Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD.
Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.
J Natl Cancer Inst. 2020 Feb 1;112(2):191-199. doi: 10.1093/jnci/djz077.
Epidemiologic data are inconsistent regarding the vitamin E-lung cancer association, and no study to our knowledge has examined serologic changes in vitamin E status in relation to subsequent risk.
In a cohort of 22 781 male smokers in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study, we ascertained 3184 lung cancer cases during up to 28 years of observation. Cox proportional hazards models examined whether higher serum alpha-tocopherol concentrations at baseline, 3 years, or the interval change were associated with lower lung cancer risk. All statistical tests were two-sided.
After adjustment for age, body mass index, smoking intensity and duration, serum total cholesterol, and trial intervention group, we found lower lung cancer risk in men with high baseline alpha-tocopherol (fifth quintile [Q5] vs Q1, hazard ratio [HR] = 0.76, 95% confidence interval [CI] = 0.66 to 0.87, Ptrend < .001). A similar reduction in risk was seen for serum alpha-tocopherol at 3 years (Q5 vs Q1, HR = 0.78, 95% CI = 0.67 to 0.91, Ptrend = .004). The inverse risk association appeared stronger for younger men and those who had smoked fewer years but was similar across trial intervention groups. We also found reduced risk among men not supplemented with vitamin E who had a lower serum alpha-tocopherol at baseline and greater increases in concentrations at 3 years (third tertile vs first tertile of serum alpha-tocopherol change, HR = 0.74, 95% CI = 0.59 to 0.91, P = .005).
Higher vitamin E status, as measured by serum alpha-tocopherol concentration, as well as repletion of a low vitamin E state, was related to decreased lung cancer risk during a 28-year period. Our findings provide evidence supporting the importance of adequate physiological vitamin E status for lung cancer risk reduction.
关于维生素 E 与肺癌的关联，流行病学数据并不一致，据我们所知，没有研究检测过维生素 E 状态的血清学变化与随后的风险之间的关系。
在一项为期 28 年的观察中，我们在 22781 名男性吸烟者的 Alpha-生育酚、β-胡萝卜素癌症预防研究中确定了 3184 例肺癌病例。Cox 比例风险模型检验了基线、3 年或间隔变化时较高的血清α-生育酚浓度是否与较低的肺癌风险相关。所有统计检验均为双侧检验。
调整年龄、体重指数、吸烟强度和持续时间、血清总胆固醇和试验干预组后，我们发现基线时高α-生育酚（第五五分位 [Q5]与 Q1 相比，风险比 [HR] = 0.76，95%置信区间 [CI] = 0.66 至 0.87，Ptrend <.001）的男性肺癌风险较低。3 年内血清α-生育酚水平降低（Q5 与 Q1 相比，HR = 0.78，95%CI = 0.67 至 0.91，Ptrend =.004）也观察到了类似的风险降低。这种反向风险关联在年龄较小的男性和吸烟年限较短的男性中更为明显，但在试验干预组之间相似。我们还发现，基线血清α-生育酚水平较低且 3 年内浓度增加较多的未补充维生素 E 的男性风险降低（血清α-生育酚变化的第三三分位与第一三分位相比，HR = 0.74，95%CI = 0.59 至 0.91，P =.005）。
血清α-生育酚浓度衡量的较高维生素 E 状态，以及补充低维生素 E 状态，与 28 年内肺癌风险降低有关。我们的研究结果为充分的生理维生素 E 状态对降低肺癌风险的重要性提供了证据。
