叶酸与前列腺癌风险：随机临床试验结果
Folic acid and risk of prostate cancer: results from a randomized clinical trial
摘要关于叶酸水平与前列腺癌风险之间的关联，相关数据稀少且存在矛盾。我们在阿司匹林/叶酸息肉预防研究中研究了前列腺癌发生情况，该研究是一项安慰剂对照随机试验，研究阿司匹林和叶酸补充用于结直肠腺瘤化疗预防的试验，时间为1994年7月6日至2006年12月31日。参与者被随访长达10.8年（中位数=7.0年，四分位区间=6.0-7.8年），并定期要求报告所有疾病和住院情况。单独服用阿司匹林对前列腺癌发病率无统计学显著影响，但根据叶酸治疗存在显著差异。在643名随机分配接受安慰剂或叶酸补充的男性中，叶酸组10年内被诊断为前列腺癌的估计概率为9.7%（95%置信区间[CI] = 6.5%至14.5%），安慰剂组为3.3%（95% CI = 1.7%至6.4%）（年龄调整风险比=2.63， 95% CI = 1.23至5.65，Wald检验P = 0.01）。相比之下，非复合维生素使用者的基础膳食叶酸摄入量与血浆叶酸与前列腺癌风险呈负相关，尽管在调整后的分析中这些关联未达到统计学显著性。这些发现凸显了叶酸在前列腺癌中潜在的复杂作用，以及含叶酸补充剂与天然叶酸来源可能存在的不同影响。
AbstractData regarding the association between folate status and risk of prostate cancer are sparse and conflicting. We studied prostate cancer occurrence in the Aspirin/Folate Polyp Prevention Study, a placebo-controlled randomized trial of aspirin and folic acid supplementation for the chemoprevention of colorectal adenomas conducted between July 6, 1994, and December 31, 2006. Participants were followed for up to 10.8 (median = 7.0, interquartile range = 6.0-7.8) years and asked periodically to report all illnesses and hospitalizations. Aspirin alone had no statistically significant effect on prostate cancer incidence, but there were marked differences according to folic acid treatment. Among the 643 men who were randomly assigned to placebo or supplementation with folic acid, the estimated probability of being diagnosed with prostate cancer over a 10-year period was 9.7% (95% confidence interval [CI] = 6.5% to 14.5%) in the folic acid group and 3.3% (95% CI = 1.7% to 6.4%) in the placebo group (age-adjusted hazard ratio = 2.63, 95% CI = 1.23 to 5.65, Wald test P = .01). In contrast, baseline dietary folate intake and plasma folate in nonmultivitamin users were inversely associated with risk of prostate cancer, although these associations did not attain statistical significance in adjusted analyses. These findings highlight the potential complex role of folate in prostate cancer and the possibly different effects of folic acid-containing supplements vs natural sources of folate.
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