Human Nutrition Research Centre, Population Heath Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
Division of Haematology and Immunology, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, United Kingdom.
Cancer Prev Res (Phila). 2022 Sep 1;15(9):623-634. doi: 10.1158/1940-6207.CAPR-22-0044.
The CAPP2 trial investigated the long-term effects of aspirin and resistant starch on cancer incidence in patients with Lynch syndrome (LS). Participants with LS were randomized double-blind to 30 g resistant starch (RS) daily or placebo for up to 4 years. We present long-term cancer outcomes based on the planned 10-year follow-up from recruitment, supplemented by National Cancer Registry data to 20 years in England, Wales, and Finland. Overall, 463 participants received RS and 455 participants received placebo. After up to 20 years follow-up, there was no difference in colorectal cancer incidence (n = 52 diagnosed with colorectal cancer among those randomized to RS against n = 53 on placebo) but fewer participants had non-colorectal LS cancers in those randomized to RS (n = 27) compared with placebo (n = 48); intention-to-treat (ITT) analysis [HR, 0.54; 95% confidence interval (CI), 0.33-0.86; P = 0.010]. In ITT analysis, allowing for multiple primary cancer diagnoses among participants by calculating incidence rate ratios (IRR) confirmed the protective effect of RS against non-colorectal cancer LS cancers (IRR, 0.52; 95% CI, 0.32-0.84; P = 0.0075). These effects are particularly pronounced for cancers of the upper GI tract; 5 diagnoses in those on RS versus 21 diagnoses on placebo. The reduction in non-colorectal cancer LS cancers was detectable in the first 10 years and continued in the next decade. For colorectal cancer, ITT analysis showed no effect of RS on colorectal cancer risk (HR, 0.92; 95% CI, 0.62-1.34; P = 0.63). There was no interaction between aspirin and RS treatments. In conclusion, 30 g daily RS appears to have a substantial protective effect against non-colorectal cancer cancers for patients with LS.
Regular bowel screening and aspirin reduce colorectal cancer among patients with LS but extracolonic cancers are difficult to detect and manage. This study suggests that RS reduces morbidity associated with extracolonic cancers. See related Spotlight, p. 557.
CAPP2 试验研究了阿司匹林和抗性淀粉对林奇综合征（LS）患者癌症发病率的长期影响。LS 患者被随机双盲分为每天 30 克抗性淀粉（RS）或安慰剂，最长 4 年。我们根据招募时计划的 10 年随访，以及英格兰、威尔士和芬兰的国家癌症登记处数据，报告了长期癌症结果。共有 463 名参与者接受了 RS，455 名参与者接受了安慰剂。在长达 20 年的随访后，RS 组与安慰剂组的结直肠癌发病率没有差异（RS 组诊断为结直肠癌的有 52 例，安慰剂组有 53 例），但 RS 组的非结直肠癌 LS 癌患者较少（RS 组有 27 例，安慰剂组有 48 例）；意向治疗（ITT）分析[HR，0.54；95%置信区间（CI），0.33-0.86；P=0.010]。在 ITT 分析中，通过计算发病率比值比（IRR）允许参与者中存在多种原发性癌症诊断，确认了 RS 对非结直肠癌 LS 癌的保护作用（IRR，0.52；95%CI，0.32-0.84；P=0.0075）。RS 对上消化道癌症的保护作用尤为明显；RS 组有 5 例诊断，安慰剂组有 21 例诊断。非结直肠癌 LS 癌的减少在头 10 年即可检测到，并在接下来的 10 年中持续存在。对于结直肠癌，ITT 分析显示 RS 对结直肠癌风险没有影响（HR，0.92；95%CI，0.62-1.34；P=0.63）。阿司匹林和 RS 治疗之间没有相互作用。总之，每天 30 克 RS 似乎对 LS 患者的非结直肠癌癌症有显著的保护作用。
定期进行肠道筛查和服用阿司匹林可降低 LS 患者的结直肠癌风险，但对结外癌症的检测和管理较为困难。这项研究表明，RS 可降低与结外癌症相关的发病率。参见相关重点文章，第 557 页。
