Influence of dietary factors on colorectal cancer survival
Influence of dietary factors on colorectal cancer survival
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DOI：
10.1136/gut.52.6.868
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发表时间：
2003-06-01
期刊：
影响因子：
24.5
通讯作者：
Faivre, J
中科院分区：
文献类型：
--
作者：
Dray, X;Boutron-Ruault, MC;Faivre, J
背景：饮食已被确定为结直肠癌（CRC）的主要决定因素，但其对结直肠癌生存的影响知之甚少。目的：研究饮食因素对接受有治愈潜力的结直肠癌手术患者生存的影响。患者：在171例纳入结直肠癌病因病例对照研究的患者中，从消化肿瘤登记处获得了148例接受肿瘤切除术以获得潜在治愈的患者的10年生存数据。方法：采用Cox比例风险生存模型，控制年龄、性别、肿瘤分期、肿瘤部位等因素。结果：仅5年生存率受诊断前饮食的影响。高碳水化合物、蛋白质和脂质摄入导致的高能量摄入与生存率的提高密切相关。能量摄入最高三分位数与最低两分位数的5年相对死亡风险为0.18（95%可信区间为0.07;0.44）。这种效果在两性中都是相似的，无论是结肠还是直肠。N+/M+肿瘤患者（相对危险度为0.06）比不太严重的肿瘤患者（相对危险度为0.37；阶段-能量相互作用项无显著性）更强。没有特定的食物或营养物质可以确定为具有预后意义。结论：高能量摄入是否会选择不那么严重的肿瘤克隆或改变抗肿瘤免疫尚不清楚。在进行干预研究之前，需要对更大的系列进行调查，但我们的发现应该促进对结直肠癌患者的营养随访。
Background: Diet has been identified as a major determinant of colorectal cancer (CRC) but little is known of its influence on CRC survival.Aims: To study the influence of dietary factors on survival in patients who had undergone potentially curative CRC surgery.Patients: Among 171 patients included in a case control study of CRC aetiological factors, 10 year survival data on 148 patients who underwent resection of the tumour for potential cure were obtained from a Registry of Digestive Tumours.Methods: Tertiles of food and nutrient intakes were entered into Cox proportional hazards survival models, controlling for age, sex, tumour stage, and tumour location.Results: Only five year survival was influenced by the pre-diagnosis diet. High energy intake, as a result of high carbohydrate, protein, and lipid intake, was strongly related to increased survival. Five year relative risk of death for the highest versus the two lowest tertiles of energy intake was 0.18 (95% confidence interval 0.07; 0.44). This effect was similar in both sexes, for the colon and for the rectum. It was stronger in patients with N+/M+ tumours (relative risk 0.06) than in those with less advanced tumours (relative risk 0.37; stage-energy interaction term non-significant). No specific food or nutrient could be identified as having prognostic significance.Conclusions: Whether high energy intake selects less severe tumoral clones or modifies antitumoral immunity remains unclear. Larger series need to be investigated before conducting intervention studies but our findings should prompt nutritional follow up in CRC patients.