Temidayo Fadelu, Sui Zhang, Robert J. Mayer, Shuji Ogino, Kimmie Ng, Jeffrey Meyerhardt, and Charles S. Fuchs, Dana-Farber/Partners CancerCare; Shuji Ogino, Kana Wu, Walter Willett, and Edward Giovannucci, Harvard TH Chan School of Public Health; Shuji Ogino, Edward Giovannucci, and Ying Bao, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Donna Niedzwiecki and Xing Ye, Alliance Statistics and Data Center, Duke University, Durham; Michael Messino, Southeast Clinical Oncology Research Consortium, Mission Hospitals, Asheville, NC; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al B. Benson, Robert H Lurie Comprehensive Cancer Center, Northwestern University; Hedy L. Kindler, University of Chicago Comprehensive Cancer, Chicago, IL; Daniel M. Atienza, Virginia Oncology Associates, Norfolk, VA; Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA; and Charles S. Fuchs, Yale Cancer Center, Yale School of Medicine, New Haven, CT.
J Clin Oncol. 2018 Apr 10;36(11):1112-1120. doi: 10.1200/JCO.2017.75.5413. Epub 2018 Feb 28.
Purpose Observational studies have reported increased colon cancer recurrence and mortality in patients with states of hyperinsulinemia, including type 2 diabetes, obesity, sedentary lifestyle, and high glycemic load diet. Nut intake has been associated with a lower risk of type 2 diabetes, metabolic syndrome, and insulin resistance. However, the effect of nut intake on colon cancer recurrence and survival is not known. Patients and Methods We conducted a prospective, observational study of 826 eligible patients with stage III colon cancer who reported dietary intake on food frequency questionnaires while enrolled onto a randomized adjuvant chemotherapy trial. Using Cox proportional hazards regression, we assessed associations of nut intake with cancer recurrence and mortality. Results After a median follow-up of 6.5 years, compared with patients who abstained from nuts, individuals who consumed two or more servings of nuts per week experienced an adjusted hazard ratio (HR) for disease-free survival of 0.58 (95% CI, 0.37 to 0.92; P = .03) and an HR for overall survival of 0.43 (95% CI, 0.25 to 0.74; P = .01). In subgroup analysis, the apparent benefit was confined to tree nut intake (HR for disease-free survival, 0.54; 95% CI, 0.34 to 0.85; P = .04; and HR for overall survival, 0.47; 95% CI, 0.27 to 0.82; P = .04). The association of total nut intake with improved outcomes was maintained across other known or suspected risk factors for cancer recurrence and mortality. Conclusion Diets with a higher consumption of nuts may be associated with a significantly reduced incidence of cancer recurrence and death in patients with stage III colon cancer.
观察性研究报告称，高胰岛素血症状态（包括 2 型糖尿病、肥胖、久坐不动的生活方式和高血糖负荷饮食）的患者发生结肠癌复发和死亡的风险增加。营养摄入与 2 型糖尿病、代谢综合征和胰岛素抵抗的风险降低有关。然而，坚果摄入对结肠癌复发和生存的影响尚不清楚。
我们对 826 名符合条件的 III 期结肠癌患者进行了前瞻性、观察性研究，这些患者在参加随机辅助化疗试验时通过食物频率问卷报告了饮食摄入情况。我们使用 Cox 比例风险回归评估了坚果摄入与癌症复发和死亡的关系。
中位随访 6.5 年后，与不食用坚果的患者相比，每周食用两份或两份以上坚果的患者无疾病生存率的调整后危险比（HR）为 0.58（95%CI，0.37 至 0.92；P=0.03），总生存率的 HR 为 0.43（95%CI，0.25 至 0.74；P=0.01）。亚组分析显示，这种明显的益处仅限于树坚果摄入（无疾病生存率的 HR，0.54；95%CI，0.34 至 0.85；P=0.04；总生存率的 HR，0.47；95%CI，0.27 至 0.82；P=0.04）。坚果总摄入量与改善结局的关联在其他已知或疑似癌症复发和死亡的危险因素中仍然存在。
坚果摄入量较高的饮食可能与 III 期结肠癌患者癌症复发和死亡发生率显著降低相关。
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