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.
PLoS One. 2020 Oct 20;15(10):e0240413. doi: 10.1371/journal.pone.0240413. eCollection 2020.
Obesity has been positively associated with upper gastrointestinal cancers, but prospective data by subtype/subsite are limited. Obesity influences hormonal factors, which may play a role in these cancers. We examined anthropometry, body fat and reproductive factors in relation to oesophageal and gastric cancer by subtype/subsite in the UK Biobank cohort.
Among 458,713 UK Biobank participants, 339 oesophageal adenocarcinomas, 124 oesophageal squamous cell carcinomas, 137 gastric cardia and 92 gastric non-cardia cancers were diagnosed during a mean of 6.5 years follow-up. Cox models estimated multivariable hazard ratios (HRs) and 95% confidence intervals (CIs).
Body mass index (BMI), hip circumference, waist circumference, waist-to-hip ratio, waist-to-height ratio, total body fat and trunk fat were positively associated with oesophageal adenocarcinoma (highest vs lowest category: HR = 2.33, 95%-CI:1.65-3.28; HR = 1.56, 95%-CI:1.15-2.13; HR = 2.30, 95%-CI:1.47-3.57; HR = 1.71, 95%-CI:1.01-2.90; HR = 2.87, 95%-CI:1.88-4.38; HR = 1.96, 95%-CI:1.30-2.96; HR = 2.34, 95%-CI:1.70-3.22, respectively). Although there were no statistically significant associations in combined sex analyses, BMI (HR = 1.83, 95%-CI:1.00-3.37), waist circumference (HR = 2.21, 95%-CI:1.27-3.84) and waist-to-hip ratio (HR = 1.92, 95%-CI:1.11-3.29) were associated with gastric cardia cancer in men; however, mutual adjustment attenuated the associations for BMI and waist-to-hip ratio. For oesophageal squamous cell carcinoma, statistically significant inverse associations were observed among women for BMI, hip circumference, waist circumference, waist-to-height ratio, total body fat and trunk fat, although they were based on small numbers. In addition, older age at first (HR = 0.44, 95%-CI:0.22-0.88) and last live birth (HR = 0.44, 95%-CI:0.22-0.87) were inversely associated with oesophageal squamous cell carcinoma and having a stillbirth/miscarriage/termination was positively associated (HR = 1.84, 95%-CI:1.10-3.07).
Obesity and abdominal obesity specifically may be a risk factor for oesophageal adenocarcinoma and gastric cardia cancer in men. Some reproductive factors may be associated with oesophageal squamous cell carcinoma in women.
肥胖与上消化道癌症呈正相关，但按亚型/部位的前瞻性数据有限。肥胖会影响激素因素，这些因素可能在上消化道癌症中发挥作用。我们在 UK Biobank 队列中检查了体型、体脂肪和生殖因素与食管和胃癌亚型/部位的关系。
在 458713 名 UK Biobank 参与者中，339 例食管腺癌、124 例食管鳞状细胞癌、137 例胃贲门癌和 92 例非贲门胃癌在平均 6.5 年的随访期间被诊断。Cox 模型估计了多变量风险比（HR）和 95%置信区间（CI）。
体重指数（BMI）、臀围、腰围、腰臀比、腰高比、总体脂肪和躯干脂肪与食管腺癌呈正相关（最高与最低类别相比：HR=2.33，95%CI：1.65-3.28；HR=1.56，95%CI：1.15-2.13；HR=2.30，95%CI：1.47-3.57；HR=1.71，95%CI：1.01-2.90；HR=2.87，95%CI：1.88-4.38；HR=1.96，95%CI：1.30-2.96；HR=2.34，95%CI：1.70-3.22，分别）。尽管在男女联合分析中没有统计学意义上的关联，但 BMI（HR=1.83，95%CI：1.00-3.37）、腰围（HR=2.21，95%CI：1.27-3.84）和腰臀比（HR=1.92，95%CI：1.11-3.29）与男性胃贲门癌有关；然而，相互调整削弱了 BMI 和腰臀比的关联。对于食管鳞状细胞癌，女性的 BMI、臀围、腰围、腰高比、总体脂肪和躯干脂肪呈显著负相关，尽管这些关联的数量较小。此外，初产年龄较大（HR=0.44，95%CI：0.22-0.88）和最后一次活产年龄较大（HR=0.44，95%CI：0.22-0.87）与食管鳞状细胞癌呈负相关，而死产/流产/终止妊娠与食管鳞状细胞癌呈正相关（HR=1.84，95%CI：1.10-3.07）。
肥胖和腹部肥胖可能是男性食管腺癌和胃贲门癌的危险因素。一些生殖因素可能与女性的食管鳞状细胞癌有关。
