Leanness and lung cancer risk: Fact or artifact?
Leanness and lung cancer risk: Fact or artifact?
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DOI：
10.1097/00001648-200205000-00006
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发表时间：
2002-05-01
期刊：
影响因子：
5.4
通讯作者：
Thun, MJ
中科院分区：
文献类型：
--
作者：
Henley, SJ;Flanders, WD;Thun, MJ
背景十多项研究已经研究了瘦与肺癌风险增加之间的关系。没有一项前瞻性研究的规模大到足以排除吸烟者或既往有疾病的人，这两个因素导致消瘦和生存率低，因此可能导致低体重指数和致命性肺癌之间的虚假关联。使用考克斯比例风险模型，我们在1982年参加美国癌症协会前瞻性研究的941，105名美国成年人中研究了这个问题。在14年的随访中，14,066人死于肺癌。在仅限于终生不吸烟者且未报告既往疾病的分析中，消瘦与男性（率比= 0.9; 95%置信区间= 0.3-3.1）或女性（率比= 1.2; 95%置信区间= 0.7-2.1）的肺癌死亡率没有实质性相关性。然而，在试图控制而不是排除吸烟者和已有疾病的人的分析中，瘦与肺癌风险增加有关。这些数据表明，瘦和肺癌死亡率之间的关联不是因果关系，而是吸烟和先前存在的疾病的影响。
Background. More than a dozen studies have examined the association between leanness and increased lung cancer risk. None of the prospective studies has been large enough to allow exclusion of smokers or persons with preexisting disease, two factors that cause both leanness and poor survival and thus may cause a spurious association between low body mass index and fatal lung cancer.Methods. Using Cox proportional hazards models, we examined this issue in a cohort of 941,105 U.S. adults enrolled in an American Cancer Society prospective study in 1982. During 14 years of follow-up, 14,066 people died of lung cancer.Results. In analyses restricted to lifelong nonsmokers who did not report preexisting disease, leanness was not substantially associated with lung cancer mortality in men (rate ratio = 0.9; 95% confidence interval = 0.3-3.1) or in women (rate ratio = 1.2; 95% confidence interval = 0.7-2.1). However, leanness was associated with increased lung cancer risk in analyses that attempted to control for, rather than exclude, smokers and persons with preexisting disease.Conclusions. These data suggest that the association between leanness and lung cancer mortality is not causal but rather is an artifact of the effects of smoking and preexisting disease.