Defining determinants of pancreatic cancer risk: are we making progress?
Defining determinants of pancreatic cancer risk: are we making progress?
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确定胰腺癌风险的决定因素：我们正在取得进展吗？
DOI：
10.1093/jnci/djp182
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发表时间：
2009
期刊：
影响因子：
--
通讯作者：
Stampfer,MeirJ
中科院分区：
文献类型：
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作者：
Wolpin,BrianM;Stampfer,MeirJ
Brian M. Wolpin，Meir J. Stampfer目前的研究（6），他们致力于扩展这一发现，并证明在最高与最低五分位数中消耗总脂肪，饱和脂肪和单不饱和脂肪的参与者中风险适度增加，多变量调整的风险比在1.2和1.4之间。有趣的是，只有动物来源的脂肪酸与风险在统计学上显着相关。Thiebaut等人的研究(6)有几个显著而重要的优势。大基数人群导致大量胰腺癌病例可供分析。研究的前瞻性设计不需要代理受访者，通过限制偏倚和错误分类的可能性，增加了结果的可解释性。收集的饮食习惯数据足够详细，可以捕捉到食物产品多样性的信息，例如“低脂”食物，并很好地证明了设计良好的食物频率问卷在饮食和癌症前瞻性研究中的实用性。总的来说，这项表现良好的前瞻性队列研究是我们对一种非常需要新见解的疾病的理解的一个受欢迎的补充。然而，现有的流行病学和实验室证据不足以证实动物脂肪本身的重要性，甚至不足以证实肉类是重要因素，而不是与肉类消费有关的其他饮食或生活方式偏好。尽管如此，足够的证据已经表明限制肉类和饱和脂肪摄入量对健康有益，目前的研究为这些建议提供了额外的支持。此外，随着进一步的研究，这项工作有可能提供有趣的线索，胰腺肿瘤发生的机制。尽管基于队列分析的大型前瞻性队列研究将继续在定义疑难疾病（如胰腺癌）的易感因素方面提供很多帮助，但我们如何超越以前的研究？有两项原则值得一提：加强合作和更多地使用来自参与者的生物样本。由于胰腺癌的发病率相对较低，合作对于提供临界质量的病例进行有意义的分析至关重要。第二，使用库存血浆、生殖系DNA和肿瘤组织样本进行精心设计的研究，以促进我们对胰腺癌发病机制的理解，这具有很大的潜力。
Brian M. Wolpin, Meir J. Stampfer current study (6), they work to extend this finding and demonstrate a modest increase in risk among those participants who consumed total fat, saturated fat, and monounsaturated fat in the highest vs the lowest quintile, with multivariable-adjusted hazard ratios between 1.2 and 1.4. Interestingly, only fatty acids from animal sources were statistically significantly associated with risk. The study by Thiébaut et al.(6) has several notable and important strengths. The large base population leads to an impressively large number of pancreatic cancer cases available for analysis. The prospective design of the study without the need for proxy respondents increases the interpretability of the results, by limiting the potential for bias and misclassification. The data collected on dietary habits were sufficiently detailed to capture information on the diversity of food products, such as “low-fat” versions of foods, and nicely demonstrate the utility of well-designed food-frequency questionnaires in prospective studies of diet and cancer. Overall, this well-performed prospective cohort study is a welcome addition to our understanding of a disease that is in great need of new insights. However, the available epidemiological and laboratory evidence are insufficient to confirm the importance of animal fats, per se, or even that meat is the important factor, as opposed to other dietary or lifestyle preferences associated with meat consumption. Nonetheless, sufficient evidence already suggests health benefits from limiting meat and saturated fat intake (8), and the current study provides additional support for these recommendations. Also, with further investigation, this work has the potential to provide interesting clues to the mechanisms underlying pancreatic tumorigenesis. Although large prospective cohort studies with questionnairebased analyses will continue to have much to offer in defining predisposing factors for difficult diseases, such as pancreatic cancer, how can we move beyond what has been done before? Two principles are worth mentioning: increased collaboration and greater use of participant-derived biological samples. Because of the relatively low incidence rate of pancreatic cancer, collaboration is vital to provide the critical mass of cases for meaningful analyses. Second, there is great potential for well-designed studies using banked plasma, germline DNA, and tumor tissue samples to advance our understanding of pancreatic cancer pathogenesis.