Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.
Diabetes Care. 2018 Jul;41(7):1432-1437. doi: 10.2337/dc17-2518. Epub 2018 Apr 20.
We assessed whether type 2 diabetes is associated with renal cell carcinoma (RCC), independent of key potential confounders, in two large prospective cohorts with biennially updated covariate data.
A total of 117,570 women from the Nurses' Health Study (NHS) and 48,866 men from the Health Professionals Follow-Up Study (HPFS) were followed from 1976 and 1986, respectively, through 2014. Multivariable Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% CIs for associations between type 2 diabetes and pathology-confirmed RCC, overall and by stage, grade, and histologic subtype.
During 38 years of follow-up in the NHS, we confirmed 418 RCC case subjects, including 120 fatal cases. Over 28 years in the HPFS, we confirmed 302 RCC case subjects, including 87 fatal cases. Women with type 2 diabetes had a significantly increased risk of RCC compared with women without type 2 diabetes (multivariable HR 1.53; 95% CI 1.14-2.04), with some evidence that the association was stronger for ≤5 (HR 2.15; 95% CI 1.44-3.23) than >5 (HR 1.22; 95% CI 0.84-1.78) years' duration of type 2 diabetes ( 0.03). Among men, type 2 diabetes was not associated with total RCC (HR 0.89; 95% CI 0.56-1.41) or with RCC defined by stage, grade, or subtype. Sample sizes for analyses by stage, grade, and subtype were limited.
We found that type 2 diabetes was independently associated with a greater risk of RCC in women but not in men.
我们评估了在两个大型前瞻性队列中,2 型糖尿病是否与肾细胞癌(RCC)相关,这两个队列的协变量数据每两年更新一次。
从 1976 年开始,NHS 共纳入 117570 名女性,从 1986 年开始,HPFS 共纳入 48866 名男性,随访至 2014 年。多变量 Cox 比例风险模型用于计算 2 型糖尿病与病理证实的 RCC 之间的风险比(HR)和 95%置信区间(CI),包括总体和按阶段、分级和组织学亚型划分的关联。
在 NHS 的 38 年随访期间,我们共确诊了 418 例 RCC 病例,其中 120 例为致命病例。在 HPFS 的 28 年随访期间,我们共确诊了 302 例 RCC 病例,其中 87 例为致命病例。与没有 2 型糖尿病的女性相比,患有 2 型糖尿病的女性患 RCC 的风险显著增加(多变量 HR 1.53;95%CI 1.14-2.04),并且有证据表明,在 2 型糖尿病持续时间≤5 年(HR 2.15;95%CI 1.44-3.23)的女性中,这种关联更强,而在持续时间>5 年(HR 1.22;95%CI 0.84-1.78)的女性中则较弱(P=0.03)。在男性中,2 型糖尿病与总 RCC(HR 0.89;95%CI 0.56-1.41)或按阶段、分级或亚型定义的 RCC 无关。由于阶段、分级和亚型分析的样本量有限,因此无法进行这些分析。
我们发现,2 型糖尿病与女性 RCC 风险的增加独立相关,但与男性无关。