美国国立卫生研究院-美国退休人员协会饮食与健康研究中黑人和白人男性的前列腺癌风险因素。
Prostate cancer risk factors in black and white men in the NIH-AARP Diet and Health Study.
机构信息
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.
出版信息
Prostate Cancer Prostatic Dis. 2019 Mar;22(1):91-100. doi: 10.1038/s41391-018-0070-9. Epub 2018 Aug 14.
BACKGROUND
There are few prospective studies comparing race-specific associations between diet, nutrients, and health-related parameters, and prostate cancer risk.
METHODS
Race-specific prostate cancer risk associations were examined among men in the National Institutes of Health (NIH)-AARP Diet and Health Study. We identified 1417 cases among black men (209 advanced), and 28,845 among white men (3898 advanced). Cox proportional hazards regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs). We also evaluated the cumulative change in the HR for black race following adjustment for each factor.
RESULTS
Race-specific prostate cancer associations were similar in black and white men across disease subtypes only for history of diabetes (overall : HR = 0.77, 95% CI: 0.65-0.90 and HR = 0.72, 95% CI: 0.69-0.76, respectively; P = 0.66). By contrast, there was a positive risk association with height for white men and inverse for black men (P: non-advanced = 0.01; advanced = 0.04). This difference remained among men with at least 2 years of follow-up for non-advanced (P = 0.01), but not advanced disease (P = 0.24); or after adjustment for prostate cancer screening (non-advanced P = 0.53, advanced P = 0.31). The only other evidence of interaction with race was observed for dietary vitamin D intake and non-advanced disease, but only after adjustment for screening (P = 0.02). Cumulative adjustment for each factor increased the HR for black race by 32.9% for overall cancer and 12.4% for advanced disease.
CONCLUSIONS
Our data suggest few of the dietary, nutrient, and health-related factors associated with prostate cancer risk in predominantly non-Hispanic white men were associated with risk in black men, and adjustment for these factors widen the black-white difference in risk. Larger studies of black men, particularly with prospective data, are needed to help identify risk factors relevant to this population.
背景
针对饮食、营养与健康相关参数与前列腺癌风险之间的种族特异性关联，鲜有前瞻性研究对此进行比较。
方法
美国国立卫生研究院（NIH）-AARP 饮食与健康研究对男性进行了种族特异性前列腺癌风险关联研究。我们在黑人男性中发现了 1417 例病例（209 例为晚期），在白人男性中发现了 28845 例（3898 例为晚期）。使用 Cox 比例风险回归模型估计了风险比（HR）和 95%置信区间（CI）。我们还评估了在调整每个因素后，黑人种族的 HR 累积变化。
结果
仅在糖尿病史方面，黑人和白人男性的疾病亚型之间的种族特异性前列腺癌关联相似（总体：HR=0.77，95%CI：0.65-0.90；HR=0.72，95%CI：0.69-0.76，分别；P=0.66）。相比之下，身高与白人男性呈正相关，而与黑人男性呈负相关（P：非晚期=0.01；晚期=0.04）。在至少有 2 年非晚期随访的男性中，这种差异仍然存在（P=0.01），但在晚期疾病中则不存在（P=0.24）；或在调整前列腺癌筛查后，也不存在（非晚期 P=0.53，晚期 P=0.31）。唯一观察到与种族存在交互作用的证据是饮食维生素 D 摄入与非晚期疾病相关，但仅在调整了筛查后才有（P=0.02）。对每个因素进行累积调整后，黑人种族的总体癌症 HR 增加了 32.9%，晚期疾病的 HR 增加了 12.4%。
结论
我们的数据表明，与非西班牙裔白人男性前列腺癌风险相关的饮食、营养和健康相关因素中，很少有与黑人男性的风险相关，而对这些因素进行调整则会扩大风险的黑白差异。需要对黑人男性进行更大规模的研究，特别是前瞻性研究，以帮助确定与该人群相关的风险因素。
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