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The reduced risk of colorectal cancer associated with taking aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) may be confined to individuals already at risk because of elevations in a particular inflammatory factor in the blood.



In a report in the March issue of Gastroenterology, investigators from Dana-Farber Cancer Institute and Massachusetts General Hospital (MGH) report finding that higher baseline levels of a novel inflammatory marker indicated increased risk of developing colorectal tumors and also predicted who might benefit from taking aspirin or NSAIDs.



"These findings suggest that a blood biomarker may be helpful in deciding whether individuals should take aspirin or NSAIDs to reduce their cancer risk," says Andrew Chan, MD, MPH, of the MGH Gastrointestinal Unit, the paper's lead author. "They also indicate that chronic inflammatory pathways are quite complex and further studies are needed to understand which facets of the inflammatory response are most associated with the development of colorectal cancer."

該項論文首要撰文人,麻薩諸塞綜合醫院胃腸科的Andrew Chan醫學博士宣稱:「此些研究發現暗示,有種血液生物標記或許有助益於,決定個體是否應服用阿斯匹靈或非類固醇消炎藥物,來降低其該種癌腫風險。同時也顯示,諸多慢性發炎途徑十分複雜,因此需要進一步的研究,來瞭解哪些方面的發炎反應,與罹患結腸直腸癌最有關聯。」


In recent years, considerable research has supported the importance of inflammation in the development of chronic conditions such as cardiovascular disease and several forms of cancer. Many studies have found reduced incidence of colorectal cancer among individuals who regularly take aspirin or other NSAIDs, and disorders such as colitis and inflammatory bowel disease are known to increase the risk.



To investigate whether moderately elevated levels of chronic inflammation also raise the risk of colorectal cancer, the investigators analyzed data from the Nurses Health Study (NHS), which has followed more than 120,000 female registered nurses since 1976, gathering comprehensive health information from its participants every two years.



The current study analyzed data from NHS participants who had provided a blood sample in 1989 or 1990 and were cancer-free at that time. After identifying 280 participants who developed colorectal cancer during the subsequent 14 years and 555 age-matched controls who did not, the research team analyzed their baseline levels of three inflammatory factors — C-reactive protein (CRP), interleukin-6 (IL-6) and soluble tumor necrosis factor receptor-2 (sTNFR-2).

目前(2011)該項研究分析了,來自護士健康研究,在19891990年曾提供血液樣本,且當時無癌症之參與者的數據。在確認280名於隨後14年間罹患大腸癌的參與者,及555名年齡相稱沒有罹患的對照者之後,該研究團隊分析了,她們的C -反應蛋白(CRP是由肝臟生成的血漿蛋白,主要被當作發炎的指標)、白細胞介素-6 (IL-6:是一種多功能細胞因子,由於其免疫和造血活性的廣泛範圍及其誘導急性期反應的強大能力,在宿主防禦中起核心作用)及可溶性腫瘤壞死因子受-2(sTNFR-2)等,三種發炎因子的基線水平。


Although no association was seen between levels of CRP or IL-6 and risk of developing colorectal cancer, participants with the highest levels of sTNFR-2 had a 60 percent greater risk than did those with the lowest levels of the factor. In addition, the reduced risk of developing colorectal tumors associated with regularly taking aspirin or NSAIDs was primarily seen among participants with high baseline sTNFR-2 levels.

雖然未發現CRPIL-6與罹患結腸直腸癌風險間的關聯性,不過具有最高s TNFR-2水平的參與者,具有比該因子水平最低者多60%的風險。此外,與定期服用阿斯匹靈或非類固醇消炎藥物有所關連之罹患結腸直腸腫瘤降低的風險,主要是在具有高sTNFR-2基線水平的參與者中被發現。


"Our results suggest that, even though chronic inflammation may increase colorectal cancer risk, not all blood markers of inflammation are markers of that risk," says Chan. "The most common blood biomarkers of inflammation — CRP and IL-6 — do not appear to be relevant, while sTNFR-2 does. A better understanding of the significance of these markers will help us identify individuals most likely to benefit from chemoprevention using aspirin or NSAIDs."



Charles Fuchs, MD, MPH, of Dana-Farber, the study's senior author adds: "Understanding the specific inflammatory pathways that influence risk for colorectal cancer will be critical. While there is widespread agreement that inflammation is broadly related to cancer risk, some pathways may be protective while others are detrimental. More clearly defining the relevant pathways should help us better tailor therapies and interventions that will reduce cancer risk."

該項研究資深撰文人,達納法伯癌症研究所的Charles Fuchs醫學博士附言:「瞭解影響結腸直腸癌風險的特定發炎途徑,會是至關重要的。儘管有普遍的認同,發炎與癌症風險有廣泛關係。不過有些途徑可能具保護性,而其他是有害的。更明確界定有關聯的途徑,可能有助於人們更完善量身訂製,能降低癌症風險的療法及干預手段。


The study was supported by grants from the National Institutes of Health and the Damon Runyon Cancer Research Foundation.






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