Terry P, Lagergren J, Hansen H, Wolk A, Nyrén O
Department of Medical Epidemiology, Karolinska Institutet, Box 281, 171 77 Stockholm, Sweden.
Eur J Cancer Prev. 2001 Aug;10(4):365-9. doi: 10.1097/00008469-200108000-00010.
The incidence of adenocarcinoma of the oesophagus has increased rapidly in recent decades. In order to appreciate the potential for prevention by means of dietary modification, we estimated the aetiological fractions and the increments in absolute risk attributable to low intake of fruit and vegetables for adenocarcinoma and squamous cell carcinoma of the oesophagus and for adenocarcinoma of the gastroesophageal junction. We conducted a nationwide population-based case-control study in Sweden, with participation of 608 cases and 815 controls. We used unconditional logistic regression to estimate relative risks, from which we calculated aetiological fractions. Individuals in the highest exposure quartile (median 4.8 servings/day) versus the lowest (median 1.5 servings/day) showed approximately 50% lower risk of oesophageal adenocarcinoma and 40% lower risk of oesophageal squamous cell carcinoma, but no risk reduction for gastric cardia adenocarcinoma. Approximately 20% of oesophageal adenocarcinoma, and likewise squamous cell carcinoma, in Sweden was attributed to consuming less than three servings of fruit and vegetables per day. A very large number of individuals (over 25,000) would need to increase their fruit and vegetable consumption moderately in order to prevent one oesophageal cancer per year. Moderate relative risk reductions translate into weak absolute risk reductions for oesophageal cancers in Sweden.
近几十年来，食管癌的发病率迅速上升。为了评估通过饮食调整进行预防的可能性，我们估算了食管腺癌、食管鳞状细胞癌以及胃食管交界腺癌因水果和蔬菜摄入量低所致的病因分数和绝对风险增量。我们在瑞典开展了一项基于全国人口的病例对照研究，共有608例病例和815名对照参与。我们使用无条件逻辑回归来估算相对风险，并据此计算病因分数。处于最高暴露四分位数组（中位数为每天4.8份）的个体与最低暴露四分位数组（中位数为每天1.5份）相比，食管腺癌风险降低约50%，食管鳞状细胞癌风险降低40%，但贲门腺癌风险未降低。在瑞典，约20%的食管腺癌以及同样比例的食管鳞状细胞癌归因于每天食用水果和蔬菜不足三份。为了每年预防一例食管癌，大量个体（超过25000人）需要适度增加水果和蔬菜的摄入量。在瑞典，适度的相对风险降低转化为食管癌绝对风险的微弱降低。
