Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France.
Int J Cancer. 2020 Feb 15;146(4):929-942. doi: 10.1002/ijc.32386. Epub 2019 May 21.
Obesity has been associated with upper gastrointestinal cancers; however, there are limited prospective data on associations by subtype/subsite. Obesity can impact hormonal factors, which have been hypothesized to play a role in these cancers. We investigated anthropometric and reproductive factors in relation to esophageal and gastric cancer by subtype and subsite for 476,160 participants from the European Prospective Investigation into Cancer and Nutrition cohort. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox models. During a mean follow-up of 14 years, 220 esophageal adenocarcinomas (EA), 195 esophageal squamous cell carcinomas, 243 gastric cardia (GC) and 373 gastric noncardia (GNC) cancers were diagnosed. Body mass index (BMI) was associated with EA in men (BMI ≥30 vs. 18.5-25 kg/m : HR = 1.94, 95% CI: 1.25-3.03) and women (HR = 2.66, 95% CI: 1.15-6.19); however, adjustment for waist-to-hip ratio (WHR) attenuated these associations. After mutual adjustment for BMI and HC, respectively, WHR and waist circumference (WC) were associated with EA in men (HR = 3.47, 95% CI: 1.99-6.06 for WHR >0.96 vs. <0.91; HR = 2.67, 95% CI: 1.52-4.72 for WC >98 vs. <90 cm) and women (HR = 4.40, 95% CI: 1.35-14.33 for WHR >0.82 vs. <0.76; HR = 5.67, 95% CI: 1.76-18.26 for WC >84 vs. <74 cm). WHR was also positively associated with GC in women, and WC was positively associated with GC in men. Inverse associations were observed between parity and EA (HR = 0.38, 95% CI: 0.14-0.99; >2 vs. 0) and age at first pregnancy and GNC (HR = 0.54, 95% CI: 0.32-0.91; >26 vs. <22 years); whereas bilateral ovariectomy was positively associated with GNC (HR = 1.87, 95% CI: 1.04-3.36). These findings support a role for hormonal pathways in upper gastrointestinal cancers.
肥胖与上消化道癌症有关；然而，关于亚型/部位的关联，前瞻性数据有限。肥胖会影响激素因素，这些因素被认为在上消化道癌症中发挥作用。我们调查了欧洲癌症前瞻性调查和营养队列的 476160 名参与者中与食管和胃癌亚型/部位相关的人体测量和生殖因素。使用 Cox 模型估计多变量风险比 (HR) 和 95%置信区间 (CI)。在平均 14 年的随访期间，诊断出 220 例食管腺癌 (EA)、195 例食管鳞状细胞癌、243 例胃贲门癌 (GC) 和 373 例胃非贲门癌 (GNC)。体重指数 (BMI) 与男性 (BMI≥30 与 18.5-25kg/m2：HR=1.94，95%CI：1.25-3.03) 和女性 (HR=2.66，95%CI：1.15-6.19) 的 EA 有关；然而，调整腰围与臀围比 (WHR) 后，这些关联减弱。分别调整 BMI 和 HC 后，WHR 和腰围 (WC) 与男性的 EA 有关 (WHR>0.96 与<0.91 相比 HR=3.47，95%CI：1.99-6.06；WC>98 与<90cm 相比 HR=2.67，95%CI：1.52-4.72) 和女性 (WHR>0.82 与<0.76 相比 HR=4.40，95%CI：1.35-14.33；WC>84 与<74cm 相比 HR=5.67，95%CI：1.76-18.26)。WHR 与女性的 GC 也呈正相关，WC 与男性的 GC 也呈正相关。与 EA 相关的生育次数 (HR=0.38，95%CI：0.14-0.99；>2 次与 0 次) 和首次妊娠年龄 (HR=0.54，95%CI：0.32-0.91；>26 岁与<22 岁) 呈负相关，而双侧卵巢切除术与 GNC 呈正相关 (HR=1.87，95%CI：1.04-3.36)。这些发现支持激素途径在上消化道癌症中的作用。
