Risk factors for colorectal cancer significantly vary by anatomic site
Risk factors for colorectal cancer significantly vary by anatomic site
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DOI：
10.1136/bmjgast-2019-000313
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发表时间：
2019-08-01
影响因子：
3.1
通讯作者：
Gupta, Samir
中科院分区：
文献类型：
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作者：
Demb, Joshua;Earles, Ashley;Gupta, Samir
目的对1999-2011年接受过1次以上结肠镜检查的美国退伍军人进行病例对照研究，探讨结直肠癌（CRC）的危险因素。病例在结肠镜检查时有癌症登记确定的CRC，而对照组在结肠镜检查时和结肠镜检查后3年内没有CRC。主要结局为CRC，按解剖部位分层：近端、远端或直肠。候选危险因素包括年龄，性别，种族/民族，体重指数，身高，糖尿病，吸烟状况，阿司匹林暴露的调整OR和95%CIs.Results总结21 744例CRC病例（n=7017直肠; n=7039远端; n=7688近端）和612 646对照。男性直肠癌（OR=2.84，95%CI 2.25 - 3.58）的几率显著高于女性远端癌（OR=1.84，95%CI 1.50 - 2.24）。相对于白人，黑人直肠癌的几率显著较低（OR=0.88，95% CI 0.82 - 0.95），但远端（OR=1.27，95% CI 1.19 - 1.37）和近端（OR=1.62，95% CI 1.52 - 1.72）的几率增加。糖尿病患病率与近端癌（OR=1.29，95%CI 1.22 - 1.36）的相关性高于远端癌（OR=1.15，95%CI 1.08 - 1.22）或直肠癌（OR=1.12，95%CI 1.06 - 1.19）。与从不吸烟相比，目前吸烟与直肠癌（OR=1.81，95%CI 1.68至1.95）的相关性高于近端癌（OR=1.53，95%CI 1.43至1.65）或远端癌（OR=1.46，95%CI 1.35至1.57）。阿司匹林使用与直肠癌发生率降低的相关性（OR=0.71，95% CI 0.67 ~ 0.76）显著高于远端（OR=0.85，95% CI 0.81 ~ 0.90）或近端（OR=0.91，95% CI 0.86 ~ 0.95）。占网站可以使更好地了解CRC发病机制和癌症控制策略。
Objective To conduct an anatomic site-specific case-control study of candidate colorectal cancer (CRC) risk factors.Design Case-control study of US veterans with >1 colonoscopy during 1999-2011. Cases had cancer registry-identified CRC at colonoscopy, while controls were CRC free at colonoscopy and within 3 years of colonoscopy. Primary outcome was CRC, stratified by anatomic site: proximal, distal, or rectal. Candidate risk factors included age, sex, race/ethnicity, body mass index, height, diabetes, smoking status, and aspirin exposure summarised by adjusted ORs and 95% CIs.Results 21 744 CRC cases (n=7017 rectal; n=7039 distal; n=7688 proximal) and 612 646 controls were included. Males had significantly higher odds relative to females for rectal cancer (OR=2.84, 95% CI 2.25 to 3.58) than distal cancer (OR=1.84, 95% CI 1.50 to 2.24). Relative to whites, blacks had significantly lower rectal cancer odds (OR=0.88, 95% CI 0.82 to 0.95), but increased distal (OR=1.27, 95% CI 1.19 to 1.37) and proximal odds (OR=1.62, 95% CI 1.52 to 1.72). Diabetes prevalence was more strongly associated with proximal (OR=1.29, 95% CI 1.22 to 1.36) than distal (OR=1.15, 95% CI 1.08 to 1.22) or rectal cancer (OR=1.12, 95% CI 1.06 to 1.19). Current smoking was more strongly associated with rectal cancer (OR=1.81, 95% CI 1.68 to 1.95) than proximal cancer (OR=1.53, 95% CI 1.43 to 1.65) or distal cancer (OR=1.46, 95% CI 1.35 to 1.57) compared with never smoking. Aspirin use was significantly more strongly associated with reduced rectal cancer odds (OR=0.71, 95% CI 0.67 to 0.76) than distal (OR=0.85, 95% CI 0.81 to 0.90) or proximal (OR=0.91, 95% CI 0.86 to 0.95).Conclusion Candidate CRC risk factor associations vary significantly by anatomic site. Accounting for site may enable better insights into CRC pathogenesis and cancer control strategies.