Coulter Ian D, Hardy Mary L, Morton Sally C, Hilton Lara G, Tu Wenli, Valentine Di, Shekelle Paul G
RAND, Southern California Evidence-based Practice Center, Santa Monica, CA, USA.
J Gen Intern Med. 2006 Jul;21(7):735-44. doi: 10.1111/j.1525-1497.2006.00483.x.
To evaluate the evidence of the supplements vitamin C and vitamin E for treatment and prevention of cancer.
Systematic review of trials and meta-analysis. DATA SOURCES AND MAIN RESULTS: Thirty-eight studies showed scant evidence that vitamin C or vitamin E beneficially affects survival. In the ATBC Cancer Prevention Study Group, no statistically significant effect of treatment was seen for any cancer individually, and our pooled relative risk (regardless of tumor type) for alpha-tocopherol alone was 0.91 (95% confidence interval [CI]: 0.74, 1.12). All cause mortality was not significant. In the Linxian General Population Trial, the relative risks for cancer death for vitamin C (combined with molybdenum) was 1.06 (95% CI: 0.92, 1.21) and for vitamin E (combined with beta-carotene and selenium) was 0.87 (95% CI: 0.76, 1.00). We identified only 3 studies that reported statistically significant beneficial results: vitamin C (in combination with BCG) was found to be beneficial in a single trial of bladder cancer and vitamin E (in combination with omega-3 fatty acid) increased survival in patients with advanced cancer. In the ATBC trial, in analyses of 6 individual cancers, the prevention of prostate cancer in subjects treated with alpha-tocopherol was statistically significant (RR=0.64, 95% CI: 0.44, 0.94).
The systematic review of the literature does not support the hypothesis that the use of supplements of vitamin C or vitamin E in the doses tested helps prevent and/or treat cancer in the populations tested. There were isolated findings of benefit, which require confirmation.
评估补充维生素C和维生素E用于治疗和预防癌症的证据。
对试验进行系统评价和荟萃分析。
38项研究显示,几乎没有证据表明维生素C或维生素E对生存率有有益影响。在ATBC癌症预防研究组中,单独针对任何一种癌症治疗均未观察到统计学上的显著效果,我们单独使用α-生育酚的合并相对风险(不考虑肿瘤类型)为0.91(95%置信区间[CI]:0.74,1.12)。全因死亡率无显著差异。在林县人群试验中,维生素C(与钼联合)的癌症死亡相对风险为1.06(95%CI:0.92,1.21),维生素E(与β-胡萝卜素和硒联合)为0.87(95%CI:0.76,1.00)。我们仅发现3项报告了统计学上显著有益结果的研究:在一项膀胱癌单项试验中发现维生素C(与卡介苗联合)有益,维生素E(与ω-3脂肪酸联合)可提高晚期癌症患者的生存率。在ATBC试验中,对6种个体癌症的分析显示,用α-生育酚治疗的受试者预防前列腺癌具有统计学显著性(RR = 0.64,95%CI:0.44,0.94)。
对文献的系统评价不支持以下假设,即在受试人群中使用所测试剂量的维生素C或维生素E补充剂有助于预防和/或治疗癌症。有个别有益发现,尚需证实。