旧金山湾区基于人群的胰腺癌患者的肥胖与生存。
Obesity and survival in population-based patients with pancreatic cancer in the San Francisco Bay Area.
机构信息
Department of Epidemiology and Biostatistics, University of California San Francisco, 3333 California Street, Suite 280, San Francisco, CA 94118-1944, USA.
出版信息
Cancer Causes Control. 2012 Dec;23(12):1929-37. doi: 10.1007/s10552-012-0070-3. Epub 2012 Sep 27.
BACKGROUND
Obesity has been consistently associated with increased risk of pancreatic cancer incidence and mortality. However, studies of obesity and overall survival in patients with pancreatic cancer are notably lacking, especially in population-based studies.
METHODS
Active and passive follow-up were used to determine vital status and survival for 510 pancreatic cancer patients diagnosed from 1995 to 1999 in a large population-based case-control study in the San Francisco Bay Area. Survival rates were computed using Kaplan-Meier methods. Hazard ratios (HR) and 95 % confidence intervals (CI) were estimated in multivariable Cox proportional hazards models as measures of the association between pre-diagnostic obesity and pancreatic cancer survival.
RESULTS
An elevated hazard ratio of 1.3 (95 % CI, 0.91-1.81) was observed for obese [body mass index (BMI) ≥ 30] compared with normal range BMI (<25) patients. Associations between BMI and overall survival did not statistically significantly vary by known prognostic and risk factors (all p-interaction ≥0.18), yet elevated HRs consistently were observed for obese compared with normal BMI patients [localized disease at diagnosis (HR, 3.1), surgical resection (HR, 1.6), ever smokers (HR, 1.6), diabetics (HR, 3.3)]. Poor survival was observed among men, older patients, more recent and current smokers, whereas improved survival was observed for Asian/Pacific Islanders.
CONCLUSIONS
Our results in general provide limited support for an association between pre-diagnostic obesity and decreased survival in patients with pancreatic cancer. Patterns of reduced survival associated with obesity in some patient subgroups could be due to chance and require assessment in larger pooled studies.
背景
肥胖与胰腺癌发病率和死亡率的增加密切相关。然而，关于肥胖与胰腺癌患者总体生存率的研究明显缺乏，尤其是在基于人群的研究中。
方法
在旧金山湾区一项大型基于人群的病例对照研究中，对 1995 年至 1999 年间诊断出的 510 例胰腺癌患者进行主动和被动随访，以确定其生存状态和生存率。使用 Kaplan-Meier 方法计算生存率。多变量 Cox 比例风险模型估计风险比（HR）和 95%置信区间（CI），作为衡量诊断前肥胖与胰腺癌生存之间关联的指标。
结果
与正常 BMI（<25）患者相比，肥胖（BMI≥30）患者的危险比（HR）为 1.3（95%CI，0.91-1.81）。BMI 与总体生存率之间的关联不因已知的预后和风险因素而存在统计学差异（所有 p 交互作用≥0.18），但与正常 BMI 患者相比，肥胖患者的 HR 始终较高[诊断时局部疾病（HR，3.1），手术切除（HR，1.6），曾经吸烟者（HR，1.6），糖尿病患者（HR，3.3）]。男性、年龄较大、近期和当前吸烟者的生存较差，而亚洲/太平洋岛民的生存则有所改善。
结论
我们的结果总体上对诊断前肥胖与胰腺癌患者生存率降低之间的关联提供了有限的支持。肥胖与某些患者亚组生存降低相关的模式可能是偶然的，需要在更大的汇总研究中进行评估。
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