增加蔬菜摄入量不能降低早期前列腺癌患者疾病进展的风险_前列腺癌

美国加州大学圣地亚哥摩尔综合癌症中心J. Kellogg Parsons联合罗斯韦尔公园综合癌症中心James Marshall课题组取得一项新突破。他们分析了增加蔬菜摄入的行为干预对早期前列腺癌患者癌症进展的影响。相关论文2020年1月14日发表在《美国医学会杂志》上。

基于专家意见、临床前研究和观察数据制定的指南，鼓励前列腺癌幸存者多吃蔬菜以改善预后。

为了确定增加蔬菜摄入量对早期前列腺癌患者癌症进展的影响，2011年1月至2017年8月，研究组在美国的91家泌尿外科和肿瘤内科诊所进行了一项随机临床试验，共招募了478名50-80岁的男性，均经活检证实为前列腺癌，cT2a期及以下，血清前列腺特异性抗原（PSA）水平低于10ng/mL。将这些患者按1：1随机分组，其中膳食干预组237名，研究组每天给患者打电话，敦促其保证每日食用7种以上蔬菜；对照组241名，仅给予关于饮食和前列腺癌的书面材料。

478名患者的平均年龄为64岁，平均PSA水平为4.9ng/mL，有443名患者纳入主要分析。共有245名患者疾病进展，其中干预组124名，对照组121名，两组的进展时间无显著差异。干预组和对照组24个月的K-M无进展百分比分别为43.5%和41.4%。

研究结果表明，在接受积极检测的早期前列腺癌患者中，增加蔬菜摄入量的行为干预并未显著降低前列腺癌进展的风险。研究结果不支持前列腺癌患者多吃蔬菜来改善预后。

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