Abdominal obesity and the risk of esophageal and gastric cardia carcinomas
Abdominal obesity and the risk of esophageal and gastric cardia carcinomas
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DOI：
10.1158/1055-9965.epi-07-0748
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发表时间：
2008-02-01
影响因子：
3.8
通讯作者：
Zhao, Wei
中科院分区：
文献类型：
--
作者：
Corley, Douglas A.;Kubo, Ai;Zhao, Wei
背景：食管腺癌的发病率正在迅速增加。身体质量指数（BMI）是一个危险因素，但其分布并不反映癌症的人口分布（白色男性中最高）。腹部肥胖模式可以解释这种不一致性，但目前还没有研究。研究方法：在Kaiser Permanente多阶段健康检查队列的206，974名成员中进行的巢式病例对照研究;受试者接受详细的问卷调查，包括BMI和人体测量的标准化检查，以及使用登记数据进行的食管癌和贲门癌随访。结果如下：检测到101例食管腺癌、105例贲门腺癌和144例食管鳞状细胞癌（所有病例的BMI数据可用;一个子集的腹部测量）。腹径增加与食管腺癌风险增加密切相关[比值比（OR），3.47; 95%可信区间（95%CI），1.29-9.33;腹径，>= 25 cm vs < 20 cm]。调整BMI并没有减少这种关联（BMI调整OR，4.78; 95%CI，1.14-20.11）。尽管反流型症状分别与腹部直径和癌症风险相关，但调整胃食管反流型症状后，这种相关性也没有减弱。腹部直径与贲门腺癌（OR，1.28; 95%CI，0.38-4.25;直径，>= 25与< 20 cm）或食管鳞状细胞癌（OR，0.78; 95%CI，0.32-1.92）的风险无关。结论：腹径增加与食管腺癌风险增加相关，与BMI无关。癌症风险基本上不是通过胃食管反流型症状介导的，尽管症状可能不完全衡量反流的严重程度。鉴于腹部肥胖在男性中更为常见，这些发现表明肥胖的增加可能不成比例地增加男性食管腺癌的风险。
Background: Esophageal adenocarcinoma is rapidly increasing in incidence. Body mass index (BMI) is a risk factor, but its distribution does not reflect the demographic distribution of the cancer (which is highest among White men). Abdominal obesity patterns may explain this discordance, but no studies exist to date. Methods: Nested case-control study within 206,974 members of the Kaiser Permanente multiphasic health checkup cohort; subjects received detailed questionnaires, a standardized examination including BMI and anthropometric measurements, and follow-up of esophageal and cardia cancers using registry data. Results: 101 incident esophageal adenocarcinomas, 105 cardia adenocarcinomas, and 144 esophageal squamous cell carcinomas were detected (BMI data available for all cases; abdominal measurements for a subset). Increasing abdominal diameter was strongly associated with an increased risk of esophageal adenocarcinoma [odds ratio (OR), 3.47; 95% confidence interval (95% CI), 1.29-9.33; abdominal diameter,, >= 25 versus < 20 cm]. Adjustment for BMI did not diminish this association (BMI-adjusted OR, 4.78; 95% CI, 1.14-20.11). The association was also not diminished by adjustment for gastroesophageal reflux-type symptoms, although reflux-type symptoms were separately associated with both abdominal diameter and cancer risk. Abdominal diameter was not associated with the risk of cardia adenocarcinomas (OR, 1.28; 95% CI, 0.38-4.25; diameter,>= 25 versus < 20 cm) or esophageal squamous cell carcinomas (OR, 0.78; 95% CI, 0.32-1.92). Conclusions: Increasing abdominal diameter was associated with an increased risk of esophageal adenocarcinoma, independent of BMI. Cancer risk was not substantially mediated through gastroesophageal reflux-type symptoms, although symptoms may imperfectly measure reflux severity. Given abdominal obesity is more common among males, these findings suggest that increases in obesity may disproportionately increase the risk of esophageal adenocarcinoma in males.