美國《臨床腫瘤學雜誌》2018年2月28日在線先發
食用堅果與III期結腸癌患者的生存：來自CALGB89803（聯盟）試驗的結果
https://doi.org/10.1200/JCO.2017.75.5413
目的
已有觀察性研究報告，高胰島素血癥包括2型糖尿病、肥胖、久坐不動的生活方式和高血糖負荷飲食，有這些情況的患者結腸癌複發率和死亡率升高，食用堅果可以降低2型糖尿病、代謝綜合症、胰島素抵抗的風險，但食用堅果對結腸癌復發和生存的影響尚不知。
患者
我們對826名符合條件的III期結腸癌患者實施了一項前瞻性、觀察性研究，這些患者在入組到一項隨機化輔助化療臨床試驗的同時，根據飲食情況問卷調查表，報告了膳食攝入量。採用Cox比例風險迴歸分析，我們評價了食用堅果與癌症復發、死亡的相關性。
結果
中位隨訪6.5年後，與不吃堅果的患者相比，每週食用≥2份堅果的患者，調校後的無病生存風險比（HR）為0.58（95%CI，0.37-0.92；趨勢P=0.03）、總生存風險比為0.43（95%CI，0.25-0.74；趨勢P=0.01）。在亞組分析中，明顯獲益僅限於食用樹堅果（無病生存風險比，0.54；95%CI，0.34-0.85；趨勢P=0.04。總生存的風險比，0.47；95%CI，0.27-0.82；趨勢P=0.04）。即使有其它已知或疑似癌症復發、死亡風險因素，堅果總食用量與轉歸改善的相關性仍持續存在。
結論
在III期結腸癌患者中，高堅果食用量的飲食可能與癌症復發、死亡明顯下降相關。
《壹篇》南南和北北
Nut Consumption and Survival in Patients With Stage III Colon Cancer: Results From CALGB 89803 (Alliance)
https://doi.org/10.1200/JCO.2017.75.5413
Purpose
Observational studies have reported increased colon cancer recurrence and mortality in patients with states of hyperinsulinemia, including type 2 diabetes, obesity, sedentary lifestyle, and high glycemic load diet. Nut intake has been associated with a lower risk of type 2 diabetes, metabolic syndrome, and insulin resistance. However, the effect of nut intake on colon cancer recurrence and survival is not known.
Patients and Methods
We conducted a prospective, observational study of 826 eligible patients with stage III colon cancer who reported dietary intake on food frequency questionnaires while enrolled onto a randomized adjuvant chemotherapy trial. Using Cox proportional hazards regression, we assessed associations of nut intake with cancer recurrence and mortality.
Results
After a median follow-up of 6.5 years, compared with patients who abstained from nuts, individuals who consumed two or more servings of nuts per week experienced an adjusted hazard ratio (HR) for disease-free survival of 0.58 (95% CI, 0.37 to 0.92; Ptrend = .03) and an HR for overall survival of 0.43 (95% CI, 0.25 to 0.74; Ptrend = .01). In subgroup analysis, the apparent benefit was confined to tree nut intake (HR for disease-free survival, 0.54; 95% CI, 0.34 to 0.85; Ptrend = .04; and HR for overall survival, 0.47; 95% CI, 0.27 to 0.82; Ptrend = .04). The association of total nut intake with improved outcomes was maintained across other known or suspected risk factors for cancer recurrence and mortality.
Conclusion
Diets with a higher consumption of nuts may be associated with a significantly reduced incidence of cancer recurrence and death in patients with stage III colon cancer.
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