膳食血糖负荷与 III 期结肠癌患者的癌症复发和生存：CALGB 89803 的研究结果。
Dietary glycemic load and cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803.
机构信息
Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, USA.
出版信息
J Natl Cancer Inst. 2012 Nov 21;104(22):1702-11. doi: 10.1093/jnci/djs399. Epub 2012 Nov 7.
BACKGROUND
The influence of glycemic load and related measures on survival among colon cancer patients remains largely unknown.
METHODS
We conducted a prospective, observational study of 1011 stage III colon cancer patients reporting dietary intake during and 6 months after participation in an adjuvant chemotherapy trial. We examined the influence of glycemic load, glycemic index, fructose, and carbohydrate intakes on cancer recurrence and mortality using Cox proportional hazards regression; all tests of statistical significance were two-sided.
RESULTS
Stage III colon cancer patients in the highest quintile of dietary glycemic load experienced an adjusted hazard ratio (HR) for disease-free survival of 1.79 (95% confidence interval [CI] = 1.29 to 2.48), compared with those in the lowest quintile (P (trend) across quintiles <.001). Increased glycemic load was associated with similar detriments in recurrence-free (P (trend) across quintiles <.001) and overall survival (P (trend) across quintiles <.001). These associations differed statistically significant by body mass index (BMI) (P (interaction) =.01). Whereas glycemic load was not associated with disease-free survival in patients with BMI < 25kg/m(2), higher glycemic load was statistically significant associated with worse disease-free survival among overweight or obese participants (BMI ≥ 25kg/m(2); HR = 2.26; 95% CI = 1.53 to 3.32; P (trend) across quintiles <.001). Increasing total carbohydrate intake was similarly associated with inferior disease-free, recurrence-free, and overall survival (P (trend) across quintiles <.001).
CONCLUSION
Higher dietary glycemic load and total carbohydrate intake were statistically significant associated with an increased risk of recurrence and mortality in stage III colon cancer patients. These findings support the role of energy balance factors in colon cancer progression and may offer potential opportunities to improve patient survival.
背景
血糖负荷和相关指标对结肠癌患者生存的影响在很大程度上仍不清楚。
方法
我们对 1011 例 III 期结肠癌患者进行了前瞻性、观察性研究，这些患者在参加辅助化疗试验期间和之后的 6 个月内报告了饮食摄入量。我们使用 Cox 比例风险回归检验了血糖负荷、血糖指数、果糖和碳水化合物摄入量对癌症复发和死亡的影响；所有统计检验均为双侧检验。
结果
与最低五分位组相比，膳食血糖负荷最高五分位组的 III 期结肠癌患者无病生存率的调整后危险比（HR）为 1.79（95%置信区间[CI] = 1.29 至 2.48）（P（趋势）<0.001）。血糖负荷增加与无复发生存（P（趋势）<0.001）和总生存（P（趋势）<0.001）相似的损害相关。这些关联在体重指数（BMI）（P（交互作用）= 0.01）方面存在统计学差异。虽然血糖负荷与 BMI < 25kg/m2 的患者的无病生存率无关，但在超重或肥胖参与者（BMI ≥ 25kg/m2）中，较高的血糖负荷与无病生存率显著相关更差（HR = 2.26；95%CI = 1.53 至 3.32；P（趋势）<0.001）。总碳水化合物摄入量的增加也与无病生存率、无复发生存率和总生存率的降低显著相关（P（趋势）<0.001）。
结论
较高的膳食血糖负荷和总碳水化合物摄入量与 III 期结肠癌患者的复发和死亡风险增加具有统计学意义的关联。这些发现支持能量平衡因素在结肠癌进展中的作用，并可能为改善患者生存提供潜在机会。
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