增加蔬菜攝入量不能降低早期前列腺癌患者疾病進展的風險
美國加州大學圣地亞哥摩爾綜合癌癥中心J. Kellogg Parsons聯(lián)合羅斯韋爾公園綜合癌癥中心James Marshall課題組取得一項新突破。他們分析了增加蔬菜攝入的行為干預對早期前列腺癌患者癌癥進展的影響。相關論文2020年1月14日發(fā)表在《美國醫(yī)學會雜志》上。
基于專家意見、臨床前研究和觀察數(shù)據(jù)制定的指南，鼓勵前列腺癌幸存者多吃蔬菜以改善預后。
為了確定增加蔬菜攝入量對早期前列腺癌患者癌癥進展的影響，2011年1月至2017年8月，研究組在美國的91家泌尿外科和腫瘤內(nèi)科診所進行了一項隨機臨床試驗，共招募了478名50-80歲的男性，均經(jīng)活檢證實為前列腺癌，cT2a期及以下，血清前列腺特異性抗原（PSA）水平低于10ng/mL。將這些患者按1：1隨機分組，其中膳食干預組237名，研究組每天給患者打電話，敦促其保證每日食用7種以上蔬菜；對照組241名，僅給予關于飲食和前列腺癌的書面材料。
478名患者的平均年齡為64歲，平均PSA水平為4.9ng/mL，有443名患者納入主要分析。共有245名患者疾病進展，其中干預組124名，對照組121名，兩組的進展時間無顯著差異。干預組和對照組24個月的K-M無進展百分比分別為43.5%和41.4%。
研究結(jié)果表明，在接受積極檢測的早期前列腺癌患者中，增加蔬菜攝入量的行為干預并未顯著降低前列腺癌進展的風險。研究結(jié)果不支持前列腺癌患者多吃蔬菜來改善預后。
附：英文原文
Title: Effect of a Behavioral Intervention to Increase Vegetable Consumption on Cancer Progression Among Men With Early-Stage Prostate Cancer: The MEAL Randomized Clinical Trial
Author: J. Kellogg Parsons, David Zahrieh, James L. Mohler, Electra Paskett, Donna E. Hansel, Adam S. Kibel, Heshan Liu, Drew K. Seisler, Loki Natarajan, Martha White, Olwen Hahn, John Taylor, Sheri J. Hartman, Sean P. Stroup, Peter Van Veldhuizen, Lannis Hall, Eric J. Small, Michael J. Morris, John P. Pierce, James Marshall
Issue&Volume: 2020/01/14
Abstract:
Importance Guidelines endorsing vegetable-enriched diets to improve outcomes for prostate cancer survivors are based on expert opinion, preclinical studies, and observational data.
Objective To determine the effect of a behavioral intervention that increased vegetable intake on cancer progression in men with early-stage prostate cancer.
Design, Setting, and Participants The Men’s Eating and Living (MEAL) Study (CALGB 70807 [Alliance]) was a randomized clinical trial conducted at 91 US urology and medical oncology clinics that enrolled 478 men aged 50 to 80 years with biopsy-proven prostate adenocarcinoma (International Society of Urological Pathology grade group?=?1 in those <70 years and ≤2 in those ≥70 years), stage cT2a or less, and serum prostate-specific antigen (PSA) level less than 10 ng/mL. Enrollment occurred from January 2011 to August 2015; 24-month follow-up occurred from January 2013 to August 2017.
Interventions Patients were randomized to a counseling behavioral intervention by telephone promoting consumption of 7 or more daily vegetable servings (MEAL intervention; n?=?237) or a control group, which received written information about diet and prostate cancer (n?=?241).
Main Outcomes and Measures The primary outcome was time to progression; progression was defined as PSA level of 10 ng/mL or greater, PSA doubling time of less than 3 years, or upgrading (defined as increase in tumor volume or grade) on follow-up prostate biopsy.
Results Among 478 patients randomized (mean [SD] age, 64 [7] years; mean [SD] PSA level, 4.9 [2.1] ng/mL), 443 eligible patients (93%) were included in the primary analysis. There were 245 progression events (intervention: 124; control: 121). There were no significant differences in time to progression (unadjusted hazards ratio, 0.96 [95% CI, 0.75 to 1.24]; adjusted hazard ratio, 0.97 [95% CI, 0.76 to 1.25]). The 24-month Kaplan-Meier progression-free percentages were 43.5% [95% CI, 36.5% to 50.6%] and 41.4% [95% CI, 34.3% to 48.7%] for the intervention and control groups, respectively (difference, 2.1% [95% CI, ?8.1% to 12.2%]).
Conclusions and Relevance Among men with early-stage prostate cancer managed with active surveillance, a behavioral intervention that increased vegetable consumption did not significantly reduce the risk of prostate cancer progression. The findings do not support use of this intervention to decrease prostate cancer progression in this population, although the study may have been underpowered to identify a clinically important difference.
DOI: 10.1001/jama.2019.20207
Source: https://jamanetwork.com/journals/jama/article-abstract/2758598
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