Silverman D T, Schiffman M, Everhart J, Goldstein A, Lillemoe K D, Swanson G M, Schwartz A G, Brown L M, Greenberg R S, Schoenberg J B, Pottern L M, Hoover R N, Fraumeni J F
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892-7240, USA.
Br J Cancer. 1999 Aug;80(11):1830-7. doi: 10.1038/sj.bjc.6690607.
In a population-based case-control study of pancreatic cancer conducted in three areas of the USA, 484 cases and 2099 controls were interviewed to evaluate the aetiologic role of several medical conditions/interventions, including diabetes mellitus, cholecystectomy, ulcer/gastrectomy and allergic states. We also evaluated risk associated with family history of cancer. Our findings support previous studies indicating that diabetes is a risk factor for pancreatic cancer, as well as a possible complication of the tumour. A significant positive trend in risk with increasing years prior to diagnosis of pancreatic cancer was apparent (P-value for test of trend = 0.016), with diabetics diagnosed at least 10 years prior to diagnosis having a significant 50% increased risk. Those treated with insulin had risks similar to those not treated with insulin (odds ratio (OR) = 1.6 and 1.5 respectively), and no trend in risk was associated with increasing duration of insulin treatment. Cholecystectomy also appeared to be a risk factor, as well as a consequence of the malignancy. Subjects with a cholecystectomy at least 20 years prior to the diagnosis of pancreatic cancer experienced a 70% increased risk, which was marginally significant. In contrast, subjects with a history of duodenal or gastric ulcer had little or no elevated risk (OR = 1.2; confidence interval = 0.9-1.6). Those treated by gastrectomy had the same risk as those not receiving surgery, providing little support for the hypothesis that gastrectomy is a risk factor for pancreatic cancer. A significant 40% reduced risk was associated with hay fever, a non-significant 50% decreased risk with allergies to animals, and a non-significant 40% reduced risk with allergies to dust/moulds. These associations, however, may be due to chance since no risk reductions were apparent for asthma or several other types of allergies. In addition, we observed significantly increased risks for subjects reporting a first-degree relative with cancers of the pancreas (OR = 3.2), colon (OR = 1.7) or ovary (OR = 5.3) and non-significantly increased risks for cancers of the endometrium (OR = 1.5) or breast (OR = 1.3). The pattern is consistent with the familial predisposition reported for pancreatic cancer and with the array of tumours associated with hereditary non-polyposis colon cancer.
在美国三个地区开展的一项基于人群的胰腺癌病例对照研究中，对484例病例和2099例对照进行了访谈，以评估几种疾病状况/干预措施的病因学作用，包括糖尿病、胆囊切除术、溃疡/胃切除术和过敏状态。我们还评估了与癌症家族史相关的风险。我们的研究结果支持先前的研究，表明糖尿病是胰腺癌的一个风险因素，也是肿瘤的一种可能并发症。在胰腺癌诊断前的年份增加时，风险呈显著的正趋势（趋势检验的P值 = 0.016），在胰腺癌诊断前至少10年被诊断出的糖尿病患者风险显著增加50%。接受胰岛素治疗的患者与未接受胰岛素治疗的患者风险相似（比值比分别为1.6和1.5），且风险与胰岛素治疗持续时间的增加无关联趋势。胆囊切除术似乎也是一个风险因素，也是恶性肿瘤的一个后果。在胰腺癌诊断前至少20年接受胆囊切除术的受试者风险增加70%，这一增加幅度接近显著。相比之下，有十二指肠或胃溃疡病史的受试者风险几乎没有升高或没有升高（比值比 = 1.2；置信区间 = 0.9 - 1.6）。接受胃切除术的患者与未接受手术的患者风险相同，这几乎不支持胃切除术是胰腺癌风险因素这一假设。花粉症使风险显著降低40%，对动物过敏使风险降低50%（不显著），对灰尘/霉菌过敏使风险降低40%（不显著）。然而，这些关联可能是由于偶然因素，因为哮喘或其他几种过敏类型并未出现风险降低的情况。此外，我们观察到，报告有胰腺癌（比值比 = 3.2）、结肠癌（比值比 = 1.7）或卵巢癌（比值比 = 5.3）一级亲属的受试者风险显著增加，而子宫内膜癌（比值比 = 1.5）或乳腺癌（比值比 = 1.3）的风险增加不显著。这种模式与胰腺癌报告的家族易感性以及与遗传性非息肉病性结肠癌相关的一系列肿瘤一致。
