Risk Factor Profiles Differ for Cancers of Different Regions of the Colorectum.,Gastroenterology

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Risk Factor Profiles Differ for Cancers of Different Regions of the Colorectum.
Gastroenterology ( IF 25.7 ) Pub Date : 2020-04-01 , DOI: 10.1053/j.gastro.2020.03.054
Liang Wang ₁ , Chun-Han Lo ₂ , Xiaosheng He ₃ , Dong Hang ₄ , Molin Wang ₅ , Kana Wu ₆ , Andrew T Chan ₇ , Shuji Ogino ₈ , Edward L Giovannucci ₉ , Mingyang Song ₁₀

Affiliation

Center of Gastrointestinal Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Department of Colorectal Surgery, the Six Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China.
Department of Epidemiology and Biostatistics, Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, P.R. China.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Broad Institute of MIT and Harvard, Cambridge, Massachusetts; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Broad Institute of MIT and Harvard, Cambridge, Massachusetts; Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts; Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.

Background & Aims

The molecular features of colorectal tumors differ with their anatomic location. Colorectal tumors are usually classified as proximal or distal. We collected data from 3 cohorts to identify demographic, clinical, anthropometric, lifestyle, and dietary risk factors for colorectal cancer (CRC) at 7 anatomic subsites. We examined whether the associations differ among refined subsites and whether there are trends in associations from cecum to rectum.

Methods

We collected data from the Nurses’ Health Study, Nurses’ Health Study 2, and Health Professionals Follow-up Study (45,351 men and 178,016 women, followed for a median 23 years) on 24 risk factors in relation to risk of cancer in cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectosigmoid junction, and rectum. Hazard ratios were estimated using Cox proportional hazards regression. We tested for linear and nonlinear trends in associations with CRC among subsites and within proximal colon, distal colon, and rectum.

Results

We documented 3058 cases of CRC (474 in cecum, 633 in ascending colon, 250 in transverse colon, 221 in descending colon, 750 in sigmoid colon, 202 in rectosigmoid junction, and 528 in rectum). The positive associations with cancer risk decreased, from cecum to rectum, for age and family history of CRC. In contrast, the inverse associations with cancer risk increased, from cecum to rectum, for endoscopic screening and intake of whole grains, cereal fiber, and processed red meat. There was a significant nonlinear trend in the association between CRC and female sex, with hazard ratios ranging from 1.73 for ascending colon cancer to 0.54 for sigmoid colon cancer. For proximal colon cancers, the association with alcohol consumption and smoking before age 30 years increased from the cecum to transverse colon. For distal colon cancers, the positive association with waist circumference in men was greater for descending vs sigmoid colon cancer.

Conclusions

In an analysis of 3058 cases of CRC, we found that risk factor profiles differed for cancers along the colorectum. Proximal vs distal classifications are not sufficient to encompass the regional variations in colorectal tumor features and risk factors.

中文翻译：

结直肠不同区域癌症的危险因素概况不同。

背景与目标

大肠肿瘤的分子特征因其解剖位置而异。大肠肿瘤通常分为近端或远端。我们从3个队列中收集了数据，以确定7个解剖亚位的大肠癌（CRC）的人口统计学，临床，人体测量学，生活方式和饮食风险因素。我们检查了精制子站点之间的关联是否不同，以及从盲肠到直肠的关联是否存在趋势。

方法

我们从“护士健康研究”，“护士健康研究2”和“健康专业人员随访研究”（45,351名男性和178,016名女性，平均随访23年）中收集了与24种与盲肠癌风险相关的危险因素的数据，升结肠，横结肠，降结肠，乙状结肠，直肠乙状结肠连接点和直肠。风险比使用Cox比例风险回归法估算。我们测试了亚位点之间以及近端结肠，远端结肠和直肠内与CRC相关的线性和非线性趋势。

结果

我们记录了3058例CRC（盲肠为474例，升结肠为633例，横结肠为250例，降结肠为221例，乙状结肠为750例，直肠乙状结肠为202例，直肠为528例）。从盲肠到直肠，CRC的年龄和家族史与癌症风险的正相关性降低。相反，从盲肠到直肠，用于内窥镜检查和摄入全谷类，谷类纤维和加工红肉的风险增加与癌症风险成反比。CRC与女性之间的关联存在显着的非线性趋势，危险比范围从升结肠癌的1.73到乙状结肠癌的0.54。对于近端结肠癌，与30岁之前饮酒和吸烟的关系从盲肠到横结肠增加。对于远端结肠癌，