Community and Population Health Research, Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, USA.
Flatiron Health, New York, NY, USA.
JNCI Cancer Spectr. 2022 Jul 1;6(4). doi: 10.1093/jncics/pkac041.
Colorectal cancer survivors often use multivitamins and other over-the-counter dietary supplements, but evidence is limited regarding their potential associations with mortality.
This prospective analysis included women and men from the Cancer Prevention Study-II Nutrition Cohort who were cancer-free at baseline (1992 or 1993) and diagnosed with colorectal cancer through June 2015. Detailed information on multivitamin use, vitamin C supplements, and vitamin E supplements was self-reported on questionnaires at baseline, in 1997, and every 2 years thereafter. Pre- and postdiagnosis data were available for 3176 and 2006 colorectal cancer survivors, respectively, among whom 2116 (648 from colorectal cancer) and 1256 (242 from colorectal cancer) died. Multivariable-adjusted Cox proportional hazards regression models examined associations. All statistical tests were 2-sided.
Among colorectal cancer survivors, 49.7% and 58.5% reported multivitamin use before and after diagnosis, respectively (vitamin C use before and after diagnosis: 27.8% and 28.1%; vitamin E use before and after diagnosis: 27.5% and 29.4%, respectively). There were no statistically significant associations of pre- or postdiagnosis multivitamin use with all-cause, colorectal cancer-specific, or noncolorectal cancer mortality. Vitamin C was also not associated with any mortality outcomes. However, prediagnosis vitamin E use was associated with a non-statistically significant increased risk of all-cause mortality (multivariable adjusted hazard ratio = 1.08, 95% confidence intervals = 0.96 to 1.23) and all other noncolorectal cancer mortality (multivariable adjusted hazard ratio = 1.13, 95% confidence intervals = 0.97 to 1.31).
These results suggest that multivitamin use before or after diagnosis is not associated with mortality in colorectal cancer survivors. However, vitamin E use may be associated with increased risk of mortality and merits further investigation.
结直肠癌幸存者经常使用多种维生素和其他非处方膳食补充剂，但关于它们与死亡率潜在关联的证据有限。
本前瞻性分析纳入了癌症预防研究-II 营养队列中的女性和男性，他们在基线时（1992 年或 1993 年）无癌症，并且在 2015 年 6 月之前通过结直肠癌诊断。在基线、1997 年和此后每 2 年的问卷中，自我报告了多种维生素使用、维生素 C 补充剂和维生素 E 补充剂的详细信息。分别为 3176 名和 2006 名结直肠癌幸存者提供了发病前和发病后的数据，其中 2116 名（结直肠癌患者 648 名）和 1256 名（结直肠癌患者 242 名）死亡。多变量调整的 Cox 比例风险回归模型检查了相关性。所有统计检验均为双侧检验。
在结直肠癌幸存者中，分别有 49.7%和 58.5%报告了发病前和发病后使用多种维生素（发病前和发病后使用维生素 C：27.8%和 28.1%；发病前和发病后使用维生素 E：27.5%和 29.4%）。发病前或发病后使用多种维生素与全因、结直肠癌特异性或非结直肠癌死亡率均无统计学显著关联。维生素 C 也与任何死亡率结果无关。然而，发病前使用维生素 E 与全因死亡率增加的非统计学显著风险相关（多变量调整后的危险比=1.08，95%置信区间=0.96 至 1.23）和所有其他非结直肠癌死亡率增加的非统计学显著风险（多变量调整后的危险比=1.13，95%置信区间=0.97 至 1.31）。
这些结果表明，结直肠癌幸存者在诊断前后使用多种维生素与死亡率无关。然而，维生素 E 的使用可能与死亡率增加有关，值得进一步研究。
