Wright Margaret E, Chang Shih-Chen, Schatzkin Arthur, Albanes Demetrius, Kipnis Victor, Mouw Traci, Hurwitz Paul, Hollenbeck Albert, Leitzmann Michael F
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA.
Cancer. 2007 Feb 15;109(4):675-84. doi: 10.1002/cncr.22443.
Adiposity has been linked inconsistently with prostate cancer, and few studies have evaluated whether such associations vary by disease aggressiveness.
The authors prospectively examined body mass index (BMI) and adult weight change in relation to prostate cancer incidence and mortality in 287,760 men ages 50 years to 71 years at enrollment (1995-1996) in the National Institutes of Health-AARP Diet and Health Study. At baseline, participants completed questionnaires regarding height, weight, and cancer screening practices, including digital rectal examinations and prostate-specific antigen tests. Cox regression analysis was used to calculate relative risks (RR) and 95% confidence intervals (95% CIs).
In total, 9986 incident prostate cancers were identified during 5 years of follow-up, and 173 prostate cancer deaths were ascertained during 6 years of follow-up. In multivariate models, higher baseline BMI was associated with significantly reduced total prostate cancer incidence, largely because of the relationship with localized tumors (for men in the highest BMI category [>or=40 kg/m(2)] vs men in the lowest BMI category [<25 kg/m(2)]: RR, 0.67; 95% CI, 0.50-0.89; P = .0006). Conversely, a significant elevation in prostate cancer mortality was observed at higher BMI levels (BMI <25 kg/m(2): RR, 1.0 [referent group]; BMI 25-29.9 kg/m(2): RR, 1.25; 95% CI, 0.87-1.80; BMI 30-34.9 kg/m(2): RR, 1.46; 95% CI, 0.92-2.33; and BMI >or=35 kg/m(2): RR, 2.12; 95% CI, 1.08-4.15; P = .02). Adult weight gain from age 18 years to baseline also was associated positively with fatal prostate cancer (P = .009), but not with incident disease.
Although adiposity was not related positively to prostate cancer incidence, higher BMI and adult weight gain increased the risk of dying from prostate cancer.
肥胖与前列腺癌之间的关联并不一致，很少有研究评估这种关联是否因疾病侵袭性而异。
作者前瞻性地研究了国立卫生研究院-美国退休人员协会饮食与健康研究中287760名年龄在50岁至71岁（入组时间为1995 - 1996年）男性的体重指数（BMI）和成年后体重变化与前列腺癌发病率及死亡率的关系。在基线时，参与者完成了关于身高、体重和癌症筛查措施的问卷调查，包括直肠指检和前列腺特异性抗原检测。采用Cox回归分析计算相对风险（RR）和95%置信区间（95%CI）。
在5年的随访期间共确定了9986例前列腺癌新发病例，在6年的随访期间确定了173例前列腺癌死亡病例。在多变量模型中，较高的基线BMI与前列腺癌总发病率显著降低相关，这主要是由于与局限性肿瘤的关系（BMI最高类别[≥40 kg/m²]的男性与BMI最低类别[<25 kg/m²]的男性相比：RR，0.67；95%CI，0.50 - 0.89；P = 0.0006）。相反，在较高BMI水平观察到前列腺癌死亡率显著升高（BMI<25 kg/m²：RR，1.0[参照组]；BMI 25 - 29.9 kg/m²：RR，1.25；95%CI，0.87 - 1.80；BMI 30 - 34.9 kg/m²：RR，1.46；95%CI，0.92 - 2.33；BMI≥35 kg/m²：RR，2.12；95%CI，1.08 - 4.15；P = 0.02）。从18岁到基线的成年体重增加也与致命性前列腺癌呈正相关（P = 0.009），但与新发病例无关。
虽然肥胖与前列腺癌发病率无正相关，但较高的BMI和成年体重增加会增加前列腺癌死亡风险。
