    Casey Crump

  2. Center for Primary Health Care Research, Clinical Research Centre (CRC), Lund University, Skåne University Hospital, Building 28, Floor 11, Jan Waldenströms Gata 35, Malmö, Sweden

    Jan Sundquist & Kristina Sundquist

  3. Department of Health Research and Policy, Stanford University, HRP Redwood Building, T254B, Stanford, CA, 94305-5405, USA

    Weiva Sieh

  4. Stanford Prevention Research Center, Stanford University, Medical School Office Building, 251 Campus Drive, Room X318, Stanford, CA, 94305-5411, USA

    Marilyn A. Winkleby

Authors
  1. Casey Crump
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  2. Jan Sundquist
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  3. Weiva Sieh
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  4. Marilyn A. Winkleby
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  5. Kristina Sundquist
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Correspondence to Casey Crump.

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Crump, C., Sundquist, J., Sieh, W. et al. Perinatal risk factors for Wilms tumor in a Swedish national cohort. Eur J Epidemiol 29, 191–197 (2014). https://doi.org/10.1007/s10654-014-9880-9

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