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JAMA Oncol:15万人随访30年发现,糖尿病患者体重减轻,与胰腺癌风险增至2.8-6倍有关

2020-08-16 奇点糕 奇点网

近期,哈佛大学陈曾熙公共卫生学院团队发表的一项分析显示:新发糖尿病、有糖尿病史或是体重减轻,都与胰腺癌的发病风险上升有关。

近期,哈佛大学陈曾熙公共卫生学院团队发表的一项分析显示:新发糖尿病、有糖尿病史或是体重减轻,都与胰腺癌的发病风险上升有关。其中糖尿病史在4年之内,伴有体重减轻的新发糖尿病患者,胰腺癌的发病风险是正常人的3.6-6.8倍!

doi:10.1001/jamaoncol.2020.2948

哈佛团队的这项分析,是基于著名的护士健康研究(NHS)和健康专业人员随访研究(HPFS)两项大型队列研究中,超过15万名参与者近30年的随访资料,从而发现了胰腺癌的一部分高危人群。这项研究发表在JAMA Oncology上。

虽然早发现早治疗是防治癌症的原则,但像胰腺癌这种起病隐匿,发病率也不算高的癌症,对每个人都筛查肯定是不合适的。美国预防服务工作组(USPSTF)的权威推荐中,就明确反对在无症状人群中进行胰腺癌的常规筛查。

全人群筛查不行,那么针对高危人群呢?目前比较明确的胰腺癌高危群体,包括有明确家族史、相关基因异常和胰腺囊肿的人群,对他们进行规律性的CT、MRI等检查,能够在早期就发现大多数胰腺癌,从而带来非常明显的获益。

但是从已知高危人群中查出的胰腺癌患者,只占全部患者的15-20%,所以还得继续找胰腺癌的潜在危险群体。已经有很多研究发现,胰腺癌和2型糖尿病可能有所关联,很多胰腺癌患者会出现短暂或持续的糖尿病症状。

注意啊,胰腺和糖尿病里的胰岛还真不是一回事

不过筛查每个糖尿病患者也不太现实。单单是中国成年人当中,现在就有超过一亿的糖尿病患者,如果再算上人数是确诊患者两三倍的糖尿病前期……要是人人都拉去做CT,影像科医生和机器绝对得罢工的。

所以说单纯看糖尿病症状也不够,除非是确诊为与胰腺癌明确相关的3c型糖尿病[7]。那再加点什么特征来定义高危人群呢?有人想到了癌症患者常见的体重减轻。一般糖尿病患者多见的是变胖,但3c型糖尿病中体重减轻就更多见。

要验证这种猜想,用来自NHS和HPFS这两项哈佛公共卫生学院“看家宝”级别队列研究的数据,简直再合适不过了。截至到本次研究收集数据时,这两项队列研究都已经持续了三四十年,因此受试者的平均随访时间也超过了30年。

在本次研究的超过15万名受试者中,随访时间内累积确诊了1100多例胰腺癌,相当于0.7%的累积发病率,比美国的历史数据稍低一些。结合受试者报告的糖尿病确诊情况以及体重变化情况,研究团队计算了胰腺癌与这两种情况的关联。

先说糖尿病,它确实是与胰腺癌发病有关的危险因素。糖尿病史不足4年,也就是新发的糖尿病,与患者胰腺癌的发病风险是正常人的2.97倍有关,而长期糖尿病患者则风险稍低一些(病史4-10年,HR 2.25;病史10年以上,HR 2.07)。

近期体重减轻与胰腺癌风险的关系,就不那么明显了,只有近期体重减轻超过8磅(约3.6千克),与胰腺癌发病风险上升92%有关。但如果把近期体重减轻和新发糖尿病加在一起,对胰腺癌的风险提示就非常明显了。

根据患者年龄、BMI等特征划分的胰腺癌发病情况

研究团队根据新发糖尿病患者的体重减轻情况,划分出了两组:如果患者的体重下降在1-8磅,那么与胰腺癌风险是正常人的3.61倍有关;如果体重下降超过8磅,相关的风险就会飙升到6.75倍!即使按照BMI计算,高风险组也基本不变。

数据还显示,即使是长期患有糖尿病的患者,体重下降超过8磅也与胰腺癌发病风险显著上升有关。而相对更高危的情况包括基线BMI不超过25,也就是没有超重/肥胖的糖尿病患者,以及“不明原因”,减重与运动和饮食原因无关的患者。

研究团队还针对糖尿病患者的病史,以及一生中的体重变化情况作了分析,发现长期糖尿病患者中的胰腺癌患者,一般是初始就相对偏胖,在患癌前后才体重下降;而新发糖尿病的胰腺癌患者,初始体重则相对偏瘦,呈现瘦-胖-瘦的变化。

趋势很明显了

总而言之,本次分析发现的新发糖尿病+近期体重减轻人群,很有可能是一个数量不少、危险还高的胰腺癌高危群体。但由于队列研究的局限性,研究团队也表示,对这类人群的胰腺癌筛查能否真正带来获益,还得由临床试验来证实[8]。

不过奇点糕的意见是,“糖友”们真不一定要等试验的最终实锤。跟日常自测血糖比起来,测体重的负担低多了吧?对体重变化多上心,说不定就能把癌王早早拦下来,这绝对值啊。

原始出处:Yuan C, Babic A, Khalaf N, et al. Diabetes, Weight Change, and Pancreatic Cancer Risk [J]. JAMA Oncology, 2020.

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    2020-10-29 minlingfeng
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  4. [GetPortalCommentsPageByObjectIdResponse(id=1865890, encodeId=45a3186589007, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Thu Oct 29 05:01:16 CST 2020, time=2020-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2061955, encodeId=5da6206195582, content=<a href='/topic/show?id=e6e1e15509f' target=_blank style='color:#2F92EE;'>#癌风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71550, encryptionId=e6e1e15509f, topicName=癌风险)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, 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    2020-08-19 ms5000000741733160

    0

  5. 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  6. 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  7. 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createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Mon Aug 17 07:43:28 CST 2020, time=2020-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036228, encodeId=825510362284d, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Mon Aug 17 02:01:16 CST 2020, time=2020-08-17, status=1, ipAttribution=)]
    2020-08-17 rayms

    不仅是糖尿病人,普通人群体重迅速减轻与很多癌症相关。

    0

  8. 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createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Mon Aug 17 07:43:28 CST 2020, time=2020-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036228, encodeId=825510362284d, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Mon Aug 17 02:01:16 CST 2020, time=2020-08-17, status=1, ipAttribution=)]
    2020-08-17 ms5000001908858550

    0

  9. 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createdAvatar=https://img.medsci.cn/20200817/2786f976001a4edd9a06b98ec2527751/bef891b389dd48d8a0076e15cba6fc86.jpg, createdBy=72015403602, createdName=ms5000001908858550, createdTime=Mon Aug 17 13:10:36 CST 2020, time=2020-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809573, encodeId=5e078095e384, content=<a href='/topic/show?id=4f77e665253' target=_blank style='color:#2F92EE;'>#糖尿病#</a><a href='/topic/show?id=04b5839e6a9' target=_blank style='color:#2F92EE;'>#胰腺癌#</a><a href='/topic/show?id=48b983982ae' target=_blank style='color:#2F92EE;'>#胰腺癌风险#</a>买际上体重快速下降,不是胰腺癌也可能是其它肿瘤, beContent=null, objectType=article, channel=null, level=null, likeNumber=259, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76652, encryptionId=4f77e665253, topicName=糖尿病), TopicDto(id=83976, encryptionId=04b5839e6a9, topicName=胰腺癌), TopicDto(id=83982, encryptionId=48b983982ae, topicName=胰腺癌风险)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Mon Aug 17 07:43:28 CST 2020, time=2020-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036228, encodeId=825510362284d, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Mon Aug 17 02:01:16 CST 2020, time=2020-08-17, status=1, ipAttribution=)]
    2020-08-17 lovetcm

    #糖尿病##胰腺癌##胰腺癌风险#买际上体重快速下降,不是胰腺癌也可能是其它肿瘤

    0

  10. 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    2020-08-17 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

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