Long-term effect of resistant starch on cancer risk in carriers of hereditary colorectal cancer: an analysis from the CAPP2 randomised controlled trial

被引：68

作者：

Mathers, John C. ^{[1
]}

Movahedi, Mohammad ^{[25
,26
]}

Macrae, Finlay ^{[4
]}

Mecklin, Jukka-Pekka ^{[5
]}

Moeslein, Gabriela ^{[6
]}

Olschwang, Sylviane ^{[7
]}

Eccles, Diana ^{[8
]}

Evans, Gareth ^{[9
]}

Maher, Eamonn R. ^{[10
]}

Bertario, Lucio ^{[11
]}

Bisgaard, Marie-Luise ^{[12
]}

Dunlop, Malcolm ^{[13
]}

Ho, Judy W. C. ^{[14
]}

Hodgson, Shirley ^{[15
]}

Lindblom, Annika ^{[16
]}

Lubinski, Jan ^{[17
]}

Morrison, Patrick J. ^{[18
]}

Murday, Victoria

Ramesar, Raj ^{[19
]}

Side, Lucy ^{[20
]}

Scott, Rodney J. ^{[21
]}

Thomas, Huw J. W. ^{[22
]}

Vasen, Hans ^{[23
,24
]}

Gerdes, Anne-Marie ^{[2
,3
]}

Barker, Gail ^{[2
]}

Crawford, Gillian ^{[8
]}

Elliott, Faye ^{[25
]}

Pylvanainen, Kirsi ^{[5
]}

Wijnen, Juul ^{[27
]}

Fodde, Riccardo ^{[28
]}

Lynch, Henry ^{[29
]}

Bishop, D. Timothy ^{[25
]}

Burn, John ^{[2
]}

机构：

[1] Newcastle Univ, Human Nutr Res Ctr, Inst Ageing & Hlth, Newcastle Upon Tyne NE4 5PL, Tyne & Wear, England

[2] Newcastle Univ, Inst Med Genet, Newcastle Upon Tyne NE4 5PL, Tyne & Wear, England

[3] Rigshosp, DK-2100 Copenhagen, Denmark

[4] Royal Melbourne Hosp, Melbourne, Vic, Australia

[5] Jyvaskyla Cent Hosp, Dept Surg, Jyvaskyla, Finland

[6] HELIOS St Josefs Hosp, Bochum, Germany

[7] Inst J Paoli I Calmettes, Dept Oncol Genet, F-13009 Marseille, France

[8] Univ Southampton, Fac Med, Southampton SO9 5NH, Hants, England

[9] St Marys Hosp, Dept Med Genet, Manchester M13 0JH, Lancs, England

[10] Univ Birmingham, Ctr Rare Dis & Personalised Med, Birmingham, W Midlands, England

[11] Ist Nazl Studio & la Cura dei Tumori, Milan, Italy

[12] Univ Copenhagen, ICMM, Med Genet Clin, Hvidovre, Denmark

[13] Western Gen Hosp, MRC Human Genet Unit, Edinburgh EH4 2XU, Midlothian, Scotland

[14] Queen Mary Hosp, Dept Surg, Hereditary GI Canc Registry, Hong Kong, Hong Kong, Peoples R China

[15] Univ London St Georges Hosp, London, England

[16] Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden

[17] Int Hereditary Canc Ctr, Szczecin, Poland

[18] Queens Univ Belfast, Belfast City Hosp, Dept Med Genet, Belfast, Antrim, North Ireland

[19] Univ Cape Town, Div Human Genet, Observatory, South Africa

[20] Churchill Hosp, Dept Clin Genet, Oxford OX3 7LJ, England

[21] John Hunter Hosp, Hunter Area Pathol Serv, New Lambton, Australia

[22] Univ London Imperial Coll Sci Technol & Med, St Marks Hosp, London, England

[23] Leiden Univ, Med Ctr, Netherlands Fdn Detect Hereditary Tumours, Leiden, Netherlands

[24] Leiden Univ, Med Ctr, Dept Gastroenterol, Leiden, Netherlands

[25] Univ Leeds, Leeds Inst Mol Med, Epidemiol & Biostat Sect, Leeds, W Yorkshire, England

[26] Beheshti Univ Med Sci, Sch Publ Hlth, Dept Epidemiol, Tehran, Iran

[27] Leiden Univ, Med Ctr, Ctr Human & Clin Genet, Leiden, Netherlands

[28] Erasmus Univ, Med Ctr, Dept Pathol, Rotterdam, Netherlands

[29] Creighton Univ, Med Ctr, Dept Preventat Med & Publ Hlth, Hereditary Canc Inst, Omaha, NE USA

来源：

LANCET ONCOLOGY | 2012年 / 13卷 / 12期

基金：

英国医学研究理事会;

关键词：

HIGH-FIBER DIET; COLONIC FERMENTATION; LOW-FAT; INTESTINAL TUMORIGENESIS; RECURRENCE; ASPIRIN; PREVENTION; BUTYRATE; APOPTOSIS; TIME;

D O I：

10.1016/S1470-2045(12)70475-8

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background Observational studies report that higher intake of dietary fibre (a heterogeneous mix including non-starch polysaccharides and resistant starches) is associated with reduced risk of colorectal cancer, but no randomised trials with prevention of colorectal cancer as a primary endpoint have been done. We assessed the effect of resistant starch on the incidence of colorectal cancer. Methods In the CAPP2 study, individuals with Lynch syndrome were randomly assigned in a two-by-two factorial design to receive 600 mg aspirin or aspirin placebo or 30 g resistant starch or starch placebo, for up to 4 years. Randomisation was done with a block size of 16. Post-intervention, patients entered into double-blind follow-up; participants and investigators were masked to treatment allocation. The primary endpoint for this analysis was development of colorectal cancer in participants randomly assigned to resistant starch or resistant-starch placebo with both intention-to-treat and per-protocol analyses. This study is registered, ISRCTN 59521990. Findings 463 patients were randomly assigned to receive resistant starch and 455 to receive resistant-starch placebo. At a median follow-up 52.7 months (IQR 28.9-78.4), 53 participants developed 61 primary colorectal cancers (27 of 463 participants randomly assigned to resistant starch, 26 of 455 participants assigned to resistant-starch placebo). Intention-to-treat analysis of time to first colorectal cancer showed a hazard ratio (HR) of 1.40 (95% CI 0.78-2.56; p=0.26) and Poisson regression accounting for multiple primary events gave an incidence rate ratio (IRR) of 1.15 (95% CI 0.66-2.00; p=0.61). For those completing 2 years of intervention, per-protocol analysis yielded a HR of 1.09 (0.55-2.19, p=0.80) and an IRR of 0.98 (0.51-1.88, p=0.95). No information on adverse events was gathered during post-intervention follow-up. Interpretation Resistant starch had no detectable effect on cancer development in carriers of hereditary colorectal cancer. Dietary supplementation with resistant starch does not emulate the apparently protective effect of diets rich in dietary fibre against colorectal cancer.

引用

页码：1242 / 1249

页数：8

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