Prediagnostic Body Mass Index Trajectories in Relation to Prostate Cancer Incidence and Mortality in the PLCO Cancer Screening Trial
Prediagnostic Body Mass Index Trajectories in Relation to Prostate Cancer Incidence and Mortality in the PLCO Cancer Screening Trial
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DOI：
10.1093/jnci/djw225
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发表时间：
2017-03-01
影响因子：
10.3
通讯作者：
Cook, Michael B.
中科院分区：
文献类型：
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作者：
Kelly, Scott P.;Graubard, Barry I.;Cook, Michael B.
背景：有证据表明，成年后肥胖与患“有临床意义的”前列腺癌的风险增加有关。方法：在前列腺癌、肺癌、结直肠癌和卵巢癌筛查试验的69 873名男性的前瞻性队列中，我们研究了成人生命过程中诊断前BMI与前列腺癌和致命前列腺癌(前列腺癌特异性死亡率)风险的关系。在13年的随访中，我们发现了7822例前列腺癌病例，其中3078例是侵袭性的，255例是致命的。采用潜伏类轨迹模型确定BMI轨迹。结果：20岁、50岁的BMI和基线调查问卷(平均年龄63岁)与前列腺癌风险增加相关(每增加5个单位的风险比为1.27-1.32)。在确定的五个BMI轨迹中，与保持正常BMI的男性相比，20岁时BMI正常(HR=1.95，95%CI=1.21至3.12)或超重(HR=2.65，95%CI=1.35至5.18)并发展为肥胖的男性患前列腺癌的风险增加。侵袭性前列腺癌和非侵袭性前列腺癌与BMI无关，总体前列腺癌与BMI呈轻度负相关。结论：我们的结果表明，成年后导致肥胖的BMI轨迹会增加致命前列腺癌的风险。
Background: Evidence suggests that obesity in adulthood is associated with increased risk of "clinically significant" prostate cancer. However, studies of body mass index (BMI) across the adult life course and prostate cancer risks remain limited.Methods: In a prospective cohort of 69 873 men in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial, we examined associations of prediagnostic BMI across the adult life course with risk of incident prostate cancer and fatal prostate cancer (prostate cancer-specific mortality). At 13 years of follow-up, we identified 7822 incident prostate cancer cases, of which 3078 were aggressive and 255 fatal. BMI trajectories were determined using latent-class trajectory modeling. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).Results: BMI at age 20 years, 50 years, and baseline questionnaire (mean age = 63 years) were associated with increased risks of fatal prostate cancer (HRs = 1.27-1.32 per five-unit increase). In five BMI trajectories identified, fatal prostate cancer risk was increased in men who had a normal BMI (HR = 1.95, 95% CI = 1.21 to 3.12) or who were overweight (HR = 2.65, 95% CI = 1.35 to 5.18) at age 20 years and developed obesity by baseline compared with men who maintained a normal BMI. Aggressive and nonaggressive prostate cancer were not associated with BMI, and modest inverse associations were seen for total prostate cancer.Conclusions: Our results suggest that BMI trajectories during adulthood that result in obesity lead to an elevated risk of fatal prostate cancer.