Häggström Christel, Stocks Tanja, Nagel Gabriele, Manjer Jonas, Bjørge Tone, Hallmans Göran, Engeland Anders, Ulmer Hanno, Lindkvist Björn, Selmer Randi, Concin Hans, Tretli Steinar, Jonsson Håkan, Stattin Pär
aDepartment of Surgical and Perioperative sciences, Urology and Andrology, Umeå University, Umeå, Sweden; bDepartment of Clinical Sciences in Malmö, Diabetes and Cardiovascular Diseases, Genetic Epidemiology, Lund University, Lund, Sweden; cInstitute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; dAgency for Preventive and Social Medicine, Bregenz, Austria; eDepartment of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden; fDepartment of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; gNorwegian Institute of Public Health, Oslo/Bergen, Norway; hDepartment of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden; iDepartment of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria; jInstitute of Population-based Cancer Research, The Cancer Registry of Norway, Oslo, Norway; and kDepartment of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.
Epidemiology. 2014 Nov;25(6):823-8. doi: 10.1097/EDE.0000000000000174.
Few previous studies of metabolic aberrations and prostate cancer risk have taken into account the fact that men with metabolic aberrations have an increased risk of death from causes other than prostate cancer. The aim of this study was to calculate, in a real-life scenario, the risk of prostate cancer diagnosis, prostate cancer death, and death from other causes.
In the Metabolic Syndrome and Cancer Project, prospective data on body mass index, blood pressure, glucose, cholesterol, and triglycerides were collected from 285,040 men. Risks of prostate cancer diagnosis, prostate cancer death, and death from other causes were calculated by use of competing risk analysis for men with normal (bottom 84%) and high (top 16%) levels of each factor, and a composite score.
During a mean follow-up period of 12 years, 5,893 men were diagnosed with prostate cancer, 1,013 died of prostate cancer, and 26,328 died of other causes. After 1996, when prostate-specific antigen testing was introduced, men up to age 80 years with normal metabolic levels had 13% risk of prostate cancer, 2% risk of prostate cancer death, and 30% risk of death from other causes, whereas men with metabolic aberrations had corresponding risks of 11%, 2%, and 44%.
In contrast to recent studies using conventional survival analysis, in a real-world scenario taking risk of competing events into account, men with metabolic aberrations had lower risk of prostate cancer diagnosis, similar risk of prostate cancer death, and substantially higher risk of death from other causes compared with men who had normal metabolic levels.
先前很少有关于代谢异常与前列腺癌风险的研究考虑到代谢异常的男性因前列腺癌以外的原因死亡的风险增加这一事实。本研究的目的是在现实生活场景中计算前列腺癌诊断风险、前列腺癌死亡风险以及其他原因导致的死亡风险。
在代谢综合征与癌症项目中，收集了285,040名男性的体重指数、血压、血糖、胆固醇和甘油三酯的前瞻性数据。通过对每个因素处于正常水平（最低84%）和高水平（最高16%）的男性以及综合评分使用竞争风险分析，计算前列腺癌诊断风险、前列腺癌死亡风险以及其他原因导致的死亡风险。
在平均12年的随访期内，5,893名男性被诊断为前列腺癌，1,013人死于前列腺癌，26,328人死于其他原因。1996年引入前列腺特异性抗原检测后，80岁及以下代谢水平正常的男性患前列腺癌的风险为13%，死于前列腺癌的风险为2%，死于其他原因的风险为30%，而代谢异常的男性相应风险分别为11%、2%和44%。
与最近使用传统生存分析的研究不同，在考虑竞争事件风险的现实场景中，与代谢水平正常的男性相比，代谢异常的男性前列腺癌诊断风险较低，前列腺癌死亡风险相似，但其他原因导致的死亡风险显著更高。
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