Ansary-Moghaddam Alireza, Huxley Rachel, Barzi Federica, Lawes Carlene, Ohkubo Takayoshi, Fang Xianghua, Jee Sun Ha, Woodward Mark
The George Institute, University of Sydney, Australia.
Cancer Epidemiol Biomarkers Prev. 2006 Dec;15(12):2435-40. doi: 10.1158/1055-9965.EPI-06-0368.
Pancreatic cancer accounts for about 220,000 deaths each year. Known risk factors are smoking and type 2 diabetes. It remains to be seen whether these risk factors are equally important in Asia and whether other modifiable risk factors have important associations with pancreatic cancer.
An individual participant data analysis of 30 cohort studies was carried out, involving 420,310 Asian participants (33% female) and 99,333 from Australia/New Zealand (45% female). Cox proportional hazard models, stratified by study and sex and adjusted for age, were used to quantify risk factors for death from pancreatic cancer.
During 3,558,733 person-years of follow-up, there were 324 deaths from pancreatic cancer (54% Asia and 33% female). Mortality rates (per 100,000 person-years) from pancreatic cancer were 10 for men and 8 for women. The following are age-adjusted hazard ratios (95% confidence interval) for death from pancreatic cancer: for current smoking, 1.61 (1.12-2.32); for diabetes, 1.76 (1.15-2.69); for a 2-cm increase in waist circumference, 1.08 (1.02-1.14). All three relationships remained significant (P < 0.05) after adjustment for other risk factors. There was no evidence of heterogeneity in the strength of these associations between either cohorts from Asia and Australia/New Zealand or between the sexes. In men, the combination of cigarette smoking and diabetes more than doubled the likelihood of pancreatic cancer (2.47; 95% confidence interval, 1.17-5.21) in both regions.
Smoking, obesity, and diabetes are important and are potentially modifiable risk factors for pancreatic cancer in populations of the Asia-Pacific region. Activities to prevent them can be expected to lead to a major reduction in the number of deaths from this cancer, particularly in Asia with its enormous population.
胰腺癌每年导致约22万人死亡。已知的风险因素是吸烟和2型糖尿病。这些风险因素在亚洲是否同样重要，以及其他可改变的风险因素是否与胰腺癌有重要关联，仍有待观察。
对30项队列研究进行了个体参与者数据分析，涉及420310名亚洲参与者（33%为女性）和99333名来自澳大利亚/新西兰的参与者（45%为女性）。采用按研究和性别分层并根据年龄进行调整的Cox比例风险模型，对胰腺癌死亡的风险因素进行量化。
在3558733人年的随访期间，有324人死于胰腺癌（54%来自亚洲，33%为女性）。胰腺癌的死亡率（每10万人年）男性为10，女性为8。以下是胰腺癌死亡的年龄调整风险比（95%置信区间）：当前吸烟者为1.61（1.12 - 2.32）；糖尿病患者为1.76（1.15 - 2.69）；腰围增加2厘米为1.08（1.02 - 1.14）。在调整其他风险因素后，这三种关系均保持显著（P < 0.05）。无论是亚洲和澳大利亚/新西兰的队列之间，还是性别之间，这些关联强度均无异质性证据。在男性中，吸烟和糖尿病同时存在使两个地区患胰腺癌的可能性增加了一倍多（2.47；95%置信区间，1.17 - 5.21）。
吸烟、肥胖和糖尿病是亚太地区人群中胰腺癌重要且潜在可改变的风险因素。预计预防这些因素的活动将大幅减少该癌症的死亡人数，尤其是在人口众多的亚洲。
