Hu Yang, Ding Ming, Yuan Chen, Wu Kana, Smith-Warner Stephanie A, Hu Frank B, Chan Andrew T, Meyerhardt Jeffrey A, Ogino Shuji, Fuchs Charles S, Giovannucci Edward L, Song Mingyang
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Gastroenterology. 2018 Mar;154(4):916-926.e9. doi: 10.1053/j.gastro.2017.11.010. Epub 2017 Nov 20.
BACKGROUND & AIMS: Few studies have examined the association between coffee intake and survival after diagnosis of colorectal cancer (CRC). We performed a prospective study to investigate the association between coffee intake after a diagnosis of CRC and mortality.
We collected data from the Nurses' Health Study (1984-2012) and Health Professionals Follow-up Study (1986-2012), following 1599 patients diagnosed with stage 1, 2, or 3 CRC. CRC was reported on questionnaires and ascertained by review of medical records and pathology reports; intake of food and beverages was determined from responses to semi-quantitative food frequency questionnaires. Participants were asked how often during the previous year that they consumed coffee, with 1 cup as the standard portion size. The first questionnaire response collected at least 6 months but not more than 4 years after diagnosis was used for assessment of post-diagnostic intake (median time from diagnosis to the dietary assessment, 2.2 years). The last semi-quantitative food frequency questionnaire prior to diagnosis was used to assess pre-diagnostic dietary intake.
During a median of 7.8 years of follow-up, we documented 803 deaths, of which 188 were because of CRC. In the multivariable adjusted models, compared with nondrinkers, patients who consumed at least 4 cups of coffee per day had a 52% lower risk of CRC-specific death (hazard ratio [HR] 0.48; 95% CI, 0.28-0.83; P for trend=.003) and 30% reduced risk of all-cause death (HR, 0.70; 95% CI, 0.54-0.91; P for trend <.001). High intake of caffeinated and decaffeinated coffee (2 or more cups/day) was associated with lower risk of CRC-specific mortality and all-cause mortality. When coffee intake before vs after CRC diagnosis were examined, compared with patients consistently consuming low amounts (less than 2 cups/day), those who maintained a high intake (2 or more cups/day) had a significantly lower risk of CRC-specific death (multivariable HR, 0.63; 95% CI, 0.44-0.89) and death from any cause (multivariable HR, 0.71; 95% CI, 0.60-0.85).
In an analysis data from the Nurses' Health Study and Health Professionals Follow-up Study, we associated intake of caffeinated and decaffeinated coffee after diagnosis of CRC with lower risk of CRC-specific death and overall death. Studies are needed to determine the mechanisms by which coffee might reduce CRC progression.
很少有研究探讨咖啡摄入量与结直肠癌(CRC)诊断后的生存率之间的关联。我们进行了一项前瞻性研究,以调查CRC诊断后咖啡摄入量与死亡率之间的关联。
我们收集了护士健康研究(1984 - 2012年)和卫生专业人员随访研究(1986 - 2012年)的数据,跟踪1599例被诊断为1、2或3期CRC的患者。通过问卷报告CRC,并通过查阅病历和病理报告来确定;食物和饮料的摄入量根据对半定量食物频率问卷的回答来确定。参与者被问及在前一年中他们喝咖啡的频率,以1杯作为标准份量。在诊断后至少6个月但不超过4年收集的第一份问卷回答用于评估诊断后的摄入量(从诊断到饮食评估的中位时间为2.2年)。诊断前最后一份半定量食物频率问卷用于评估诊断前的饮食摄入量。
在中位7.8年的随访期间,我们记录了803例死亡,其中188例死于CRC。在多变量调整模型中,与不喝咖啡者相比,每天至少喝4杯咖啡的患者CRC特异性死亡风险降低52%(风险比[HR]0.48;95%置信区间,0.28 - 0.83;趋势P值 = 0.003),全因死亡风险降低30%(HR,0.70;95%置信区间,0.54 - 0.91;趋势P值 < 0.001)。高摄入量的含咖啡因和不含咖啡因的咖啡(每天2杯或更多)与较低的CRC特异性死亡率和全因死亡率相关。当检查CRC诊断前后的咖啡摄入量时,与持续低摄入量(每天少于2杯)的患者相比,保持高摄入量(每天2杯或更多)的患者CRC特异性死亡风险显著降低(多变量HR,0.63;95%置信区间,0.44 - 0.89),任何原因导致的死亡风险也降低(多变量HR,0.71;95%置信区间,0.60 - 0.85)。
在对护士健康研究和卫生专业人员随访研究的数据分析中,我们发现CRC诊断后摄入含咖啡因和不含咖啡因的咖啡与较低的CRC特异性死亡风险和总体死亡风险相关。需要开展研究以确定咖啡可能降低CRC进展的机制。