F1000 highlights
F1000 highlights
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DOI：
10.1111/j.1743-7563.2009.1234.x
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发表时间：
2009-06
期刊：
影响因子：
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通讯作者：
Donghui Li;Jeffrey S. Morris;Jun Liu;Manal M Hassan;R. S. Day;Melissa L. Bondy;J. Abbruzzese
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文献类型：
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作者：
Donghui Li;Jeffrey S. Morris;Jun Liu;Manal M Hassan;R. S. Day;Melissa L. Bondy;J. Abbruzzese
肥胖是胰腺癌的一个危险因素。目的：证明超重与胰腺癌患者的风险、发病年龄和总生存率之间的相关性。设计、地点和参与者：病例对照研究，841例胰腺癌患者和754例健康个体，年龄、种族和性别匹配。该研究于2004年至2008年在美国的一所大学癌症中心进行。从14至19岁开始，以10年的时间间隔，直至研究招募前一年，通过个人访谈收集身高和体重史。主要观察指标分别采用非条件Logistic回归、线性回归和考克斯比例风险回归模型分析患者体重指数（BMI）与胰腺癌风险、发病年龄和总生存率之间的关系。结果超重的人（BMI为25-29.9）从14岁到39岁（最高比值比[OR]，1.67; 95%置信区间[CI]，1.20-2.34）或肥胖年龄在20 - 49岁（最高OR为2.58; 95%CI为1.70-3.90）的患者（BMI ≥ 30）患胰腺癌的风险增加，与糖尿病状态无关。这种关联在男性中更强（调整OR，1.80; 95% CI，1.45-2.23），14 - 59岁的平均BMI高于女性（校正OR，1.32; 95% CI，1.02-1.70）和曾经吸烟者（调整后OR，1.75; 95% CI，1.37-2.22）比从不吸烟者（调整后OR，1.46; 95% CI，1.16-1.84）。根据14至59岁的平均BMI，胰腺癌的人群归因风险百分比为从不吸烟者10.3%，曾经吸烟者21.3%。年龄在20 ~ 49岁之间的超重或肥胖者胰腺癌的发病年龄提前2 ~ 6年（正常体重患者的中位发病年龄为64岁，超重患者为61岁[P = .02]，肥胖患者为59岁[P < .001]）。与体重正常的患者相比，在调整所有临床因素后，30 - 79岁或招募前一年超重或肥胖的患者无论疾病分期和肿瘤切除情况如何，胰腺癌的总生存率均降低（超重患者：风险比，1.26 [95% CI，0.94-1.69]，P = .04;肥胖患者：风险比，1.86 [95% CI，1.35-2.56]，P < .001）。结论：成年早期超重或肥胖与胰腺癌的风险更高和发病年龄更小有关。老年肥胖与胰腺癌患者总体生存率较低相关。
CONTEXT Obesity has been implicated as a risk factor for pancreatic cancer. OBJECTIVE To demonstrate the association of excess body weight across an age cohort and the risk, age of onset, and overall survival of patients with pancreatic cancer. DESIGN, SETTING, AND PARTICIPANTS A case-control study of 841 patients with pancreatic adenocarcinoma and 754 healthy individuals frequency matched by age, race, and sex. The study was conducted at a university cancer center in the United States from 2004 to 2008. Height and body weight histories were collected by personal interview starting at ages 14 to 19 years and over 10-year intervals progressing to the year prior to recruitment in the study. MAIN OUTCOME MEASURES The associations between patients' body mass index (BMI) and risk of pancreatic cancer, age at onset, and overall survival were examined by unconditional logistic regression, linear regression, and Cox proportional hazard regression models, respectively. RESULTS Individuals who were overweight (a BMI of 25-29.9) from the ages of 14 to 39 years (highest odds ratio [OR], 1.67; 95% confidence interval [CI], 1.20-2.34) or obese (a BMI > or = 30) from the ages of 20 to 49 years (highest OR, 2.58; 95% CI, 1.70-3.90) had an associated increased risk of pancreatic cancer, independent of diabetes status. The association was stronger in men (adjusted OR, 1.80; 95% CI, 1.45-2.23) by mean BMI from the ages of 14 to 59 years than in women (adjusted OR, 1.32; 95% CI, 1.02-1.70) and in ever smokers (adjusted OR, 1.75; 95% CI, 1.37-2.22) than in never smokers (adjusted OR, 1.46; 95% CI, 1.16-1.84). The population-attributable risk percentage of pancreatic cancer based on the mean BMI from the ages of 14 to 59 years was 10.3% for never smokers and 21.3% for ever smokers. Individuals who were overweight or obese from the ages of 20 to 49 years had an earlier onset of pancreatic cancer by 2 to 6 years (median age of onset was 64 years for patients with normal weight, 61 years for overweight patients [P = .02], and 59 years for obese patients [P < .001]). Compared with those with normal body weight and after adjusting for all clinical factors, individuals who were overweight or obese from the ages of 30 to 79 years or in the year prior to recruitment had reduced overall survival of pancreatic cancer regardless of disease stage and tumor resection status (overweight patients: hazard ratio, 1.26 [95% CI, 0.94-1.69], P = .04; obese patients: hazard ratio, 1.86 [95% CI, 1.35-2.56], P < .001). CONCLUSIONS Overweight or obesity during early adulthood was associated with a greater risk of pancreatic cancer and a younger age of disease onset. Obesity at an older age was associated with a lower overall survival in patients with pancreatic cancer.