Bonelli Luigina, Aste Hugo, Bovo Paolo, Cavallini Giorgio, Felder Martina, Gusmaroli Riccardo, Morandini Erminio, Ravelli Paolo, Briglia Romolo, Lombardo Lucio, De Micheli Alberto, Pugliese Vittorio
Unit of Clinical Epidemiology, National Cancer Institute, Genova, Italy.
Pancreas. 2003 Aug;27(2):143-9. doi: 10.1097/00006676-200308000-00007.
The role of cigarette smoking and diabetes mellitus as risk factors for exocrine pancreatic cancer (PC) was investigated in a hospital based case-control study. Current smokers were at increased risk for PC (OR = 2.36, 95% CI 1.53-3.63): the magnitude of the risk was related to the lifetime amount of smoking (chi2(trend) = 17.00; P < 0.0001). Among former smokers, after 15 years from ceasing smoking, the risk for PC dropped to the level of a lifetime non-smoker, whichever the lifetime smoking amount. Diabetes was associated with a 2.89-fold increased risk for PC (95% CI 1.71-4.86): the risk was 4.76 (95% CI 1.99-11.53) for diabetes diagnosed up to 2 years before the diagnosis of PC and dropped to 2.07 (95% CI 1.02-4.20) for diabetes diagnosed more than 5 years before PC. The risk for PC was estimated according to the treatment used to control diabetes: it was 6.49 (95% CI 2.28-18.48) for insulin treated diabetes and 2.12 (95% CI 1.16-3.87) for diabetes treated with oral hypoglycemic drugs. The risk of PC for diabetes treated for more than 5 years before the diagnosis of PC was 6.21 (95% CI 1.61-23.96) for patients treated with insulin and 1.21 (95% CI 0.50-2.92) for those treated with oral hypoglycemic drugs: the type of treatment needed to control the disease may discriminate between the diabetes that represents a consequence of cancer from the diabetes that could represent an etiological co-factor. More studies are needed to clarify whether long-lasting insulin-treated diabetes is an etiological co-factor in PC.
在一项基于医院的病例对照研究中，对吸烟和糖尿病作为外分泌性胰腺癌（PC）风险因素的作用进行了调查。当前吸烟者患PC的风险增加（OR = 2.36，95%CI 1.53 - 3.63）：风险程度与终生吸烟量有关（χ2趋势 = 17.00；P < 0.0001）。在既往吸烟者中，戒烟15年后，PC风险降至终生不吸烟者的水平，无论终生吸烟量如何。糖尿病与PC风险增加2.89倍相关（95%CI 1.71 - 4.86）：在PC诊断前2年内诊断的糖尿病，风险为4.76（95%CI 1.99 - 11.53），而在PC诊断前5年以上诊断的糖尿病，风险降至2.07（95%CI 1.02 - 4.20）。根据控制糖尿病所用的治疗方法估计PC风险：胰岛素治疗的糖尿病风险为6.49（95%CI 2.28 - 18.48），口服降糖药治疗的糖尿病风险为2.12（95%CI 1.16 - 3.87）。在PC诊断前5年以上接受治疗的糖尿病患者中，胰岛素治疗患者的PC风险为6.21（95%CI 1.61 - 23.96），口服降糖药治疗患者的PC风险为1.21（95%CI 0.50 - 2.92）：控制疾病所需的治疗类型可能区分作为癌症后果的糖尿病和可能作为病因协同因素的糖尿病。需要更多研究来阐明长期胰岛素治疗的糖尿病是否是PC的病因协同因素。
