Ryan Aoife M, Rowley Suzanne P, Fitzgerald Anthony P, Ravi Narayanasamy, Reynolds John V
University Department of Clinical Surgery, Trinity Centre for Health Sciences, St. James's Hospital/Trinity College Dublin, Dublin 8, Ireland.
Eur J Cancer. 2006 May;42(8):1151-8. doi: 10.1016/j.ejca.2005.12.024. Epub 2006 Apr 19.
Recent evidence links obesity with the rising incidence of oesophageal adenocarcinoma. In Ireland between 1995 and 2004 the incidence of oesophageal adenocarcinoma increased by 38%, and this coincided with a 67% increase in the prevalence of obesity. In this study, a prospective case-control study was undertaken in 760 patients presenting to a tertiary centre between 1994 and 2004 diagnosed with cancer of the oesophagus, gastric cardia or stomach. Data were compared with 893 healthy controls. Multivariate logistic regression models were used to calculate the odds ratio (OR) of developing either cancer type according to quartiles of body mass index (BMI). Based on pre-illness BMI, 82% of patients who developed adenocarcinoma of the oesophagus were either overweight or obese compared with 59% of the healthy control population (P<0.001). A dose-dependent relationship existed between BMI and oesophageal adenocarcinoma in males. The adjusted odds ratio was 4.3 (95% CI: 2.3-7.9) among males in the highest BMI quartile compared with males in the lowest quartile (P<0.001 for trend). Using common cut-off points for BMI, the OR of adenocarcinoma of the lower oesophagus was 11.3 times higher (95% CI: 3.5-36.4) for individuals with a BMI >30 kg/m2 versus individuals with a BMI <22 kg/m2 (P<0.001 for trend). For adenocarcinoma of the gastric cardia, males in the top quartile of BMI had an OR of 3.5 (95% CI: 1.3-9.4) compared with the lowest quartile (P=0.03 for trend). A significant (P<0.001) inverse relationship between BMI and oesophageal SCC was observed. The odds ratio for adenocarcinoma of the oesophagus, the oesophago-gastric junction and gastric cardia rose significantly with increasing BMI. For tumours of the lower oesophagus, obesity increased the risk 10.9-fold. The increased risk is significant in males only.
近期证据表明肥胖与食管腺癌发病率上升有关。在爱尔兰，1995年至2004年间食管腺癌发病率上升了38%，与此同时肥胖患病率增加了67%。在本研究中，于1994年至2004年间在一家三级中心对760例被诊断患有食管癌、贲门癌或胃癌的患者进行了一项前瞻性病例对照研究。将数据与893名健康对照者进行比较。使用多变量逻辑回归模型根据体重指数（BMI）四分位数计算发生这两种癌症类型的比值比（OR）。基于患病前BMI，发生食管腺癌的患者中82%超重或肥胖，而健康对照人群中这一比例为59%（P<0.001）。男性中BMI与食管腺癌之间存在剂量依赖关系。最高BMI四分位数的男性与最低四分位数的男性相比，调整后的比值比为4.3（95%CI：2.3 - 7.9）（趋势P<0.001）。使用BMI的常用切点，BMI>30 kg/m² 的个体与BMI<22 kg/m² 的个体相比，食管下段腺癌的OR高11.3倍（95%CI：3.5 - 36.4）（趋势P<0.001）。对于贲门癌，BMI最高四分位数的男性与最低四分位数相比，OR为3.5（95%CI：1.3 - 9.4）（趋势P = .03）。观察到BMI与食管鳞癌之间存在显著的（P<0.001）负相关关系。食管腺癌、食管胃交界癌和贲门癌的比值比随BMI升高而显著上升。对于食管下段肿瘤，肥胖使风险增加10.9倍。风险增加仅在男性中显著。
