Brasky Theodore M, White Emily, Chen Chi-Ling
Theodore M. Brasky, The Ohio State University College of Medicine, Columbus, OH; Theodore M. Brasky and Emily White, Fred Hutchinson Cancer Research Center, Seattle, WA; Chi-Ling Chen, College of Public Health and College of Medicine, National Taiwan University, Taipei, Taiwan.
J Clin Oncol. 2017 Oct 20;35(30):3440-3448. doi: 10.1200/JCO.2017.72.7735. Epub 2017 Aug 22.
Purpose Inconsistent findings have been reported of a link between the use of one-carbon metabolism-related B vitamins and lung cancer risk. Because of the high prevalence of supplemental vitamin B use, any possible increased association warrants further investigation. We examined the association between long-term use of supplemental B vitamins on the one-carbon metabolism pathway and lung cancer risk in the Vitamins and Lifestyle (VITAL) cohort, which was designed specifically to look at supplement use relative to cancer risk. Methods A total of 77,118 participants of the VITAL cohort, 50 to 76 years of age, were recruited between October 2000 and December 2002 and included in this analysis. Incident, primary, invasive lung cancers (n = 808) were ascertained by prospectively linking the participants to a population-based cancer registry. The 10-year average daily dose from individual and multivitamin supplements were the exposures of primary interest. Results Use of supplemental vitamins B, folate, and B was not associated with lung cancer risk among women. In contrast, use of vitamin B and B from individual supplement sources, but not from multivitamins, was associated with a 30% to 40% increase in lung cancer risk among men. When the 10-year average supplement dose was evaluated, there was an almost two-fold increase in lung cancer risk among men in the highest categories of vitamin B (> 20 mg/d; hazard ratio, 1.82; 95% CI, 1.25 to 2.65) and B (> 55µg/d; hazard ratio, 1.98; 95% CI, 1.32 to 2.97) compared with nonusers. For vitamin B and B, the risk was even higher among men who were smoking at baseline. In addition, the B and B associations were apparent in all histologic types except adenocarcinoma, which is the type less related to smoking. Conclusion This sex- and source-specific association provides further evidence that vitamin B supplements are not chemopreventive for lung cancer and may be harmful.
目的 关于一碳代谢相关B族维生素的使用与肺癌风险之间的联系，已有不一致的研究结果报道。由于补充维生素B的使用非常普遍，任何可能增加的关联都值得进一步研究。我们在维生素与生活方式（VITAL）队列中研究了长期使用一碳代谢途径中的补充B族维生素与肺癌风险之间的关联，该队列是专门为研究补充剂使用与癌症风险的关系而设计的。方法 VITAL队列中共有77118名年龄在50至76岁之间的参与者，于2000年10月至2002年12月招募并纳入本分析。通过前瞻性地将参与者与基于人群的癌症登记处关联，确定了808例原发性侵袭性肺癌病例。主要关注的暴露因素是来自单一维生素补充剂和复合维生素补充剂的10年平均每日剂量。结果 在女性中，补充维生素B、叶酸和B与肺癌风险无关。相比之下，来自单一维生素补充剂而非复合维生素的维生素B和B的使用，与男性肺癌风险增加30%至40%相关。当评估10年平均补充剂剂量时，维生素B（>20毫克/天；风险比，1.82；95%可信区间，1.25至2.65）和B（>55微克/天；风险比，1.98；95%可信区间，1.32至2.97）最高剂量组的男性肺癌风险几乎增加了两倍，与未使用者相比。对于维生素B和B，基线时吸烟的男性风险更高。此外，除腺癌外，所有组织学类型中B和B的关联均明显，腺癌与吸烟的相关性较小。结论 这种性别和来源特异性关联进一步证明，维生素B补充剂对肺癌没有化学预防作用，可能是有害的。
