Jacobs Eric J, Newton Christina C, Stevens Victoria L, Patel Alpa V, Flanders W Dana, Gapstur Susan M
Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia.
Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, Georgia.
Cancer Epidemiol Biomarkers Prev. 2020 Dec;29(12):2680-2685. doi: 10.1158/1055-9965.EPI-20-0591. Epub 2020 Sep 22.
Some evidence suggests the association between body mass index (BMI) and pancreatic cancer risk is weaker among current smokers than among never smokers.
We examined the association between BMI and pancreatic cancer mortality among adults who reported smoking status at enrollment into Cancer Prevention Study-II in 1982, including 420,543 never smokers, 282,244 former cigarette smokers, and 219,885 current cigarette smokers. After excluding the first 3 years of follow-up to reduce reverse causation, we calculated multivariable-adjusted hazard ratios (HR).
During the full follow-up period from 1985 to 2014, 7,904 participants died of pancreatic cancer. The HR per 5 BMI units was lower among current smokers [HR = 1.14; 95% confidence interval (CI), 1.07-1.20] than never smokers (HR = 1.22; 95% CI, 1.17-1.27), although this difference was not statistically significant ( = 0.06). BMI was significantly less strongly associated with pancreatic cancer mortality among current smokers reporting ≥20 cigarettes/day (HR = 1.10; 95% CI, 1.03-1.18) than among never smokers. During follow-up within 10 years of enrollment, when current smokers at enrollment were the most likely to have still been smoking, BMI was not associated with pancreatic cancer mortality among current smokers (HR = 1.02; 95% CI, 0.90-1.16, = 0.03 for difference between current and never smokers). BMI HRs were similar among former and never smokers.
These results support a weaker association between BMI and pancreatic cancer among current smokers than among never smokers.
In populations with low smoking prevalence, the pancreatic cancer burden due to BMI is likely to be higher than that predicted by risk estimates from studies including substantial numbers of smokers.
一些证据表明，与从不吸烟者相比，当前吸烟者的体重指数（BMI）与胰腺癌风险之间的关联较弱。
我们研究了1982年参加癌症预防研究-II时报告吸烟状况的成年人中，BMI与胰腺癌死亡率之间的关联，其中包括420,543名从不吸烟者、282,244名既往吸烟者和219,885名当前吸烟者。在排除随访的前3年以减少反向因果关系后，我们计算了多变量调整风险比（HR）。
在1985年至2014年的整个随访期间，7,904名参与者死于胰腺癌。每5个BMI单位的HR在当前吸烟者中[HR = 1.14；95%置信区间（CI），1.07 - 1.20]低于从不吸烟者（HR = 1.22；95% CI，1.17 - 1.27），尽管这种差异无统计学意义（P = 0.06）。在报告每天吸烟≥20支的当前吸烟者中，BMI与胰腺癌死亡率的关联明显弱于从不吸烟者（HR = 1.10；95% CI，1.03 - 1.18）。在入组后10年内的随访期间，当入组时的当前吸烟者最有可能仍在吸烟时，BMI与当前吸烟者的胰腺癌死亡率无关（HR = 1.02；95% CI，0.90 - 1.16，当前吸烟者与从不吸烟者之间差异的P = 0.03）。既往吸烟者和从不吸烟者的BMI HR相似。
这些结果支持当前吸烟者中BMI与胰腺癌之间的关联比从不吸烟者中更弱。
在吸烟率较低的人群中，因BMI导致的胰腺癌负担可能高于包含大量吸烟者的研究的风险估计所预测的负担。
