Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Department of Histopathology and Morbid Anatomy, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland.
Cancer Epidemiol Biomarkers Prev. 2018 Jul;27(7):783-789. doi: 10.1158/1055-9965.EPI-18-0076. Epub 2018 Apr 18.
Prostate cancer incidence rates vary 25-fold worldwide. Differences in PSA screening are largely, but not entirely, responsible. We examined geographic differences in prevalence of histologic prostate inflammation and subsequent prostate cancer risk. Seven thousand nonHispanic white men were enrolled in the REduction by DUtasteride of prostate Cancer Events (REDUCE) trial from Europe ( = 4,644), North America ( = 1,746), South America ( = 466), and Australia/New Zealand ( = 144). Histologic inflammation in baseline negative prostate biopsies was classified as chronic (lymphocytes/macrophages) or acute (neutrophils). Multivariable logistic regression was used to examine associations between region and prostate inflammation, and between region and prostate cancer risk at 2-year biopsy. Prevalence of prostate inflammation varied across region, with broadly similar patterns for acute and chronic inflammation. Relative to Europe, prevalence of acute inflammation was higher in North America [odds ratio (OR), 1.77; 95% confidence interval (CI), 1.51-2.08] and Australia/New Zealand (OR, 2.07; 95% CI, 1.40-3.06). Men from these regions had lower prostate cancer risk than Europeans at biopsy. Among North Americans, prevalence of acute inflammation was higher in Canada versus the United States (OR, 1.40; 95% CI, 1.07-1.83), but prostate cancer risk did not differ between these regions. Among Europeans, prevalence of acute inflammation was lower in Northern and Eastern (OR, 0.79; 95% CI, 0.65-0.97 and OR 0.62; 95% CI, 0.45-0.87, respectively), relative to Western Europe, and these men had higher prostate cancer risk at biopsy. Prevalence of histologic prostate inflammation varied by region. Geographic differences in prostate inflammation tracked inversely with geographic differences in prostate cancer risk. Characterization of premalignant prostate biology and the relationship with subsequent prostate cancer risk could inform prostate cancer prevention efforts. .
前列腺癌的发病率在全球范围内差异高达 25 倍。PSA 筛查的差异在很大程度上，但并非完全是导致这种差异的原因。我们研究了前列腺炎症的流行程度和随后的前列腺癌风险在地理上的差异。来自欧洲（n=4644）、北美（n=1746）、南美（n=466）和澳新地区（n=144）的 7000 名非西班牙裔白人男性参加了 REDUCE 试验（Dutasteride 减少前列腺癌事件研究）。在基线时前列腺活检呈阴性的患者中，将组织学炎症分为慢性（淋巴细胞/巨噬细胞）或急性（中性粒细胞）。采用多变量逻辑回归分析来检验地区与前列腺炎症之间的关联，以及地区与 2 年活检时前列腺癌风险之间的关联。前列腺炎症的患病率在不同地区有所不同，急性和慢性炎症的模式大致相似。与欧洲相比，北美的急性炎症患病率较高（比值比[OR]，1.77；95%置信区间[CI]，1.51-2.08），澳新地区更高（OR，2.07；95%CI，1.40-3.06）。这些地区的男性在活检时的前列腺癌风险低于欧洲人。在北美人中，加拿大的急性炎症患病率高于美国（OR，1.40；95%CI，1.07-1.83），但这两个地区的前列腺癌风险没有差异。在欧洲人中，与西欧相比，北欧和东欧的急性炎症患病率较低（OR，0.79；95%CI，0.65-0.97 和 OR 0.62；95%CI，0.45-0.87），这些男性在活检时的前列腺癌风险较高。前列腺炎症的组织学患病率因地区而异。前列腺炎症的地理差异与前列腺癌风险的地理差异呈负相关。对癌前前列腺生物学的特征描述及其与随后的前列腺癌风险的关系，可能为前列腺癌的预防工作提供信息。
