Dray X, Boutron-Ruault M-C, Bertrais S, Sapinho D, Benhamiche-Bouvier A-M, Faivre J
Institut Scientifique et Technique de l'Alimentation et de la Nutrition, INSERM U557, CNAM, 5 rue Vertbois, 75003 Paris, France.
Gut. 2003 Jun;52(6):868-73. doi: 10.1136/gut.52.6.868.
Diet has been identified as a major determinant of colorectal cancer (CRC) but little is known of its influence on CRC survival.
To study the influence of dietary factors on survival in patients who had undergone potentially curative CRC surgery.
Among 171 patients included in a case control study of CRC aetiological factors, 10 year survival data on 148 patients who underwent resection of the tumour for potential cure were obtained from a Registry of Digestive Tumours.
Tertiles of food and nutrient intakes were entered into Cox proportional hazards survival models, controlling for age, sex, tumour stage, and tumour location.
Only five year survival was influenced by the pre-diagnosis diet. High energy intake, as a result of high carbohydrate, protein, and lipid intake, was strongly related to increased survival. Five year relative risk of death for the highest versus the two lowest tertiles of energy intake was 0.18 (95% confidence interval 0.07; 0.44). This effect was similar in both sexes, for the colon and for the rectum. It was stronger in patients with N+/M+ tumours (relative risk 0.06) than in those with less advanced tumours (relative risk 0.37; stage-energy interaction term non-significant). No specific food or nutrient could be identified as having prognostic significance.
Whether high energy intake selects less severe tumoral clones or modifies antitumoral immunity remains unclear. Larger series need to be investigated before conducting intervention studies but our findings should prompt nutritional follow up in CRC patients.
饮食已被确认为结直肠癌（CRC）的主要决定因素，但对其对CRC生存的影响知之甚少。
研究饮食因素对接受潜在根治性CRC手术患者生存的影响。
在一项CRC病因学因素的病例对照研究纳入的171例患者中，从消化肿瘤登记处获得了148例行肿瘤切除术以期根治的患者的10年生存数据。
将食物和营养素摄入量的三分位数纳入Cox比例风险生存模型，对年龄、性别、肿瘤分期和肿瘤位置进行控制。
只有五年生存率受诊断前饮食的影响。由于高碳水化合物、蛋白质和脂肪摄入导致的高能量摄入与生存率增加密切相关。能量摄入最高三分位数与两个最低三分位数相比，五年死亡相对风险为0.18（95%置信区间0.07；0.44）。这种效应在男女、结肠和直肠中相似。在N+/M+肿瘤患者中（相对风险0.06）比在肿瘤进展程度较低的患者中（相对风险0.37；分期-能量交互项无显著性）更强。没有特定的食物或营养素被确定具有预后意义。
高能量摄入是选择了侵袭性较小的肿瘤克隆还是改变了抗肿瘤免疫仍不清楚。在进行干预研究之前需要对更多病例系列进行调查，但我们的研究结果应促使对CRC患者进行营养随访。
