MacInnis Robert J, English Dallas R, Hopper John L, Giles Graham G
Cancer Epidemiology Centre, The Cancer Council Victoria, and Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, University of Melbourne, Victoria, Australia.
Int J Cancer. 2006 May 15;118(10):2628-31. doi: 10.1002/ijc.21638.
Although evidence has been mounting that obesity may be related to the increased incidence of oesophageal and gastric cardia malignancies, these reports (mainly case-control studies) have relied on imperfect measures of obesity such as body mass index (BMI), and generally have not clearly distinguished between anatomical subsites within the oesophagus and stomach. In a prospective study of people aged 27-75 years, we directly measured fat mass and fat-free mass (using bioelectrical impedance analysis), height, weight and waist and hip circumferences. Among 41,295 people followed on average for 11.3 years, 30 cases with cancers in the gastric cardia or lower third of the oesophagus and 68 cases with noncardia gastric adenocarcinomas were ascertained via the population cancer registry. The risk of adenocarcinoma of the lower oesophagus and gastric cardia was positively associated with BMI with a hazards ratio (HR) and (95% confidence interval) for people with BMI>or=30 kg/m2 compared with those<25 kg/m2, of 3.7 (1.1-12.4), an HR per 10 cm increase in waist circumference of 1.46 (1.05-2.04), and a HR per 10 kg increase on fat-free mass of 2.06 (1.15-3.69). Noncardia gastric adenocarcinoma showed little relationship with body size. We observed an increased risk of adenocarcinoma of the lower oesophagus and gastric cardia associated with increased BMI, central adiposity and the nonfat component of weight, but found no association with noncardia gastric adenocarcinoma. An increasing prevalence of obesity may be associated with the increasing incidence of gastro-oesophageal cancer observed in many populations.
尽管越来越多的证据表明肥胖可能与食管和贲门恶性肿瘤发病率的增加有关，但这些报告（主要是病例对照研究）所依赖的肥胖测量方法并不完善，如体重指数（BMI），而且通常没有明确区分食管和胃内的解剖亚部位。在一项针对27至75岁人群的前瞻性研究中，我们直接测量了脂肪量和去脂体重（使用生物电阻抗分析）、身高、体重以及腰围和臀围。在平均随访11.3年的41295人中，通过人群癌症登记处确定了30例贲门或食管下三分之一癌症患者以及68例非贲门胃腺癌患者。与BMI<25kg/m²的人相比，BMI≥30kg/m²的人患食管下腺癌和贲门癌的风险呈正相关，风险比（HR）及95%置信区间为3.7（1.1 - 12.4）；腰围每增加10cm，HR为1.46（1.05 - 2.04）；去脂体重每增加10kg，HR为2.06（1.15 - 3.69）。非贲门胃腺癌与体型几乎没有关系。我们观察到食管下腺癌和贲门癌的风险增加与BMI增加、中心性肥胖以及体重的非脂肪成分有关，但未发现与非贲门胃腺癌有关。肥胖患病率的上升可能与许多人群中观察到的胃食管癌发病率上升有关。
