Edefonti Valeria, Hashibe Mia, Parpinel Maria, Turati Federica, Serraino Diego, Matsuo Keitaro, Olshan Andrew F, Zevallos Jose P, Winn Deborah M, Moysich Kirsten, Zhang Zuo-Feng, Morgenstern Hal, Levi Fabio, Kelsey Karl, McClean Michael, Bosetti Cristina, Galeone Carlotta, Schantz Stimson, Yu Guo-Pei, Boffetta Paolo, Amy Lee Yuan-Chin, Chuang Shu-Chun, La Vecchia Carlo, Decarli Adriano
Dipartimento di Scienze Cliche e di Comunità Sezione Di Statistica Medica E Biometria "Giulio A. Maccacaro,", Università degli Studi di Milano, Milan, Italy.
Division of Public Health, Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, USA.
Int J Cancer. 2015 Jul 15;137(2):448-62. doi: 10.1002/ijc.29388. Epub 2015 Jan 28.
Evidence of associations between single nutrients and head and neck cancer (HNC) is still more limited and less consistent than that for fruit and vegetables. However, clarification of the protective mechanisms of fruit and vegetables is important to our understanding of HNC etiology. We investigated the association between vitamin C intake from natural sources and cancer of the oral cavity/pharynx and larynx using individual-level pooled data from ten case-control studies (5,959 cases and 12,248 controls) participating in the International Head and Neck Cancer Epidemiology (INHANCE) consortium. After harmonization of study-specific exposure information via the residual method, adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated using unconditional multiple logistic regression models on quintile categories of 'non-alcohol energy-adjusted' vitamin C intake. In the presence of heterogeneity of the estimated ORs among studies, we derived those estimates from generalized linear mixed models. Higher intakes of vitamin C were inversely related to oral and pharyngeal (OR = 0.54, 95% CI: 0.45-0.65, for the fifth quintile category versus the first one, p for trend<0.001) and laryngeal cancers (OR = 0.52, 95% CI: 0.40-0.68, p for trend = 0.006), although in the presence of heterogeneity among studies for both sites. Inverse associations were consistently observed for the anatomical subsites of oral and pharyngeal cancer, and across strata of age, sex, education, body mass index, tobacco, and alcohol, for both cancer sites. The inverse association of vitamin C intake from foods with HNC may reflect a protective effect on these cancers; however, we cannot rule out other explanations.
与水果和蔬菜相比，单一营养素与头颈癌（HNC）之间关联的证据仍然更为有限且不太一致。然而，阐明水果和蔬菜的保护机制对于我们理解HNC病因非常重要。我们使用参与国际头颈癌流行病学（INHANCE）联盟的十项病例对照研究（5959例病例和12248例对照）的个体水平汇总数据，调查了天然来源维生素C摄入量与口腔/咽癌和喉癌之间的关联。通过残差法对各研究的暴露信息进行协调后，使用无条件多因素logistic回归模型对“非酒精能量调整后”维生素C摄入量的五分位数类别估计调整后的比值比（OR）和相应的95%置信区间（CI）。在研究间估计的OR存在异质性的情况下，我们从广义线性混合模型中得出这些估计值。维生素C摄入量较高与口腔和咽癌（第五五分位数类别与第一类别相比，OR = 0.54，95%CI：0.45 - 0.65，趋势p<0.001）以及喉癌（OR = 0.52，95%CI：0.40 - 0.68，趋势p = 0.006）呈负相关，尽管两个部位的研究间均存在异质性。对于口腔和咽癌的解剖亚部位，以及两个癌症部位的年龄、性别、教育程度、体重指数、烟草和酒精分层，均一致观察到负相关。食物中维生素C摄入量与HNC的负相关可能反映了对这些癌症的保护作用；然而，我们不能排除其他解释。
