Anthropometric and reproductive factors and risk of esophageal and gastric cancer by subtype and subsite: results from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort
A partir des données de la cohorte européenne EPIC portant sur 476 160 participants, cette étude analyse l'association entre des facteurs anthopométriques et reproductifs et le risque de cancer de l'œsophage ou de l'estomac par sous-type (durée moyenne de suivi : 14 ans)
Obesity has been associated with upper gastrointestinal cancers; however, there are limited prospective data on associations by subtype/subsite. Obesity can impact hormonal factors, which have been hypothesized to play a role in these cancers. We investigated anthropometric and reproductive factors in relation to esophageal and gastric cancer by subtype and subsite for 476,160 participants from the European Prospective Investigation into Cancer and Nutrition cohort. Multivariable hazard ratios (HRs) and 95%-confidence intervals (CIs) were estimated using Cox models. During a mean follow-up of 14 years, 220 esophageal adenocarcinomas (EA), 195 esophageal squamous cell carcinomas, 243 gastric cardia (GC) and 373 gastric non-cardia (GNC) cancers were diagnosed. Body mass index (BMI) was associated with EA in men (BMI≥30 vs 18.5-25kg/m2: HR=1.94, 95%-CI: 1.25-3.03) and women (HR=2.66, 95%-CI: 1.15-6.19); however, adjustment for waist-to-hip ratio (WHR) attenuated these associations. WHR and waist circumference (WC) were associated with EA in men (HR=3.47, 95%-CI: 1.99-6.06 for WHR >0.96 vs <0.91; HR=2.67, 95%-CI: 1.52-4.72 for WC >98 vs <90cm), and women (HR=4.40, 95%-CI: 1.35-14.33 for WHR >0.82 vs <0.76; HR=5.67, 95%-CI: 1.76-18.26 for WC >83 vs <74cm). WHR was also positively associated with GC in women, and WC was positively associated with GC in men. Inverse associations were observed between parity and EA (HR=0.38, 95%-CI: 0.14-0.99; >2 vs 0) and age at first pregnancy and GNC (HR=0.54, 95%-CI: 0.32-0.91; >26 vs <22 years); whereas bilateral ovariectomy was positively associated with GNC (HR=1.87, 95%-CI: 1.04-3.36). These findings support a role for hormonal pathways in upper gastrointestinal cancers. This article is protected by copyright. All rights reserved.