Reduced aflatoxin exposure presages decline in liver cancer mortality in an endemic region of China.
Reduced aflatoxin exposure presages decline in liver cancer mortality in an endemic region of China.
复制标题
黄曲霉毒素暴露的减少预示着中国肝癌流行地区死亡率的下降。
DOI：
10.1158/1940-6207.capr-13-0168
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发表时间：
2013-10
期刊：
影响因子：
--
通讯作者：
Kensler TW
中科院分区：
文献类型：
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作者：
Chen JG;Egner PA;Ng D;Jacobson LP;Muñoz A;Zhu YR;Qian GS;Wu F;Yuan JM;Groopman JD;Kensler TW
原发性肝癌（PLC）是全球癌症死亡的第三大原因。在撒哈拉以南非洲和亚洲的流行地区，PLC主要由慢性乙型肝炎病毒（HBV）感染和摄入黄曲霉毒素引起。虽然在中国的队列研究中已经观察到这两个危险因素之间的协同相互作用，但在这里，我们确定了20世纪80年代农业改革导致玉米消费量减少和21世纪初实施补贴的乙肝疫苗接种对PLC一级预防的影响。采用基于人群的癌症登记来跟踪中国启东的PLC死亡率，并与HBV免疫时间表进行比较。从20世纪80年代至今的存档队列收集中随机选择血清样本进行黄曲霉毒素生物标志物分析。在20世纪60年代至80年代的出生队列中，年龄在35岁以下的启东人的PLC死亡率降低了50%以上，尽管所有人都是在新生儿普遍接种疫苗之前出生的。黄曲霉毒素生物标志物的中位水平从1989年19.3 pg/mg白蛋白下降到2009年无法检测到（<0.5 pg/mg）。据估计，在政府的推动下，将主食从玉米改为大米，可降低PLC死亡率，人口归因效益为65%；其中83%的获益发生在HBV感染者身上。中国的食品政策改革导致黄曲霉毒素暴露量大幅下降，这与HBV疫苗接种无关，降低了肝癌风险。目前乙肝疫苗的广泛覆盖预示着未来会有更大的风险降低。
Primary liver cancer (PLC) is the third leading cause of cancer mortality globally. In endemic areas of sub-Saharan Africa and Asia PLC largely arises from chronic infection with hepatitis B virus (HBV) and ingestion of aflatoxins. While synergistic interactions between these two risk factors have been observed in cohort studies in China, here we determined the impact of agricultural reforms in the 1980s leading to diminished maize consumption and implementation of subsidized universal vaccination against HBV in the 2000s on PLC primary prevention. A population-based cancer registry was used to track PLC mortality in Qidong, China and was compared to the timeline of HBV immunization. Randomly selected serum samples from archived cohort collections from the 1980s to present were analyzed for aflatoxin biomarkers. Greater than 50% reductions in PLC mortality rates occurred across birth cohorts from the 1960s to the 1980s for Qidongese less than 35 years of age although all were born before universal vaccination of newborns. Median levels of the aflatoxin biomarker decreased from 19.3 pg/mg albumin in 1989 to undetectable (<0.5 pg/mg) by 2009. A population attributable benefit of 65% for reduced PLC mortality was estimated from a government facilitated switch of dietary staple from maize to rice; 83% of this benefit was in those infected with HBV. Food policy reforms in China resulted in a dramatic decrease in aflatoxin exposure, which, independent of HBV vaccination, reduced liver cancer risk. The extensive HBV vaccine coverage now in place augurs even greater risk reductions in the future.