Table CDR62763 Colorectal Cancer Prevention/结直肠癌预防
ID Type Description_en Description_zh
w1 Word Aspirin 阿司匹林
w2 Word Indication 适应证
w3 Word Risk 风险
w4 Word Vitamins 维生素
w5 Word Calcium 钙剂
w6 Word Authors 作者
w7 Word Consistency: Fair 一致性:一般
w8 Word Dose/Trial Drug 剂量/试验用药
w9 Word Physical activity 体力活动​
w10 Word Bile acids 胆汁酸
w11 Word Diet modification 饮食调整
w12 Word Estrogen-only therapy 仅雌激素治疗
w13 Word Consistency: Consistent 一致性:一致
w14 Word Polyp removal 息肉切除
w15 Word Calcium supplementation 钙剂补充
w16 Word Consistency: N/A 一致性:不适用
p1 Phrase Rofecoxib 25 mg/qd 罗非考昔25 mg/qd
p2 Phrase Chemoprevention sporadic adenoma 化学预防散发性腺瘤
p3 Phrase Nonsteroidal anti-inflammatory drugs 非甾体类抗炎药
p4 Phrase Definition of prevention 预防的定义
p5 Phrase Use of statins 他汀类药物
p6 Phrase External Validity: N/A 外部效度:不适用
p7 Phrase Excessive alcohol use 过度饮酒
p8 Phrase Risk increases with age 风险随年龄增长而增加
p9 Phrase Naproxen seemed least harmful 相对而言,萘普生的风险最低
p10 Phrase Study Design: Cohort studies 研究设计:队列研究
p11 Phrase Postmenopausal female hormone supplements 绝经后补充雌激素
p12 Phrase RCTs have been consistent RCT研究间结论一致
p13 Phrase Colorectal Cancer (PDQ®): Prevention 结直肠癌(PDQ®):预防​
p14 Phrase Who is at Risk 哪些人是结直肠癌的危险人群
p15 Phrase Study Design: Evidence from RCTs 研究设计:来自RCT的证据
p16 Phrase Hormone therapy (estrogen plus progestin) 激素治疗(雌激素联合孕激素)
p17 Phrase Internal Validity: Not applicable (N/A) 内部效度:不适用
p18 Phrase Nested case-control study all users ​巢式病例对照研究所有用户
p19 Phrase Dietary fiber, vegetables, and fruit 膳食纤维与蔬果
p20 Phrase Study Design: Cohort and RCTs 研究设计:队列与RCT
p21 Phrase Dietary fat and meat intake 摄取膳食脂肪与肉类
p22 Phrase Validity of dietary questionnaires used 选用的饮食调查问卷效度
p23 Phrase Study Design: Large cohort studies 研究设计:大型队列研究
p24 Phrase Study Design: Meta-analyses of RCTs 研究设计:RCT荟萃分析
p25 Phrase Study Design: One-hundred six observational studies 研究设计: 106项观察性研究
p26 Phrase Etiology and pathogenesis of colorectal cancer 结直肠癌的病因和发病机制
p27 Phrase Study Design: Cohort studies and meta-analysis 研究设计:队列研究与荟萃分析
p28 Phrase Study Design: One randomized controlled trial 研究设计:一项随机对照试验
p29 Phrase Rofecoxib <25 mg/qd; rofecoxib >25 mg/qd 罗非考昔<25 mg/qd;罗非考昔>25 mg/qd
p30 Phrase Sporadic adenoma prevention trial (N = 2,035) 散发性腺瘤预防试验(N=2,035)
p31 Phrase Study Design: Evidence obtained from large databases 研究设计:来自大型数据库的证据
p32 Phrase The overall 5-year survival rate is 64% 结直肠癌的5年生存率为64%
p33 Phrase Study Design: Evidence from retrospective cohort studies 研究设计:来自回顾性队列研究的证据
p34 Phrase Celecoxib 200 mg/qd vs 400 mg bid 塞来昔布200 mg/qd与400 mg bid
p35 Phrase External Validity: Good, data from national databases 外部效度:佳,数据来自美国国家数据库
p36 Phrase Study Design: Extended follow-up of four RCTs 研究设计:4项RCT的延期随访
p37 Phrase The analysis did not include fiber supplements 该分析不包括补充纤维素
s1 Sentence Interventions Associated With Decreased Risk of Colorectal Cancer 结直肠癌预防性干预措施
s2 Sentence Chemoprevention sporadic adenoma median study Rx 7.4 months 化学预防散发性腺瘤中位数研究,用药7.4个月
s3 Sentence Study Design: No adequate studies with CRC outcome 研究设计:尚无关注结直肠癌结局的充足研究
s4 Sentence Study Design: Randomized controlled trial and cohort studies 研究设计:随机对照试验和队列研究
s5 Sentence Interpretation of these studies can be quite complex 然而,如何解释研究结果非常复杂
s6 Sentence Factors Associated With Increased Risk of Colorectal Cancer 结直肠癌危险因素
s7 Sentence Cardiovascular Risks Associated With Celecoxib and Rofecoxib Dose/Drugs 塞来昔布与罗非考昔用药相关的心血管风险
s8 Sentence During the extended follow-up, the intervention was discontinued 延长随访期内,停止干预
s9 Sentence Factors associated with increased risk of colorectal cancer 结直肠癌危险因素
s10 Sentence OR = 1.47 (0.99–2.17) 3 vs 58 (1.27–10.17) OR = 1.47 (0.99–2.17) 3与58 (1.27–10.17)
s11 Sentence These substances include phenolic compounds, sulfur-containing compounds, and flavones 这些物质包括酚类化合物、含硫化合物与黄酮
s12 Sentence Factors Associated With a Decreased Risk of Colorectal Cancer 结直肠癌保护因素
s13 Sentence Differences in the average age of the population studied 研究人群平均年龄差异性
s14 Sentence External Validity: Good, studies have included large population-based studies 外部效度:佳,包括大型人群研究
s15 Sentence Serious cardiovascular events are increased by 50% to 60% 严重的心血管事件增加50%-60%
s16 Sentence Factors associated with a decreased risk of colorectal cancer 结直肠癌保护因素
s17 Sentence Other studies have corroborated the effects of dietary fiber 其他研究进一步证实了膳食纤维的作用
s18 Sentence Study Design: Observational studies, multiple RCTs, and a review 研究设计:观察性研究,多项RCT与1项综述
s19 Sentence The incidence of adverse events was similar among the groups 各组的不良事件发生率相近
s20 Sentence RR (estimated) = 2.66 (95% CI, 1.03–6.86; P = .04) RR(估值)=2.66(95% CI,1.03–6.86;P=0.04)
s21 Sentence Based on solid evidence, the harms of statins are small 证据充分:他汀类药物的危害较小
s22 Sentence Individual patient data for all in-trial cancer deaths were obtained 同时研究提供了研究期间所有患者癌症数据
s23 Sentence Further research is needed before this finding can be accepted 因此该研究结果需要进一步研究证实
s24 Sentence Internal Validity: Fair, but measurement error is a potential problem 内部效度:一般,测量误差可能存在
s25 Sentence Harms of treatment included upper gastrointestinal hemorrhage and hemorrhagic stroke 治疗并发症包括上消化道出血和出血性卒中
s26 Sentence The primary effect was on mortality from proximal colon cancer 主要是降低近端结肠癌的死亡率
s27 Sentence Variability in the consumption of other foods such as vegetables 蔬菜等其他食物摄入量的差异性
s28 Sentence Study Design: Pooled and individual prospective cohort studies plus RCTs 研究设计:汇总分析与单项前瞻性队列研究以及RCT
s29 Sentence Magnitude of Effect: Seven to nine events per 1,000 procedures 效应强度:每1,000次操作7-9例不良事件
s30 Sentence Fecal-total and secondary bile acid excretion increased during oat fiber supplementation 补充燕麦纤维后,粪便中总胆汁酸与次级胆汁酸的分泌量增加
s31 Sentence Selective COX-2 inhibitors include celecoxib (Celebrex), rofecoxib (Vioxx), and valdecoxib (Bextra) 选择性COX-2抑制剂包括塞来昔布(西乐葆)、罗非考昔(万络)与伐地考昔(Bextra)
s32 Sentence The incidence of reported major gastrointestinal bleeding events appears to be dose-related 研究报道,胃肠道出血发生率可能与用药剂量呈正相关
s33 Sentence Human studies using the labeling index are dependent on a complex methodology 人群研究使用的标记指数其方法学十分复杂
s34 Sentence Retrospective cohort studies also show the harms associated with polypectomy, including bleeding 一些回顾性队列研究也发现息肉切除术存在相关并发症,包括出血等
s35 Sentence Study Design: Evidence obtained from cohort studies and one RCT of sigmoidoscopy 研究设计:来自队列研究和1项乙状结肠镜RCT的证据
s36 Sentence There is evidence of an association of CRC with alcoholic beverage consumption 有证据表明结直肠癌与饮酒有关
s37 Sentence Interventions associated with a decreased risk of colorectal cancer: Benefits and harms 结直肠癌预防性干预措施:获益与危害
s38 Sentence The results of other ongoing adenoma recurrence studies are awaited with interest 其他有关腺瘤复发研究正在进行,其结果备受关注
s39 Sentence Four trials that demonstrated this increased risk are summarized in the Table 下表总结了证实用药会增加并发症风险的4项试验
s40 Sentence External Validity: Fair, most data from British men; fewer data from women 外部效度:一般,大部分数据来自英国男性;女性数据较少
s41 Sentence There was no increase in benefit at doses more than 75 mg/day 剂量大于75 mg/日并不增加获益
s42 Sentence Other major harms from all NSAIDs are gastrointestinal bleeding and renal impairment 非甾体类抗炎药的常见副作用还包括胃肠道出血和肾损伤
s43 Sentence Significant RR was not observed, however, until more than 10 years of use 仅当用药超过10年后,才观察到显著的RR
s44 Sentence Five studies have reported a positive association between alcohol intake and colorectal adenomas 5项研究发现饮酒与结直肠腺瘤之间存在正相关性
s45 Sentence At sigmoidoscopy, polyps were removed and cancer was detected and referred for treatment 若镜下如发现息肉则行切除术,如发现肿瘤则转诊进行治疗
s46 Sentence Based on fair evidence, removal of adenomatous polyps reduces the risk of CRC 证据一般:切除腺瘤性息肉降低结直肠癌风险
s47 Sentence About 5% of Americans are expected to develop the disease within their lifetimes 5%的美国人一生中可能患上结直肠癌
s48 Sentence Study Design: Evidence obtained from pooled analyses of multiple cohort studies and RCTs 研究设计:多项队列研究与RCT汇总分析所得证据
s49 Sentence Study Design: Evidence obtained from RCTs and high quality systematic reviews and meta-analyses 研究设计:来自RCT以及高质量的系统综述和荟萃分析的证据
s50 Sentence The absolute 20-year risk reduction in fatal CRC was 1.76% (95% CI, 0.61–2.91) 致死性结直肠癌20年风险绝对降低1.76%(95%CI,0.61-2.91)
s51 Sentence After calcium supplementation is stopped, the lower risk may persist up to 5 years 停止补充钙剂后,风险降低可持续5年
s52 Sentence The evidence is inadequate to determine whether calcium supplementation reduces the risk of CRC 缺乏可靠证据判断钙剂补充能否降低结直肠癌风险
s53 Sentence Case-control studies suggest a modest-to-strong positive relationship between alcohol consumption and large bowel cancers 1项病例对照研究发现饮酒与结直肠癌之间存在中度-高度正相关性
s54 Sentence Based on solid evidence, statins do not reduce the incidence or mortality from CRC 证据充分:他汀类药物不能降低结直肠癌发病率或死亡率
s55 Sentence Based on solid evidence, obesity is associated with increased incidence and mortality from CRC 证据充分:肥胖会增加结直肠癌的发病和死亡风险
s56 Sentence The NCI has booklets and other materials for patients, health professionals, and the public NCI为患者、医疗专业人员和大众撰写了一系列手册和其他材料
s57 Sentence For rectal cancer, most studies have observed no association or a slightly elevated risk 对于直肠癌而言,多数研究发现绝经后补充雌激素不降低或轻微增加直肠癌风险
s58 Sentence In an RCT, 170,000 persons were randomly assigned to one-time sigmoidoscopy versus usual care 一项170,000例参与者的RCT将研究对象随机分配到乙状结肠镜组(单次)和常规医疗组
s59 Sentence A diet low in fat and meat and high in fiber, fruits, and vegetables 低脂、少肉、高纤维、多果蔬饮食
s60 Sentence Based on solid evidence, cigarette smoking is associated with increased incidence and mortality from CRC 证据充分:吸烟与结直肠癌发病率与死亡率的增加相关
s61 Sentence In adults younger than 50 years, CRC incidence rates increased by about 1.1% per year 50岁以下成年人的结直肠癌发病率每年增加约1.1%
s62 Sentence Magnitude of Effect: Unknown, probably greater for larger polyps (i.e., &gt;1.0 cm) than smaller ones 效应强度:不明确,大息肉(即>1.0 cm的息肉)的效果可能优于小息肉
s63 Sentence Numerous observational studies that have examined the relationship between physical activity and colon cancer risk 大量观察性研究曾探讨结肠癌风险与体力活动之间的相关性
s64 Sentence There are, however, several unresolved issues that mitigate against making general recommendations for their use 但有些问题尚未解决,因此目前不能推荐常规使用非甾体类抗炎药
s65 Sentence There is no high-quality evidence from either observational studies or RCTs to substantiate this claim 但目前没有高质量的观察性研究或者RCT证据支持这一假说
s66 Sentence Protocol compliance and medical incidences were tracked via identical annual questionnaires throughout the 18-year period 通过相同的调查问卷记录进行18年研究方案依从性及医疗事件记录
s67 Sentence Based on solid evidence, regular physical activity is associated with a decreased incidence of CRC 证据充分:规律性体力活动可降低大肠癌发病风险
s68 Sentence The potential for the use of NSAIDs as a primary prevention measure is being studied 非甾体类抗炎药作为一级预防措施的潜在应用正在研究
s69 Sentence Most animal and epidemiologic studies show a protective effect of dietary fiber on colon carcinogenesis 大多动物研究与流行病学研究显示膳食纤维对结肠癌的发生有保护作用
s70 Sentence Most case-control studies of cigarette exposure and adenomas have found an elevated risk for smokers 多数关于吸烟与腺瘤的病例对照研究发现吸烟者腺瘤发病风险升高
s71 Sentence A number of prospective cohort studies have been conducted in the United States and abroad 在美国和其他国家有多项前瞻性队列研究已经开展
s72 Sentence COX is important in the transformation of arachidonic acid into prostanoids, prostaglandins, and thromboxane A2 COX在花生四烯酸转化为前列腺素类、前列腺素与血栓素A2的过程中发生重要作用
s73 Sentence For both incidence and mortality, the association was stronger for rectal cancer than for colon cancer 无论是发病率还是死亡率,吸烟与直肠癌关联强度大于结肠癌
s74 Sentence In laboratory studies, a high-fat intake increases the incidence of induced colon tumors in experimental animals 实验发现动物摄入大量脂肪增加结肠肿瘤发生率
s75 Sentence Both study groups have higher calcium intakes, mainly milk and dairy products, than the national average 两个研究组的钙剂摄入量高于全国平均值,主要来源于牛奶和其他奶制品的饮用
s76 Sentence For the past 20 years, the mortality rate has been declining in both men and women 在过去20年内,男性与女性死亡率均有所降低
s77 Sentence Overall, evidence indicates that statin use neither increases nor decreases the incidence or mortality of CRC 综上,证据表明他汀类药物对结直肠癌发病与死亡没有作用
s78 Sentence Six case-control studies and two cohort studies have explored potential dietary risk factors for colorectal adenomas 6项病例对照、2项队列共8项研究探索了结直肠腺瘤的饮食危险因素
s79 Sentence The low dose of ASA and the short treatment period may account for the null findings 水杨酸使用剂量较低与治疗时间较短可能是导致阴性结果的原因
s80 Sentence A central effect of bile acids in the etiology and pathogenesis of CRC has been claimed 有研究提出胆汁酸在结直肠癌的病因及病理发生机制中起重要作用
s81 Sentence Medical record reviews by a panel of experts blinded to random assignment confirmed the endpoints reported 根据随机盲法原则,一组专家对医疗记录进行审核并确认报告终点事件
s82 Sentence Thus, the evidence is inadequate to determine whether reducing dietary fat and meat would reduce CRC incidence 因此,目前关于减少脂肪与肉类摄入是否能降低结直肠癌发病率证据尚不充分
s83 Sentence There is inadequate evidence that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) reduces the risk of CRC 尚无充分证据证明使用非甾体类抗炎药(NSAIDs)能降低结直肠癌的发病风险
s84 Sentence Indirect effects on bile acid metabolism and a direct effect on colonic epithelial cells are also possible 钙剂也有可能间接影响胆汁酸代谢或直接影响结肠上皮细胞
s85 Sentence A meta-analysis found that the association did not vary by sex or location within the large bowel 一项荟萃分析发现这一相关性与年龄及病变部位无关
s86 Sentence Rofecoxib and valdecoxib are no longer marketed because of an associated increased risk of serious cardiovascular events 罗非考昔与伐地考昔因增加心血管事件发生风险不再上市
s87 Sentence Likewise, there was no benefit of the low-fat diet on all-cancer mortality, overall mortality, or cardiovascular disease 同时,研究发现低脂饮食对所有癌症死亡率、全死因死亡率及心血管疾病并不能带来益处
s88 Sentence At least three large cohort studies have found an association between obesity and CRC incidence or mortality 3项以上大规模队列研究已证实结直肠癌的发病或死亡与肥胖相关
s89 Sentence Harms of treatment were similar in the two groups and included upper gastrointestinal bleeding and hemorrhagic stroke 这两组的治疗风险相似,包括上消化道出血与出血性卒中
s90 Sentence Folic acid ingestion was associated with higher risks of having three or more adenomas and of non-CRCs 叶酸能增加3个及以上腺瘤和非结直肠腺瘤发生风险
s91 Sentence Consistency: Good for effect on incidence; N/A for effect on mortality; results were based on one trial 一致性:对于降低发病率的效果佳;对减低死亡率的影响不适用;结果基于单一试验
s92 Sentence Based on solid evidence, harms of ASA use include excessive bleeding, including gastrointestinal bleeds and hemorrhagic stroke 证据充分:服用阿司匹林的危害包括异常出血,如胃肠道出血和出血性卒中
s93 Sentence Based on fair evidence, calcium supplementation with vitamin D at doses less than 1,000 has few harms 证据一般:同时补充剂量低于1,000 mg的钙剂与维生素D几乎无危害
s94 Sentence Several but not all epidemiologic studies have observed an inverse relationship between calcium intake and cancer risk 部分流行病学研究(并非所有研究)发现癌症风险与钙剂之间存在负相关性
s95 Sentence Based on solid evidence, the major harms of polyp removal include perforation of the colon and bleeding 证据充分:切除息肉的主要危害包括结肠穿孔与出血
s96 Sentence Hence, effective primary and secondary preventive approaches must be developed to reduce the morbidity and mortality from CRC 因此必须开展有效的一级和二级预防措施以降低结直肠癌发病与死亡
s97 Sentence Genetics, experimental, and epidemiologic studies suggest that CRC results from complex interactions between inherited susceptibility and environmental factors 遗传学、实验、与流行病学研究均表明结直肠癌是遗传易感性和环境因素共同作用的结果
s98 Sentence Several observational studies have suggested a decreased risk of colon cancer among users of postmenopausal female hormone supplements 一些观察性研究发现绝经后补充雌激素的女性患结肠癌的风险降低
s99 Sentence Based on solid evidence, combined hormone therapy (conjugated equine estrogen and progestin) decreases the incidence of invasive CRC 证据充分:联合激素治疗(马结合雌激素和孕激素)降低侵袭性结直肠癌的发病率
s100 Sentence A sedentary lifestyle has been associated in some but not all studies with an increased risk of CRC 有研究发现久坐会增加结直肠癌发病风险,但也有研究得出不同结论
s101 Sentence In the Nurses’ Health Study, the minimum induction period for cancer appears to be at least 35 years “护士健康研究”发现癌症诱导期需要至少35年
s102 Sentence In a population-based case-control study, an inverse relationship between vitamin D intake and risk of CRC was found 一项基于人群的病例对照研究发现CRC风险与维生素D的摄入量之间存在负相关性
s103 Sentence The evidence on whether dietary fiber exerts a protective role in reducing the incidence of CRC is mixed 关于膳食纤维是否有助于降低结直肠癌发病率的证据尚不一致
s104 Sentence Based on fair evidence, conjugated equine estrogens do not affect the incidence of, or survival from, invasive CRC 证据一般:马结合雌激素不影响侵袭性结直肠癌的发病率或生存率
s105 Sentence There was no effect modification by sex, age, smoking, alcohol use, BMI, baseline plasma folate, or ASA use 该研究结果不受性别、年龄、吸烟、饮酒、BMI、基线血浆叶酸含量或水杨酸用药情况影响
s106 Sentence Explanations for the conflicting results regarding whether dietary fat or meat intake affects the risk of CRC include: 膳食脂肪或肉类的摄入是否影响结直肠癌的发生风险存在争议,可能的原因包括:
s107 Sentence A 50% increase in risk was associated with smoking more than a pack a day relative to never smoking 和从不吸烟者相比,每天吸烟大于1包者发病风险可增加50%
s108 Sentence The exact nature and contribution of these factors to CRC incidence and mortality is the subject of ongoing research 然而,具体因素及其在结直肠癌的发生和死亡中的作用有待进一步的研究
s109 Sentence In Norway, an increased risk for processed meat only was found, a finding that was confirmed in the Netherlands 一项挪威研究仅发现结直肠癌与经加工的肉制品摄入过多有关,荷兰一项研究发现类似结论
s110 Sentence However, use was assessed at only one time, and there is no information about dose or duration of use 但该研究仅评估了一次,并未提供剂量、用药时间信息
s111 Sentence Some but not all observational evidence indicates that this reduction may be greater for left-sided CRC than for right-sided CRC 部分观察性研究发现,该效应在左半部结直肠癌比右半部结直肠癌更显著
s112 Sentence Based on solid evidence from observational studies, excessive alcohol use is associated with an increased risk of colorectal cancer (CRC) 基于观察性研究的充分证据表明,过度饮酒与结直肠癌(CRC)的发病风险增高相关
s113 Sentence Four reports in 2007, 2010, 2011, and 2012 have analyzed long-term follow-up of RCTs of daily ASA versus the control 2007、2010、2011与2012年分别发表的4篇文章都是对每日服用水杨酸与安慰剂的人群进行长期随访的RCT
s114 Sentence Colon cancer rates are high in populations with high total fat intakes and are lower in those consuming less fat 脂肪摄入总量较高的人群结肠癌发病率较高,脂肪摄入较少人群相对较低
s115 Sentence Variations in methods of meat preparation (in some instances, mutagenic and carcinogenic HCAs could have been released at high temperatures) 肉类烹饪方法差异(高温烹饪可能导致致突变、致癌性HCA的释放)
s116 Sentence Several rigorous studies have demonstrated the effectiveness of sulindac in reducing the size and number of adenomas in familial polyposis 一些严格设计的研究已证实舒林酸能有效降低家族性息肉病患者腺瘤的大小和数目
s117 Sentence Further, details are not clear about exactly what the program of colonoscopy was that may have led to decreased mortality 此外,仍不明确何种结肠镜检查方案可能导降低死亡率
s118 Sentence Note: Separate PDQ summaries on Colorectal Cancer Screening ; Colon Cancer Treatment ; and Rectal Cancer Treatment are also available 注:关于结直肠癌分类数据总结查询详见板块:结直肠癌的筛查,结肠癌的治疗以及直肠癌的治疗
s119 Sentence Consistency: Poor (one meta-analysis of 11 RCTs for calcium alone found increased myocardial infarction; no other individual studies found this) 一致性:差(对11项单独补充钙剂的RCT行荟萃分析,发现心肌梗死风险升高,但没有单项研究发现类似结论)
s120 Sentence It is proposed that diacylglycerol enters the cell directly, stimulating protein kinase C, which is involved in intracellular signal transduction 有假说提出二酰甘油直接进入细胞刺激分泌蛋白激酶C,而蛋白激酶C继而参与细胞内信号传导
s121 Sentence Based on fair evidence, combination conjugated equine estrogen and progestin has little or no benefit in reducing mortality from CRC 证据充分:马结合雌激素联合孕激素治疗对于降低结直肠癌的死亡率只有极少或没有益处
s122 Sentence The intervention promoted a goal of reducing total fat intake by 20%, while increasing daily intake of vegetables, fruits, and grains 干预目的是减少20%的总脂肪摄入同时增加蔬果和谷物的摄入
s123 Sentence Between 2005 and 2009, the mortality rate declined by 2.4% per year in men and by 3.1% per year in women 2005-2009年,男性死亡率每年降低2.4%,女性死亡率每年降低3.1%
s124 Sentence Celecoxib reduces the incidence of adenomas; however, celecoxib does not have a clinical role in reducing the risk of sporadic CRC 塞来昔布可降低腺瘤发病率,但不能降低散发性结直肠癌发生风险
s125 Sentence Butyrate has been shown to have anticarcinogenic effects in vitro and is regarded as an important fuel for the colonic epithelium 体外研究发现丁酸盐具有抗癌活性,且丁酸盐是结肠上皮生长的重要原料
s126 Sentence The concentration of bile acids in the colon is heavily influenced by the amount and type of fat in the diet 饮食中脂肪含量与脂肪类型也会显著影响胆汁酸浓度
s127 Sentence In addition, a significantly increased risk of adenoma recurrence following polypectomy has been associated with smoking in both men and women 此外,有研究发现不论男性或女性腺瘤患者,吸烟者息肉切除术后腺瘤复发风险明显增加
s128 Sentence The study included a total of 1,743,645 person-years of follow-up, 937 cases of colon cancer, and 244 cases of rectal cancer 该研究总计随访1,743,645人年,共937例结肠癌,244例直肠癌
s129 Sentence In trials with allocation to ASA of at least 5 years, the 20-year HR for CRC mortality was 0.60 (95% CI, 0.45–0.81) 包含水杨酸服用至少5年组的研究中,20年结直肠癌死亡HR为0.60(95%CI,0.45-0.81)
s130 Sentence Although positive associations with meat consumption or with fat intake have been found frequently, the results have not always achieved statistical significance 虽然多数研究表明结肠癌与肉类或脂肪的摄入呈正相关,但部分研究结果没有统计学差异
s131 Sentence The WHS, however, showed no relationship between CRC in women and the use of 600 IU of vitamin E every other day 但WHS并未发现女性结直肠癌发生风险与隔日服用600 IU维生素E之间存在相关性
s132 Sentence A meta-analysis of cohort studies observed a RR of 0.86 (95% CI, 0.76–0.97) for incidence of CRC associated with combined hormone therapy 一项基于队列研究的荟萃分析显示,联合激素治疗组结直肠癌发病RR为0.86(95%CI,0.76-0.97)
s133 Sentence The investigators found the effect of calcium was similar across age, sex, and baseline dietary intake categories of calcium, fat, or fiber 研究者发现各年龄、性别、基线摄入钙、脂肪或纤维类别不影响钙剂效果
s134 Sentence There was little evidence, however, of a benefit for higher as compared with moderate consumption (more than vs. fewer than 3.5 servings) 但较高摄入量与中等摄入量相比(超过与小于3.5份相比)并没有差异性
s135 Sentence Consistency: Some inconsistency, with one large pooled study finding a reduced risk of distal colon cancer associated with fruit and vegetable intake 一致性:与一项大型汇总研究的结果存在不一致,该研究发现果蔬摄入可降低远端结肠癌的风险
s136 Sentence Although far from clear-cut, the available evidence suggests CRC risk is possibly associated with some interaction of dietary fat, protein, and caloric intake 虽然基于目前证据不能完全确定,但可提示结直肠癌与膳食中的脂肪、蛋白质、能量共同作用可能有关
s137 Sentence A meta-analysis of 52 observational studies found an overall adjusted RR of 0.76 (95% CI, 0.72–0.81), with similar results for men and women 对52项观察性研究行荟萃分析发现,体力活动对结肠癌的发生调整RR值值为0.76(95%CI,0.72-0.81),男性与女性无差异
s138 Sentence There was no evidence of reduction in invasive CRCs between the intervention and comparison groups with a HR of 1.08 (95% CI, 0.90–1.29) 干预组与对照组间非侵袭性结直肠癌发病率没有差异性,HR为1.08(95% CI, 0.90–1.29)
s139 Sentence Both celecoxib and rofecoxib have been associated with serious cardiovascular events including dose-related death from cardiovascular causes, myocardial infarction, stroke, or heart failure 塞来昔布与罗非考昔与严重心血管事件相关,包括与剂量相关的心血管疾病死亡、心肌梗死、卒中或心力衰竭
s140 Sentence Several case-control studies have explored the association of colon cancer risk with meat or fat consumption as well as protein and energy intake 一些病例对照研究探讨了结肠癌发生风险与肉类或脂肪、蛋白质及能量摄入量之间的相关性
s141 Sentence The 2011 analysis examined data from eight RCTs, seven of which provided individual patient data and three of which provided 20-year follow-up data 2011年分析综合了8项RCT的数据,其中7项研究提供了原始数据,其中3项研究提供了20年随访数据
s142 Sentence The NSAID piroxicam, at a dose of 20 mg/day, reduced mean rectal prostaglandin concentration by 50% in individuals with a history of adenomas 对于有腺瘤病史患者,服用吡罗昔康20 mg/日平均可降低直肠前列腺素浓度达50%
s143 Sentence Between 2005 and 2009, CRC incidence rates in the United States declined by 4.1% per year among adults aged 50 years and older 2005-2009年,美国50岁以上成人结直肠癌发病率每年降低4.1%
s144 Sentence Unlike the Seventh Day Adventists, however, the Mormon group had a consumption of meats and fat similar to that of the general population 但与基督复临安息日会教徒不同,该研究发现摩门教徒的肉类、脂质摄入量与普通人群相近
s145 Sentence Based on solid evidence, NSAIDs reduce the risk of adenomas, but the extent to which this translates into a reduction of CRC is uncertain 证据充分:非甾体类抗炎药可降低腺瘤的发病风险,但能否表明降低结直肠癌的发病率尚不明确
s146 Sentence Despite advances in surgical techniques and adjuvant therapy, there has been only a modest improvement in survival for patients who present with advanced neoplasms 尽管手术与辅助治疗有了长足发展,但晚期肿瘤患者的生存率只有微弱改善
s147 Sentence An increased bile acid concentration in the intestinal tract accompanies a high-fat diet because bile acids are released from the gallbladder after fat ingestion 脂肪消化过程会促进胆囊释放胆汁酸,故消化道中胆汁酸浓度增高与高脂饮食相关
s148 Sentence A randomized controlled dietary modification study was undertaken among 48,835 postmenopausal women aged 50 to 79 years who were also enrolled in the WHI 一项随机对照饮食研究在参与了WHI 的50-79岁绝经后女性中开展,共纳入48,835个研究对象
s149 Sentence The intervention group accomplished a reduction of fat intake of approximately 10% more than did the comparison group during the 8.1 years of follow-up 8.1年随访时间内,干预组的脂肪摄入约比对照组减少10%
s150 Sentence The potential mechanism of action of bile salts in colorectal carcinogenesis is unknown, although it has been suggested that it is mediated by diacylglycerol 胆盐对结直肠癌发生的作用机制尚不明确,但有研究提出经二酰甘油可能介导这一作用
s151 Sentence Nonselective COX inhibitors include indomethacin (Indocin); sulindac (Clinoril); piroxicam (Feldene); diflunisal (Dolobid); ibuprofen (Advil, Motrin); ketoprofen (Orudis); naproxen (Naprosyn); and naproxen sodium (Aleve, Anaprox) 非选择性COX抑制剂包括吲哚美辛(消炎痛)、舒林酸(奇诺力)、吡罗昔康(费啶)、二氟尼柳(Dolobid)、布洛芬(艾德维尔、美林)、酮洛芬(Orudis)、萘普生(消痛灵)与萘普生钠(Aleve、Anaprox)
s152 Sentence Expert-reviewed information summary about factors that may influence the risk of developing colorectal cancer and about research aimed at the prevention of this disease 经专家审核后的结直肠癌危险因素及其预防相关研究汇总
s153 Sentence During the intervention phase, women were randomly assigned to receive either an annual supply of aspirin (100 mg) or placebo, taken every other day 干预期内女性被随机分配到阿司匹林组或安慰组剂,隔天服用100 mg
s154 Sentence A third report that adds extended follow-up of an additional two RCTs (with a meta-analysis of all four RCTs) adds certainty to this conclusion 另一项依据另外2项RCT的延长随访结果(以及对这4项RCT的荟萃分析)结果报道也肯定了这一结论
s155 Sentence It is estimated that there will be 142,820 new cases diagnosed in the United States in 2013 and 50,830 deaths due to this disease 据估计,2013年美国将有142,820例结直肠癌新发病例,50,830例结直肠癌死亡病例
s156 Sentence The estrogen-only intervention component of the WHI was conducted among women who had a hysterectomy, with CRC incidence included as a secondary trial endpoint WHI实验单纯雌激素治疗组仅纳入子宫切除术后女性患者,将结直肠癌发病率作为第二结局指标
s157 Sentence Another large population-based case-control study supports the view that current tobacco use and tobacco use within the last 10 years is associated with colon cancer 另一项病例对照研究发现,现在吸烟与过去10年内有吸烟史也增加结肠癌发病风险
s158 Sentence On the basis of CPS II data, it was estimated that 12% of CRC deaths in the U.S. population in 1997 were attributable to smoking 根据CPS II提供的数据,1997年美国12%的结直肠癌死亡归因于吸烟
s159 Sentence Magnitude of Effect: The estimated average excess risk of upper gastrointestinal complications in average-risk people attributable to NSAIDs is 4/1,000 to 5/1,000 people per year 效应强度:在一般人群中使用非甾体类抗炎药引起上消化道并发症的人群归因危险度估计为4/1,000到5/1,000人年
s160 Sentence bid = twice a day; qd = every day; CI = confidence interval; HR = hazard ratio; OR = odds ratio; RR = relative risk bid=每日2次;qd=每日1次;CI=置信区间;HR=风险比;OR=比值比;RR=相对风险
s161 Sentence Based on solid evidence, harms of postmenopausal combined estrogen plus progestin hormone use include increased risk of breast cancer, coronary heart disease, and thromboembolic events 证据充分:绝经后雌激素联合孕激素治疗的危害包括增加乳腺癌、冠心病和血栓栓塞性疾病的风险
s162 Sentence The cause of reduced risk—whether due to detection and removal of large polyps or small ones, or selection of individuals at lower risk—is yet unclear 目前尚不明确风险降低的原因是检出并切除了大息肉或者小息肉,还是选择了低危人群
s163 Sentence Many epidemiologic studies have examined the relationship between fruit and vegetable intake and the incidence of colon and/or rectal cancer, with considerable variation in findings 很多流行病学研究探索了果蔬摄入量与结肠和(或)直肠癌发病率之间的关系,但结果差异很大
s164 Sentence A randomized placebo-controlled trial tested the effect of calcium supplementation (3 g calcium carbonate daily [1,200 mg elemental calcium]) on the risk of recurrent adenoma 一项随机安慰剂对照试验研究了补充钙剂(每日3g碳酸钙[1,200 mg元素钙])对降低腺瘤复发风险的作用
s165 Sentence A systematic review of 46 observational studies of ASA and CRC in 2007 found a reduction in CRC (odds ratio [OR] for any use 0.80 [0.73–0.87]) 2007年一篇总结46项水杨酸与结直肠癌发病的观察性研究的系统综述发现,服用水杨酸后结直肠癌发病率降低(任何形式服药的比值比[OR]为0.80[0.73-0.87])
s166 Sentence It has been hypothesized that orally ingested calcium lowers colon cancer risk by binding bile acids and fatty acids, thereby reducing exposure to toxic intraluminal compounds 有假说认为口服钙剂通过结合胆汁酸与脂肪酸,降低肠内毒素暴露,从而降低结肠癌发生风险
s167 Sentence There are no known harms from dietary modification, including reduction of fatty acids or meats and an increase in the intake of fiber, fruits, and vegetables 目前尚未发现饮食调整有危害,包括减少摄入脂肪酸或肉类,增加纤维、果蔬摄入等
s168 Sentence Colorectal cancer (CRC) is the third most common malignant neoplasm worldwide and the second leading cause of cancer deaths (irrespective of gender) in the United States 结直肠癌(CRC)列全球最常见恶性肿瘤第三位,列美国癌症死因第二位(不分性别)
s169 Sentence A meta-analysis of 13 case-control studies from nine countries concluded that intake of fiber-rich foods is inversely related to cancers of both the colon and rectum 对9国13项病例对照研究行荟萃分析,发现结肠癌和直肠癌与高纤维饮食呈负相关
s170 Sentence On average, fat comprises 40% to 45% of total caloric intake in high-incidence Western countries; in low-risk populations, fat accounts for only 10% of dietary calories 在发病率较高的西方国家,脂肪占摄入能量总量的40%-45%,而在低危人群中,脂肪仅占10%
s171 Sentence Experimental studies in rodents and some but not all human studies have described a decrease in colonic epithelial cell proliferation after the administration of calcium citrate 啮齿类动物研究及部分人群研究(但非所有)发现摄入柠檬酸钙后结肠上皮细胞增生减少
s172 Sentence No relationship was found between cigarette smoking, even smoking of long duration, and recurrence of adenomas in a population followed for 4 years after initial colonoscopy 另一项对首次结肠镜检查后病人进行4年随访的研究发现,吸烟、甚至长期吸烟与腺瘤复发没有相关性
s173 Sentence Fiber may act as a substrate for bacterial fermentation with a resultant increase in bacterial mass and the production of short-chain fatty acids, typified by butyrate 纤维还可作为细菌发酵的底物,增加细菌量,产生短链脂肪酸(主要为丁酸盐)
s174 Sentence Much of this reduction likely comes from removal of large (i.e., &gt;1.0 cm) polyps, while the benefit of removing smaller polyps—which are much more common—is unknown 风险降低可能主要是因为切除了较大息肉(即>1.0 cm),而更为常见的小息肉的获益并不明确
s175 Sentence Primary prevention involves the use of medications or other interventions before the clinical appearance of CRC with the intent of preventing clinical CRC and CRC mortality 一级预防包括在出现结直肠癌临床症状前,使用药物或其他干预措施,以预防临床结直肠癌发生和死亡
s176 Sentence The excess risk varies with the underlying gastrointestinal risk, however, it likely exceeds ten extra cases per 1,000 people per year in more than 10% of users 随胃肠道风险不同人群归因危险度各异,但超过10%用药者的人群归因危险度很可能超过10/1,000人年
s177 Sentence Most of these studies have shown an inverse relationship between level of physical activity and colon cancer incidence. The average RR reduction is reportedly 40% to 50% 其中,多数研究发现结肠癌发生与体力活动呈负相关,平均RR降低40%-50%
s178 Sentence The Women’s Health Initiative (WHI) trial examined, as a secondary endpoint, the effect of combined estrogen and progestin therapy and estrogen-only therapy on CRC incidence and mortality 女性健康倡导(WHI)临床研究分别评估雌孕激素联合治疗和单纯雌激素治疗对结直肠癌发病率及死亡率的影响,并作为该研究的第二结局指标
s179 Sentence Although some case-control studies have shown a reduction in risk, neither a large cohort study nor a meta-analysis of four RCTs found any effect of statin use 尽管一些病例对照研究得出保护性的结论,但大型队列研究与RCT的荟萃分析均未发现两者间的相关性
s180 Sentence The term fiber is used to describe a complex mixture of compounds, including insoluble fiber (typified by wheat bran and cellulose) and soluble fiber (usually dried beans) “纤维”一词用于描述多种化合物的混合物,包括不可溶性纤维(典型代表为麦麸与纤维素)和可溶性纤维(常见于豆干)
s181 Sentence There were 37 CRC deaths in the combined hormone therapy arm compared with 27 deaths in the placebo arm (0.04% vs 0.03%; HR 1.29; 95% CI, 0.78–2.11) 联合激素治疗组中有37例结直肠癌死亡,而安慰剂组中有27例(分别为0.04%和0.03%;HR 1.29;95%CI,0.78-2.11)
s182 Sentence The evidence is fair that elemental calcium without vitamin D as a supplement in the level of 1,000 to 1,200 mg/day increases the risk of myocardial infarction 证据一般:每日补充1,000-1,200 mg不含维生素D的钙可能增加心肌梗死风险
s183 Sentence The preponderance of evidence from both observational studies and long-term follow-up of RCTs indicates that daily ASA for at least 5 years reduces the incidence of CRC 来自观察性研究和RCT长期随访的大多数证据表明,每日服用水杨酸类药物持续至少5年可降低结直肠癌发病率
s184 Sentence However, following year 6, the exact surveillance that patients may have undergone and how that surveillance might have been associated with decreased CRC mortality were not clear 但第6年之后,仍不确定具体如何监测患者以及监测对降低结直肠癌死亡率的意义
s185 Sentence Magnitude of Effect: There were fewer CRCs in the combined hormone therapy group than in the placebo group (0.12% vs 0.16%; HR = 0.72; 95% CI, 0.56–0.94) 效应强度:联合激素治疗组的结直肠癌发病人数少于安慰剂组(0.12% vs. 0.16%;HR=0.72;95%IC,0.56-0.94)
s186 Sentence Magnitude of Effect: A pooled analysis of eight cohort studies estimated an adjusted relative risk (RR) of 1.41 (95% confidence interval [CI], 1.16–1.72) for consumption exceeding 45 g/day 效应强度:基于8项队列研究的汇总分析估计,个人饮酒量超过45g/天,发生结直肠癌的调整相对风险(RR)为1.41(95%置信区间[CI] 1.16-1.72)
s187 Sentence The primary endpoint was the proportion of patients (72% of whom were male) in whom at least one adenoma was detected following a first and/or second follow-up endoscopy 该研究主要终点为初次和(或)第二次随访内镜检测出至少1个腺瘤的患者比例(其中72%为男性)
s188 Sentence Internal Validity: Fair, some data from registries and death certificates, some loss to follow-up; variation in ASA dose; adherence to ASA unknown after end of trials (5–9 years) 内部效度:一般,一些资料来自登记档案和死亡证明,部分患者失访;阿司匹林剂量有差异;试验结束后的依从性不明(5-9年)
s189 Sentence Limitations of this study are that dietary intake during the study period was not reassessed over time, and the influence of physical activity could not be accurately determined 该研究存在局限性,整个研究期间,未重新评估膳食纤维摄入,也未对体育活动进行准确评估
s190 Sentence The natural history of large polyps is not well known, but some evidence suggests that such lesions become clinical CRC at a rate of approximately 1% per year 目前,大息肉的自然史尚未明确,但有证据表明每年约有1%大息肉可进展为临床结直肠癌
s191 Sentence In a meta-analysis of 14 randomized trials of supplemental antioxidant vitamins encompassing 170,025 individuals, no evidence of prevention of colorectal adenomas or cancer or other gastrointestinal tumors was found 对14项补充抗氧化性维生素临床试验行荟萃分析,总计有170,025例参与者,并未发现维生素有预防结直肠腺瘤、结直肠癌或其他消化道肿瘤的作用
s192 Sentence A population-based retrospective cohort study of nonaspirin NSAID use among individuals aged 65 years and older was associated with lower risk of CRC, particularly with longer durations of use 一项基于人群的回顾性队列研究发现,在65岁以上人群中使用非甾体类抗炎药可减低结直肠癌风险,长期用药者中效应尤甚
s193 Sentence Several studies assessing the effect of ASA or other nonsteroidals on polyp recurrence following polypectomy are in progress. In several of these studies, mucosal prostaglandin concentration is being measured 一些研究试图评估水杨酸或其他非甾体类抗炎药在息肉切除术后息肉复发中的作用,目前仍在进行中,其中一些研究测量了粘膜前列腺素浓度
s194 Sentence The WHS, the largest randomized trial of aspirin to date (N = 39,876), found no reduction in the incidence of colon or other cancers during the 10-year active intervention WHS是迄今最大规模的阿司匹林随机临床试验(N=39,876),发现持续10年主动干预并不能降低结肠癌或其他癌症的发病率
s195 Sentence In the three United Kingdom trials, cancer deaths after completion of the trials were obtained via death certification and cancer registration, taking the follow-up to 20 years after randomization 3项英国试验随访20年,试验结束后的癌症死亡数据通过死亡证明及癌症登记中心获得
s196 Sentence Large U.S. cohort studies have found statistically significant adjusted RR of 0.54 (95% CI, 0.33–0.90) and 0.53 (95% CI, 0.32–0.88) when comparing people with high versus low average energy expenditure 美国多项大型队列研究发现,经常运动与少量运动者的结肠癌发病调整RR值分别是0.54(95%CI,0.33-0.90)与0.53(95%CI,0.32-0.88),具有统计学差异
s197 Sentence In a subsequent analysis of more than 12 years, both randomized and observational analyses indicated that there was no association between the use of ASA and the incidence of CRC 一项汇总超过12年的随机试验与观察性研究的后续分析表明,水杨酸用药与结直肠癌发病率不相关
s198 Sentence In a multicenter RCT, a diet low in fat (20% of total calories) and high in fiber, fruits, and vegetables did not reduce the risk of recurrence of colorectal adenomas 一项多中心RCT发现低脂(占能量摄入的20%)、高纤维、高果蔬饮食并不降低结直肠腺瘤的复发风险
s199 Sentence Study Design: Pooled and individual prospective cohort studies, meta-analysis of three RCTs with adenoma recurrence as an outcome, and one large individual RCT in women with CRC as an outcome 研究设计:来自汇总分析、单项前瞻性队列研究和基于3项RCT的荟萃分析选用腺瘤复发率作为结局指标; 1项大规模RCT研究以女性结直肠癌发病率为结局指标
s200 Sentence It is important to note that the dose of calcium salt administered may be important; the usual daily doses in trials have ranged from 1,250 to 2,000 mg of calcium 值得注意的是,钙盐补充剂量可能比较重要,不同试验中每日补充的钙剂为1,250-2,000 mg
s201 Sentence However, an author would be permitted to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary].” 文章中如下写法视为允许:“NCI PDQ关于乳腺癌预防的癌症信息总结中简要描述了风险:[引用总结内容]”
s202 Sentence Three of the eight studies found that higher fat consumption was associated with increased risk. High fat intake has been found to increase the risk of adenoma recurrence following polypectomy 其中3项发现结直肠癌发生风险与高脂饮食相关;有研究发现高脂饮食还可增加息肉切除术后的腺瘤复发率
s203 Sentence A clearly defined gradient in the risk for frequency of meat and poultry consumption was not observed in a population of Seventh Day Adventists that included a large proportion of vegetarians 在基督复临安息日会人群中开展的一项研究,其中大多数人是素食主义者,并未发现到结肠癌发生风险与猪肉和家禽肉的摄入量之间存在相关性
s204 Sentence Other studies suggest that the polyps with the greatest potential to progress to CRC are larger polyps (i.e., &gt;1.0 cm), which include most of those with villous or high-grade histologic features 有研究发现最有可能进展为CRC的息肉为较大息肉(即直径>1 cm),包括绒毛状息肉或高级别组织学息肉
s205 Sentence Although evidence is currently inadequate to determine whether NSAIDs reduce CRC incidence, proponents suggest that any effect of these drugs results from their ability to inhibit the activity of cyclooxygenase (COX) 虽然现在缺乏可靠证据支持非甾体类抗炎药可降低结直肠癌发病率,但一些支持者认为这些药物都是通过抑制环氧化酶(COX)活性来降低结直肠癌发病的
s206 Sentence In two other large prospective studies, the CPS II and the Iowa Women’s Health Study (IWHS), no increase in the risk of colon cancer was seen with meat or fat consumption 在两项大型前瞻性研究中,一项CPS II,一项爱荷华州女性健康研究(IWHS),未观察到结肠癌发生风险与肉类或脂肪的摄入有关
s207 Sentence Its long-term efficacy in preventing CRC has not been shown due to increased risk of cardiovascular events, and because there are other effective ways, such as screening to reduce CRC mortality 因该药会增加心血管事件风险,且存在其他降低结直肠癌死亡率的有效方式,例如筛查,故该药预防结直肠癌的长期效果尚未证实
s208 Sentence However, a 28-year follow-up of 57,000 Finns showed no association between the development of CRC and baseline smoking status, though there was a 57% to 71% increased risk in persistent smokers 但芬兰一项对57,000人随访28年的研究发现,结直肠癌发病风险与基线吸烟情况无关,持续吸烟者结直肠癌发病风险可升高57%到71%
s209 Sentence The reductions in the group receiving 100 mg of celecoxib twice a day were 11.9% ( P = .33 for the comparison with placebo) and 14.6% ( P = .09), respectively 100 mg塞来昔布每日2次用药组这两个比例分别为11.9%(与安慰剂组相比,P=0.33)与14.6%(P=0.09)
s210 Sentence In Japan, an increased risk of colon cancer with increased frequency of meat consumption was observed in the group with infrequent vegetable consumption among a group of 265,000 men and women 其中一项共纳入265,000例男性与女性的日本研究发现,蔬菜摄入较少人群中易伴随肉类摄食量增加,进而增加结肠癌风险
s211 Sentence Magnitude of Effect: After 23 years of follow-up, incidence of CRC in the placebo group was 3.8% and in the ASA group 2.5% (hazard ratio [HR] = 0.63; 95% CI, 0.47–0.85) 效应强度:经过23年的随访,安慰剂组的结直肠癌发病率为3.8%,阿司匹林组的结直肠癌发病率为2.5%(危险比[HR]=0.63;95%CI,0.47-0.85)
s212 Sentence In a meta-analysis of eight cohort studies, the relative risk (RR) for consumption of 45 g/day (i.e., about three standard drinks/day) compared with nondrinkers was 1.41 (95% confidence interval [CI], 1.16–1.72) 一项综合8项队列研究的荟萃研究发现,与不饮酒者相比,每天摄入45g酒精(相当于每天3杯酒)人群结直肠癌发病相对风险(RR)为1.41(95% CI,1.16-1.72)
s213 Sentence Because no such exclusions (or baseline colonoscopy examinations) were done in the three comparison groups, persons who had CRC at baseline would be counted as having incident CRC in subsequent follow-up 主要偏倚是NPS试验组未纳入基线调查时已诊断的结肠癌患者,而对照组中并未排除此类患者,也未行基线结肠镜检查,进而导致对照组中基线已患结直肠癌的患者被认为是后续随访的新发病人
s214 Sentence There was no apparent effect on overall adenoma incidence (44.1% for folic acid [n = 221]); 42.4% for placebo [n = 206]; unadjusted use ratio 1.04; 95% CI, 0.9–1.20; P = .58) 叶酸对总腺瘤发生率无显著影响(叶酸组44.1%[n=221],安慰剂组42.4%[n=206],未校正的比率为1.04;95%CI,0.9-1.20;P=0.58)
s215 Sentence Mortality follow-up continued through Dec 31, 2008 via automated linkage to the National Death Index vital status and cause of death codes (ICD-10); death certificates were obtained for 99.3% of known deaths 通过自动链接美国国家死亡状态索引与死因编码数据库(ICD-10),死亡随访更新至2008年12月31日,其中99.3%死亡证明可知明确死因
s216 Sentence On the basis of analyses adjusted for numerous covariates, the authors found no association in women or men between overall fruit and vegetable consumption and the risk of colon or rectal cancer 经多变量校正分析发现,男、女性结直肠癌风险和总蔬果摄入量并无相关性
s217 Sentence The benefit appeared to be dose-related (e.g., women who used more than 14 ASA per week for longer than 10 years had a multivariate RR for cancer of 0.47 [95% CI, 0.31–0.71]) 该获益似可能与剂量相关(例如,每周服用超过14片水杨酸、用药超过10年的女性患癌症的多因素RR为0.47[95%CI,0.31-0.71])
s218 Sentence Among a group of more than 600,000 adults enrolled in an American Cancer Society study, mortality in regular users of ASA was about 40% lower for cancers of the colon and rectum 美国癌症协会的一项研究招募了超过600,000成年人,常规服用水杨酸人群的结肠癌和直肠癌死亡率降低约40%
s219 Sentence Similarly, in the Health Professionals Follow-up Study, a history of smoking was associated with both small and large adenomas and with a long induction period of at least 35 years for CRC “健康专家随访研究”发现类似结论,吸烟史与小腺瘤、大腺瘤均有关,结直肠癌的诱导期至少35年
s220 Sentence Tumor stage and grade were similar in the two groups; deaths after CRC were 34% in the hormone group compared with 30% in the placebo group (HR = 1.34; 95% CI, 0.58–3.19) 两组的肿瘤分期与分级相似,激素组结直肠癌死亡率为34%,安慰剂组为30%(HR=1.34;95%CI,0.58-3.19)
s221 Sentence It has been suggested that the inverse association with fiber may be reflective of some other closely associated dietary constituents, such as the anticarcinogens found in vegetables, fruits, legumes, nuts, and grains 该负相关性可能是膳食的某些成分所致,例如蔬菜、水果、豆类、坚果、谷物中的抗癌物质
s222 Sentence A large cohort study found a dose-response relationship between alcohol intake and death from CRC, with a RR of 1.2 (95% CI, 1.0–1.5) for four or more drinks per day compared with nondrinkers 一项大规模队列研究发现饮酒与结直肠癌死亡存在剂量反应关系,与不饮酒者相比,每天摄入至少4杯酒,死亡RR为1.2(95%CI,1.0-1.5)
s223 Sentence A systematic review of published observational studies that provide sufficient data to calculate the dose-response relationship of serum 25-hydroxyvitamin D or oral intake of vitamin D with the risk of CRC was conducted 一项对已发表的观察性研究进行系统性综述,纳入标准为研究中能够提供可靠数据,然后计算CRC风险与血清25-羟维生素D或口服维生素D的剂量反应关系
s224 Sentence Because exposure to non-ASA NSAIDs was assessed only once, assessment was by self-report, and there is no information on dose or duration of use, the certainty of this single study must be rated low 该研究中,非阿司匹林的非甾体类抗炎药暴露史经通过自我报告评估一次,同时缺少用药剂量和用药时间的信息,故该单项研究的可靠性相对较低
s225 Sentence Based on fair evidence, a diet low in fat and meat and high in fiber, fruits, and vegetables started as an adult does not reduce the risk of CRC by a clinically important degree 证据一般:成人低脂、少肉、高纤维、多果蔬饮食对结直肠癌发病风险的作用并不具有临床意义
s226 Sentence The risk of CRC begins to increase after the age of 40 years and rises sharply at ages 50 to 55 years; the risk doubles with each succeeding decade, and continues to rise exponentially 结直肠癌发病风险从40岁开始升高,在50-55岁之间急剧升高;此后每10年风险加倍,呈指数级升高
s227 Sentence The time to detection of a first adenoma was longer in the ASA group than in the placebo group (HR for the detection of a new polyp, 0.54; 95% CI, 0.43–0.94, P = .022) 水杨酸组首个腺瘤的检出时间长于安慰剂组(检测出新息肉的HR为0.54;95%CI,0.43-0.94,P=0.022)
s228 Sentence The number of CRC deaths in the combined group was higher than in the placebo group (37 vs 27 deaths), but the difference was not statistically significant (HR = 1 .29; 95% CI, 0.78–2.11) 且联合组结直肠癌死亡人数大于安慰剂组(分别37例与27例),但该差异无统计学意义(HR=1.29;95%CI,0.78-2.11)
s229 Sentence Based on solid evidence, harms of NSAID use are relatively common and potentially serious, and include upper gastrointestinal bleeding, chronic kidney disease, and serious cardiovascular events such as myocardial infarction, heart failure, and hemorrhagic stroke 证据充分:使用非甾体类抗炎药的不良反应较为常见且可能较严重,包括上消化道出血、慢性肾脏疾病,以及严重心血管事件,如心肌梗死、心力衰竭和出血性卒中等
s230 Sentence Patients in the NPS were assigned to colonoscopy at years 1 and 3; colonoscopy was also offered to one of the two comparison groups at year 1; all participants were offered colonoscopy at year 6 NPS患者在第1、3年接受结肠镜检查,2个对照组中1个对照组在第1年接受结肠镜检查,所有参与者第6年均接受结肠镜检查
s231 Sentence The inverse association with fiber was observed in 12 of the 13 studies and was similar in magnitude for left-sided and right-sided colon and rectal cancers, in men and women, and in different age groups 13项研究中12项研究观察到负相关性,且与左半结肠癌、右半结肠癌、直肠癌的关联程度相似,无性别、年龄差异
s232 Sentence Although adjustments were attempted, it is not possible to know the magnitude of the impact of this problem on the result because it is not known how long CRC may be present without causing symptoms 尽管研究人员对数据进行了调整,但结直肠癌临床前期时间不明确,因此无法确定该问题对结果的影响大小
s233 Sentence However, the degree of reduction must be viewed with caution because this study did not have a direct comparison group, relying mainly on comparison to expected data from the Surveillance, Epidemiology and End Results Program 但该研究并无设置直接对照组,主要通过与医疗保险监督、流行病学和最终结果(SEER)数据库的预期数据进行比较,因此需慎重对待死亡率降低结果
s234 Sentence Based on solid evidence, daily aspirin (acetylsalicylic acid [ASA]) for at least 5 years reduces CRC incidence and mortality. This is based on two reports of extended follow-up of two RCTs and meta-analysis of observational studies 根据2项RCT延期随访研究和1项基于观察性研究的荟萃分析显示,持续每日服用阿司匹林(乙酰水杨酸)至少5年能降低结直肠癌的发病率和死亡率
s235 Sentence Whereas previously reported meta-analyses of randomized trials of daily aspirin use demonstrated a reduction in colon cancer incidence with extended follow-up, these findings from the WHS demonstrate a similar effect from aspirin taken every other day 对曾有每日服用阿司匹林的随机临床试验荟萃分析报道,延长随访期内结肠癌发病率有所降低,这与WHS隔日服用阿司匹林试验的结果相似
s236 Sentence Perhaps the most definitive analysis to date is a prospective study that examined dietary intake data based on food frequency questionnaires from 88,764 women in the NHS and 47,325 men in the Health Professionals Follow-up Study 迄今最为明确的研究是一项前瞻性研究,该研究中饮食摄入数据来自于NHS中88,764例女性和健康专家随访研究中47,325例男性填写的饮食频率问卷
s237 Sentence A long-term follow-up study (median follow-up, 15.8 years; maximum, 23 years) of the NPS cohort suggested an approximately 53% reduction in CRC mortality due to polypectomy (not just exclusion of persons with CRC at initial exam) NPS队列长期随访研究(中位随访15.8年;最长23年)发现息肉切除术可降低53%的结直肠癌死亡率(排除包括初次检查发现的结直肠癌患者)
s238 Sentence NSAIDs include not only aspirin (ASA, which is considered separately here) and other, first-generation nonselective inhibitors of the two functional isoforms of COX, termed COX-1 and COX-2, but also newer second-generation drugs that inhibit primarily COX-2 非甾体类抗炎药药物,不仅包括阿司匹林,还包括非选择性COX一代抑制剂(抑制COX的两种功能性异构体COX-1与COX-2)和COX2的二代抑制剂
s239 Sentence Thus, it is unclear what the overall impact of endoscopy (e.g., colonoscopy screening) is, and whether there may be a large difference in impact on the left side of the colon compared with the right side 即目前内镜检查(例如结肠镜筛查)的整体作用以及对左半结肠和右半结肠作用是否存在较大差异尚不明确
s240 Sentence In a follow-up of 10 years, the left-sided CRC incidence in the low-risk group (about 95% of attendees were low risk) was 0.02% to 0.04% per year—a very low risk of CRC compared with average risk 随访10年发现,低危人群组(约95%的参与者属于低危人群)的左半部结肠癌年均发病率约为0.02%-0.04%,与平均风险人群相比结直肠癌发病风险极低
s241 Sentence It is expected that further follow-up in the United Kingdom Flexible Sigmoidoscopy Screening Trial will be able to provide more detail about the long-term effect of polypectomy, at least on the left side of the colon 我们希望英国软式乙状结肠镜筛查试验的进一步随访能够为息肉切除术的长期作用提供更多信息,至少对左半结肠的长期作用
s242 Sentence This study may be biased in several ways that inflate the apparent efficacy of polyp removal; the main problem is that potential enrollees in the NPS were excluded if they had CRC at their baseline examination 但该研究可能存在一些偏倚,高估息肉切除的作用
s243 Sentence As a result of the strong data about the impact of endoscopy on the left colon, evidence from multiple studies has raised questions about the ability of endoscopy to reduce CRC mortality in the right colon 已有大量证据证实内镜在左半结肠的积极作用,但内镜检查能否降低右半结肠癌死亡率尚存疑问
s244 Sentence In addition, some epidemiological studies have reported lower incidence rates of colon cancer in populations with high intakes of both fat and fiber, compared with populations with high levels of fat but low levels of fiber consumption 一些流行病学研究已经发现,高脂高纤维饮食人群的结肠癌发病率低于高脂低纤维饮食人群
s245 Sentence Six RCTs, including five from the United Kingdom, were included in a meta-analysis in which patients were randomly assigned to receive either aspirin or placebo and mean scheduled duration of trial treatment was 4 years or more 一项荟萃分析共纳入6项RCT,其中5项来自于英国人群,这些研究中患者被随机分配到阿司匹林组或安慰剂组,平均治疗时间≥4年
s246 Sentence A modest decrease in risk was found for both developing at least one recurrent adenoma (adjusted risk ratio [ARR] = 0.81; 95% CI, 0.67–0.99) and in the average number of adenomas (ARR = 0.76; 95% CI, 0.60–0.96) 该研究发现初次和第二次内镜检查出现至少1个腺瘤复发风险(调整相对风险[ARR]=0.81;95%CI,0.67-0.99)与平均腺瘤数目(ARR=0.76;95%CI,0.60-0.96)都轻度降低
s247 Sentence In a report from the Health Professionals Follow-up Study of 47,000 males, regular use of ASA (at least 2 times per week) was associated with a 30% overall reduction in CRC, including a 50% reduction in advanced cases “健康专家随访研究”共有47,000例男性入组,该研究发现常规服用水杨酸(每周至少2次)可降低30%结直肠癌发病,其中晚期发病可降低50%
s248 Sentence Based on meta-analysis of ORs from each trial rather than on more sensitive actuarial analysis of the individual patient data, allocation to aspirin in the RCTs reduced the 20-year risk of death due to colorectal (and esophageal) cancer 根据各项试验比值比(OR)荟萃分析,而非考虑更为敏感的患者个例数据实际分析,发现RCT中阿司匹林组20年结直肠癌(与食管癌)死亡风险降低
s249 Sentence Magnitude of Effect: The estimated average excess risk of upper gastrointestinal complications is 10 to 30 per 1,000 people for a period of 10 years, on the higher end for men and on the lower end for women 效应强度:上消化道并发症的平均超额风险大约为每1,000人中10年内会有10-30例并发症出现,男性风险高于女性
s250 Sentence A prospective study among female nurses showed an increased risk of colon cancer associated with red meat consumption (beef, pork, lamb, and processed meat) and also with the intake of saturated and monounsaturated fat, predominantly derived from animals 在女性护士中进行的一项前瞻性研究发现,结肠癌风险升高与红肉(牛肉、猪肉、羊肉、加工肉制品)摄入相关,也与主要来源于动物的饱和脂肪酸与单不饱和脂肪酸的摄入相关
s251 Sentence Ingestion of fiber could modify carcinogenesis in the large bowel by a number of potential mechanisms. These mechanisms include binding to bile acids, increasing fecal water and possibly diluting carcinogens, and decreasing transit time (not an obvious factor) 纤维摄入可通过多种机制参与改变大肠癌变过程,包括与胆汁酸结合、增加粪便含水量、稀释致癌原、减少食物通过时间(非主要因素)
s252 Sentence In addition, the conclusion about very low amounts of intake of fruits and vegetables is based on a retrospective subdivision of the lowest quartile of consumption, and its strength has not been adjusted for other potential confounding factors 同时,果蔬摄入量极低人群的得出结论主要基于最低四分位数摄入人群的回顾性研究,未校正其他混杂因素
s253 Sentence A population-based case-control study in Sweden, however, found no evidence of increased risk associated with total HCA intake; for colon cancer the RR was 0.6 (95% CI, 0.4–1.0), and for rectal cancer it was 0.7 (95% CI, 0.4–1.1) 一项在瑞典人群中进行的病例对照研究发现,结直肠癌风险与总HCA摄入并不相关,结肠癌的RR为0.6(95%CI,0.4-1.0),直肠癌的RR为0.7(95%CI,0.4-1.1)
s254 Sentence For women and men combined, the covariate-adjusted RR of colon cancer associated with one additional serving of fruits and vegetables per day was 1.02 (95% CI, 0.98–1.05); the comparable RR for rectal cancer was 1.02 (95% CI, 0.95–1.09) 综合考虑男性与女性参与者,每天多摄入一份蔬菜与水果后的协变量校正结肠癌的RR为1.02(95%CI,0.98-1.05),直肠癌的RR为1.02(95%CI,0.95-1.09)
s255 Sentence It has been hypothesized that the heterocyclic amines (HCAs) formed when meat and fish are cooked at high temperatures may contribute to the increased risk of CRCs associated with meat consumption that has been observed in epidemiologic studies 有假说认为高温烹调肉类与鱼类所产生的杂环胺(HCA)可能是导致上述相关性的原因
s256 Sentence Other evidence about the benefit of sigmoidoscopy screening (at which time both polyps and early cancer would be removed) suggests that the impact of endoscopic screening, at least on the left side of the colon, is substantial and prolonged 有研究表明乙状结肠镜筛查(应在息肉和早期癌变已经切除后进行)至少对左半结肠能带来长期明显益处
s257 Sentence In a prospective cohort study of a low-risk population, an inverse association was found with legume intake and the risk of CRC (RR for &gt;2 times/week vs 1 time/week = 0.53 [95% CI, 0.33–0.86; P for trend = .03]) 在低危人群中进行的一项前瞻性队列研究发现结直肠癌风险与豆类摄入呈负相关(每周摄入>2次与每周摄入1次相比,RR=0.53[95% CI,0.33-0.86;趋势P值=0.03])
s258 Sentence Based on sigmoidoscopy findings, persons were considered to have low risk if they had normal exams or only one or two small (&lt;1 cm) tubular adenomas; such persons were not referred either for colonoscopy workup, or for colonoscopic surveillance 乙状结肠镜检结果为正常或仅有1-2个小(<1 cm)管状腺瘤,则认为对象属于低危人群,且不再接受结肠镜检查或结肠镜监测
s259 Sentence The Nurses’ Health Study found that women with a body mass index (BMI) of more than 29, compared with women with a BMI of less than 21, had an adjusted RR for CRC incidence of 1.45 (95% CI ,1.02–2.07) “护士健康研究”发现体重指数(BMI)大于29的女性与BMI低于21的女性相比,结直肠癌调发病调整RR值值为1.45(95%CI,1.02-2.07)
s260 Sentence Magnitude of Effect: The WHI showed a 26% increase in invasive breast cancer in the combined hormone group, a 29% increase in coronary heart disease events, a 41% increase in stroke rates, and a twofold higher rate of thromboembolic events 效应强度:WHI显示联合激素治疗组的侵袭性乳腺癌事件风险增加26%,冠心病事件风险增加29%,卒中事件风险增加41%,血栓栓塞性疾病事件风险增加2倍之高
s261 Sentence Normally, COX-1 is expressed in most tissues and primarily plays a housekeeping role (e.g., gastrointestinal mucosal protection and platelet aggregation);COX-2 activity is crucial in stress responses and in mediating and propagating the pain and inflammation that are characteristic of arthritis COX-1可在多种组织中表达,发挥管家作用(即保护消化道粘膜和促进血小板聚集);COX-2在应激反应中发挥作用,同时介导并扩散疾病的疼痛与炎症,如关节炎
s262 Sentence The relatively short duration of follow-up, considering the latency period of CRC of 10 to 15 years and suboptimal doses of calcium and vitamin D, may account for the negative effects of this trial, though other factors may also be responsible 随访时间较短,结直肠癌发展时间需10-15年,且研究所用钙剂与维生素D剂量较低,可能与本研究的阴性结果有关,当然不能排除其它因素
s263 Sentence In a prospective cohort study of 35,215 women in the IWHS, an inverse association between the risk of colon cancer and vitamin E intake was found; the RR for the highest compared with the lowest quartile was 0.3 (95% CI, 0.19–0.54) 一项纳入参与了IWHS的35,215例女性的前瞻性队列研究发现,结肠癌风险与维生素E摄入呈负相关性,维生素E摄入量最高四分位数人群与最低四分位数人群相比,结肠癌发病RR为0.3(95%CI,0.19-0.54)
s264 Sentence In Utah, an inverse relationship between colon cancer and calcium was observed in a study that compared members of the Church of Jesus Christ of Latter-Day Saints (Mormons) and Seventh Day Adventists with a group from the U.S. population at large 在美国犹他州,一项研究比较耶稣基督后期圣徒教会教徒(摩门教徒)、基督复临安息日会教徒、美国普通民众(对照组)三组人群,发现结肠癌风险与钙剂补充存在负相关性
s265 Sentence An analysis of data from the National Polyp Study (NPS), with external, historical controls, has commonly been cited to show a reduction of 76% to 90% in the subsequent incidence of CRC after colonoscopic polypectomy compared with three nonconcurrent, historical control groups 源自一项包含外部对照和历史对照的美国全国息肉研究(NPS)的数据曾被多次引用说明,与3个历史对照组相比,结肠镜下息肉切除术后结直肠癌发病率降低76%-90%
s266 Sentence CRC incidence was not decreased among women who had taken estrogens; after a median of 7.1 years of follow-up, 58 invasive cancers occurred in the estrogen arm compared with 53 invasive cancers in the placebo arm (HR = 1.12; 95% CI, 0.77–1.63) 研究发现雌激素服用女性的结直肠癌发病率并没有不降低,中位随访7.1年后,雌激素组新发58例侵袭性癌症,而安慰剂组新发53例侵袭性癌症(HR=1.12;95%CI,0.77-1.63)
s267 Sentence Consistency: Poor; the RCT with CRC as an outcome found no reduction in CRC incidence, while prospective cohort studies found a reduction in CRC incidence between high and low calcium groups; three RCTs found a reduction in adenoma recurrence with calcium supplementation 一致性:较差,以结直肠癌发病率为结局指标的RCT未发现结直肠癌发病率降低,但前瞻性队列研究发现与低钙组相比,高钙组的结直肠癌发病率降低,3项RCT发现钙剂补充后腺瘤复发率降低
s268 Sentence In 17 studies with data on CRC mortality, cigarette smoking was associated with CRC death, with a RR (ever smokers vs. never smokers) of 1.25 (95% CI, 1.14–1.37), and an absolute increase in the death rate of 6.0 deaths per 100,000 person-years 另一项综合17项结直肠癌死亡率相关研究,发现结直肠癌死亡与吸烟和具有相关性,与从不吸烟者相比,曾吸烟者死亡RR为1.25(95%CI,1.14-1.37),死亡率绝对增加6.0/10万人年
s269 Sentence In a report from the Nurses’ Health Study involving 82,911 women followed for 20 years, the multivariate RR for colon cancer was 0.77 (95% CI, 0.67–0.88) among women who regularly used ASA (≥2 standard 325-mg tablets per week) compared with nonregular use “护士健康研究”对82,911例女性随访20年,该研究的一项报告发现常规服用水杨酸(每周≥2片标准325 mg片剂)的女性与不常规用药者相比,结肠癌发病多因素RR为0.77(95%CI,0.67-0.88)
s270 Sentence One study used a supplement of 10 g/day of wheat bran, cellulose, and oat bran and found a decreased mutagenic activity of fecal contents in those receiving wheat bran and cellulose supplementation, although no measurable inhibition was observed during oat bran supplementation 一项研究中参与者每天补充10g麦麸、纤维素和燕麦后,麦麸与纤维素组参与者粪便中的致癌物活性降低,但燕麦组没有变化
s271 Sentence In addition, a network meta-analysis of all large scale randomized, controlled trials (RCTs) comparing any NSAID to any other NSAID or placebo found that there is little evidence to suggest that any of the investigated drugs are safe in terms of cardiovascular effects 此外,对在不同非甾体类抗炎药间,或者非甾体类抗炎药与安慰剂之间进行研究的大规模RCT行网络荟萃分析,提示所有非甾体类抗炎药都可造成心血管不良事件
s272 Sentence The study was limited to individuals with a recent history of colorectal adenomas and could not determine the effect of calcium on risk of the first adenoma, nor was it large enough or of sufficient duration to examine the risk of invasive CRC 由于该研究仅纳入结直肠腺瘤病史的患者,故无法判断钙剂对初诊腺瘤的影响,该研究规模或持续时间尚不足以评估侵袭性结直肠癌的风险
s273 Sentence Calculated from the beginning of the intervention period through the extended follow-up (median, 18 years) an overall reduction in CRC incidence was observed for the WHS (HR = 0.80; 95% CI, 0.67–0.97; P = .021; P = .012 intervention period versus extended follow-up) 从干预开始到延长随访时间结束(中位数18年),WHS试验观察到结直肠癌发病率整体下降(HR=0.80;95%CI,0.67-0.97;P=0.021;干预期和延长随访期相比,P=0.012)
s274 Sentence A meta-analysis of 106 observational studies found a RR (ever smokers compared with nonsmokers) for CRC incidence of 1.18 (95% CI, 1.11–1.25), with an absolute risk increase of 10.8 cases per 100,000 person-years (95% CI, 7.9–13.6). There was a statistically significant dose-response effect 对106项观察性研究荟萃分析后发现,与不吸烟人群相比,吸烟人群结直肠癌发病相对风险为1.18(95%CI,1.11-1.25),绝对风险增加10.8/10万人年(95%CI,7.9-13.6),且发病与吸烟城剂量反应关系
s275 Sentence Results did not change when data were examined by vitamin use status, smoking status, or family history of CRC, nor were elevated risks seen when individuals with very low levels of fruit and vegetable consumption were compared with those having the highest levels 对维生素服用情况、吸烟史、结直肠癌家族史进行分析,也未发现结果变化,蔬果摄入量最低人群与最高人群相比,结直肠癌风险并不升高
s276 Sentence In the Physicians’ Health Study, 22,000 men aged 40 to 84 years were randomly assigned to receive placebo or ASA (325 mg every other day) for 5 years. There was no reduction in invasive cancers or adenomas at a median follow-up of 4.5 years “医师健康研究”中,22,000例40-84岁男性被随机分配等到安慰剂组或水杨酸组(隔日325mg水杨酸),该研究进行了5年,中位随访时间为4.5年,发现侵袭性癌症或腺瘤发病率并未降低
s277 Sentence For advanced neoplasms (adenomas measuring at least 10.0 mm in diameter or with tubulovillous or villous features, severe dysplasia, or invasive cancer), the RRs were 0.59 (95% CI, 0.38–0.92) in the 81-mg ASA group, and 0.83 (95% CI, 0.55–1.23) in the 325-mg ASA group 对于晚期肿瘤(腺瘤直径至少10.0 mm,或伴绒毛管状或绒毛状特征,或侵袭性癌),81 mg水杨酸组的RR为0.59(95%CI,0.38-0.92),325 mg水杨酸组的RR为0.83(95%CI,0.55-1.23)
s278 Sentence The results suggested that a daily intake of 1,000 IU of vitamin D—half the safe upper limit for intake established by the National Academy of Sciences—and a concentration of serum 25-hydroxyvitamin D of 33 ng/mL were each associated with a 50% lower risk of CRC 结果提示每日服用1,000 IU维生素D(美国国家科学院公布的安全摄入上限值的一半)和血清25-羟维生素D浓度为33 ng/mL能降低50%CRC发生风险
s279 Sentence A large population-based cohort study of Swedish twins found that heavy smoking of 35 or more years' duration was associated with a nearly threefold increased risk of developing colon cancer, though subsite analysis found a statistically significant effect only for rectal but not colon cancer 一项在瑞典双生儿中开展的大规模队列研究发现,烟龄35年以上可使结肠癌发病风险增加2倍,对发病部位进行分层后,吸烟仅增加直肠癌发病风险,对结肠癌没有左右
s280 Sentence In the Women's Health Study (WHS), a randomized 2 x 2 factorial trial of 100 mg of ASA every other day for an average of 10 years, similar rates of breast, colorectal, or other site-specific cancers were observed in both the ASA and placebo arms “女性健康研究”(WHS)是一项2x2因素设计的随机试验研究,实验组患者每2日服用100 mg 水杨酸,平均服药10年,发现水杨酸组与安慰剂组的乳腺癌、结直肠癌或其他部位癌症的发病率接近
s281 Sentence ORs for maximum aspirin use were 0.55 for colorectal cancer risk (95% CI, 0.41–0.76) and 0.47 for esophageal cancer risk (95% CI, 0.27–0.81) and for any aspirin use were 0.58 for colorectal cancer risk (95% CI, 0.44–0.78) and 0.51 for esophageal cancer (95% CI, 0.31–0.83) 最大剂量阿司匹林使用组结直肠癌死亡风险OR为0.55(95%CI,0.41–0.76),食管癌死亡风险OR为0.57(95% CI,0.27–0.81),合计阿司匹林使用组的结直肠癌风险OR为0.58(95% CI,0.44–0.78),食管癌风险OR为0.51(95% CI, 0.31–0.83)
s282 Sentence In the report from all four RCTs, the 20-year risk of death due to CRC in trials that allocated ASA for at least 5 years was reduced by about 40% (HR = 0.60; 95% CI, 0.45–0.81), absolute risk reduction was from about 3.1% to 1.9% 汇总4项RCT的报道显示,在持续用药至少5年的阿司匹林组中,结直肠癌引起的20年死亡风险减少了约40%(HR=0.60;95%CI,0.45-0.81),绝对危险降低值从约3.1%降至1.9%
s283 Sentence The analysis excluded participants who had a history of cancer in the baseline year or whose records contained incomplete information on aspirin use or smoking, and was based on follow-up questionnaires mailed to participants in 1997 (the baseline year for the analysis), 1999, 2001, and 2003 研究排除标准为:1997年(基线年)调查既往癌症病史者;1999、2001与2003年邮寄的随访问卷中阿司匹林服用、吸烟状况信息缺失者
s284 Sentence In the Cancer Prevention Study II (CPS II), a large nationwide cohort study, multivariate-adjusted CRC mortality rates were highest among current smokers, intermediate among former smokers, and lowest in nonsmokers, with increased risk observed after 20 or more years of smoking in men and women combined 癌症预防研究II(CPS II)是一项大型全国队列研究,该研究发现,多变量调整结直肠癌死亡率现吸烟者最高,曾吸烟者居中,不吸烟者最低。男性与女性全人群中,有至少20年吸烟史者风险增高
s285 Sentence However, among women who voluntarily participated in extended follow-up (N = 33,682; 16,913 from the intervention group and 16,769 from the placebo group), there was a significant reduction in CRC incidence (HR = 0.58; 95% CI, 0.42–0.8, P &lt; .001) with a median follow-up of 8 years 但对自愿参加延长随访的女性人群(N=33,682;干预组16,913例,安慰剂组15,769例)进行长达8年(中位随访时间)随访,观察到结直肠癌发病率的显著降低(HR= 0.58;95% CI,0.42–0.8,P<0.001)
s286 Sentence In the CPS II , men and women with a BMI of 30 to 34.9 had an adjusted RR for CRC mortality (compared with people with a BMI of 18.5–24.9) of 1.47 (95% CI, 1.30–1.66), with a statistically significant dose-response effect. The effects were similar in men and women CPSII研究中,BMI为30-34.9的男性与女性的结直肠癌死亡调整RR值(与BMI为18.5-24.9的人相比)为1.47(95%CI,1.30-1.66),且死亡与BMI之间存在剂量反应关系,但无性别差异
s287 Sentence In a randomized, double-blind, placebo-controlled trial involving 36,282 postmenopausal women, the administration of 500 mg of elemental calcium and 200 IU of vitamin D3 twice daily for an average of 7.0 years was not associated with a reduction in invasive CRC (HR = 1.08; 95% CI, 0.86–1.34; P = .051) 一项随机双盲安慰剂照试验共纳入36,282例绝经后女性,该研究发现每日2次补充500 mg元素钙与200 IU维生素D3平均持续7年未能降低侵袭性结直肠癌发生风险(HR=1.08;95%CI,0.86-1.34;P=0.051)
s288 Sentence In people without genetic predisposition but with a prior history of a colonic adenoma that had been removed, three randomized controlled trials (RCT) found that celecoxib and rofecoxib decrease the incidence of recurrent adenoma, although follow-up was too short to determine whether the incidence of CRC would have been affected 三项随机对照试验(RCT)在没有遗传易感性但有结肠腺瘤切除病史的人群中发现,塞来考昔和罗非考昔能降低腺瘤的复发率,但由于随访时间过短尚不能明确塞来考昔和罗非考昔是否能降低结直肠癌的发病率
s289 Sentence These include a paucity of knowledge about the proper dose and duration for these agents, and concern about whether the potential preventive benefits such as a reduction in the frequency or intensity of screening or surveillance could counterbalance long-term risks such as gastrointestinal ulceration and hemorrhagic stroke for the average-risk individual 存在的问题包括药物的最佳剂量和使用时间尚不明确,同时对预防措施潜在的获益有所担心,如以降低筛查/监测频率或强度的获益能否抵消个体的长期风险,例如胃肠道溃疡和出血性卒中发生风险
s290 Sentence A large cohort study (301,240 people with 3,894 colorectal cancer cases) published after this systematic review found an association between weekly or daily ASA use and reduced 10-year incidence of distal and rectal (but not proximal) colorectal cancer, with an HR of 0.76 (95% CI, 0.64–0.90) for rectal cancer for daily use 继该系统综述之后发表的一项大型队列研究(301,240例观察对象,3,894例结直肠癌患者)发现,每周或每日水杨酸用药与远端结肠癌及直肠癌(但非近端结肠)的10年发病率降低有关,每日用药后直肠癌的风险比为0.76(95%CI,0.64-0.90)
s291 Sentence In a population-based prospective cohort study of 61,463 women in Sweden, individuals who consumed very low amounts of fruits and vegetables (&lt;1.5 servings of fruit and vegetables/day) had a RR for developing CRC of 1.65 (95% CI, 1.23–2.2; P trend = .001) as compared with those individuals who consumed more than 2.5 servings 瑞典一项基于人群的前瞻性队列研究共纳入61,463例女性,果蔬摄入量极低人群(每天<1.5份果蔬)较每天摄入超过2.5份果蔬人群相比,发生结直肠癌的相对风险为1.65(95%CI,1.23-2.2;趋势P值=0.001)
s292 Sentence In a prospective cohort study of a low-risk population of non-Hispanic white members of the Adventist Health Study, a positive association between meat (both red and white) intake and colon cancer was observed (RR for ≥1 time per week vs. no meat intake = 1.85, 95% CI, 1.19–2.87, P for trend = .01) 对非西班牙裔白人基督复临论人群进行的一项前瞻性队列健康研究,发现结肠癌发生风险与肉类(红肉与白肉)摄入量存在正相关(每周≥1次摄入肉类与完全不摄入肉类相比,RR=1.85;95%CI,1.19-2.87,趋势P值=0.01)
s293 Sentence Associations were not observed when the data were examined for subgroups of fruits or vegetables (with the exception of legumes, which were associated with an increased risk of colon cancer in women) or individual fruits or vegetables (with the exception of prunes, which were associated with an increased risk of colon cancer in men) 对水果或蔬菜摄入子集(不包括豆类,已知豆类与女性结肠癌风险增加相关)或个人蔬菜或水果摄入量(不包括西梅,已知西梅与男性结肠癌风险增加相关)进行分析,也未发现相关性
s294 Sentence In a study of 1,121 patients with a recent history of colorectal adenomas, after a mean duration of treatment of 33 months, the unadjusted RRs of any adenoma (as compared with the placebo group) were 0.81 in the 81-mg ASA group (95% CI, 0.69–0.96) and 0.96 in the 325-mg ASA group (95% CI, 0.81–1.13) 对近期患结直肠腺瘤的1,121例患者进行研究,平均治疗时间持续33个月,81 mg水杨酸组中任何分期腺瘤的非调整RR值为0.81(与安慰剂组相比),325 mg水杨酸组任何分期腺瘤的非校正RR为0.96(95%CI,0.81-1.13)
s295 Sentence The 2007 analysis reported on two RCTs with reliable follow-up of more than 20 years. This report found that the use of 300 mg or more of ASA per day for at least 5 years reduced the incidence of CRC after a latency of 10 years (RR at 10–19 years [0.60; 95% CI, 0.42-0.87]) 2007年分析报道了2项随访时间超过20年的可靠RCT,该报告发现每日使用至少300 mg,水杨酸持续5年,可降低10年后结直肠癌发病率(10-19年RR[0.60;95%CI,0.42-0.87])
s296 Sentence In a randomized study of 635 patients with prior CRC (T1–T2 N0 M0) who had undergone curative resection, ASA intake at 325 mg/day was associated with a decrease in the adjusted RR of any recurrent adenoma as compared with the placebo group (0.65; 95% CI, 0.46–0.91) after a median duration of treatment of 31 months 一项随机研究共招募了曾患结直肠癌(T1-T2 N0 M0)并接受治愈性切除术的患者635例。每日服用水杨酸 325mg,与安慰剂组相比,中位服药时间31个月的患者,复发性腺瘤调整RR值降低(0.65;95%CI,0.46-0.91)
s297 Sentence One large cohort study (301,240 people with 3,894 colorectal cancer cases) found an association between daily or weekly nonaspirin (non–acetylsalicylic acid [non-ASA]) nonsteroidal anti-inflammatory drug (NSAID) use and reduced 10-year incidence of proximal and distal colon cancer, but not rectal cancer, with a hazard ratio (HR) of 0.67 (95% CI, 0.58–0.77) for daily use for colon cancer 一项大型队列研究(301,240人,其中3,894例结直肠癌患者)发现,每日或每周服用非阿司匹林(非乙酰水杨酸[非ASA])的非甾体类抗炎药(NSAID)可降低近端和远端结肠癌10年发病率,但不影响直肠癌发病率;其中每日用药结肠癌的风险比(HR)为0.67(95%CI,0.58-0.77)
s298 Sentence A case-control study of diet, genetic factors, and the adenoma-carcinoma sequence was conducted in Burgundy. It separated adenomas smaller than 10.0 mm in diameter from larger adenomas. A positive association between current alcohol intake and adenomas was found to be limited to the larger adenomas, suggesting that alcohol intake could act at the promotional phase of the adenoma-carcinoma sequence 一项旨在探讨饮食、遗传因素、腺瘤-癌之间相关性的病例对照研究在勃艮第进行,研究人员以腺瘤大小为10.0mm为临界值进行分层分析,发现饮酒与腺瘤的相关性仅出现在大腺瘤组,提示饮酒可能作用于腺瘤-癌变过程的促进阶段
s299 Sentence In a large cohort study, an association between recent daily aspirin use and lower-cancer mortality in the gastrointestinal tract (RR = 0.61; 95% CI, 0.47–0.78), liver (RR = 0.52; 95% CI, 0.30–0.93), and bladder (RR = 0.52; 95% CI, 0.28–0.97) were observed among the 100,139 analysis-eligible participants from the CPS II Nutrition Cohort established by the American Cancer Society in 1982 美国癌症协会于1982年启动的大型CPS II营养队列中,共纳入100,139例合格参与者分析发现,近期每日服用阿司匹林的参与者消化道癌(RR = 0.61;95% CI,0.47–0.78)、肝癌(RR = 0.52;95% CI,0.30–0.93)与胆囊癌(RR = 0.52;95% CI,0.28–0.97)的死亡率均降低
s300 Sentence In a double-blind, placebo-controlled, two-factor, phase III RCT (ASA/Folate Polyp Prevention Study) involving 1,021 men and women with a recent history of colorectal adenoma, folic acid (1 mg/day) was associated with higher risks of developing at least one advanced adenoma (11.6% for folic acid [n = 35]); 6.9% for placebo [n = 21]; unadjusted RR = 1.67; 95% CI, 1.00–2.80; P = .05) 一项安慰剂对照的两因素双盲III期RCT(ASA/叶酸息肉预防研究)共纳入1,021例有近期结直肠息肉史的男性与女性,该研究发现叶酸(1 mg/天)可增加至少1个高级别腺瘤发生风险(叶酸组发生率11.6%[n=35],安慰剂组6.9%[n=21];未校正RR=1.67;95%CI,1.00-2.80;P=0.05)
s301 Sentence Data from the Women’s Health Initiative (WHI), a randomized, placebo-controlled trial evaluating estrogen plus progestin, with a mean intervention of 5.6 years and a follow-up of 11.6 years showed that women taking combined hormone therapy had a statistically significant higher stage of cancer (regional and distant) at diagnosis but not a statistically significant number of deaths from CRC compared with women taking the placebo 来自妇女健康倡议(WHI)的数据显示,在一项评估雌孕激素联合治疗的的随机对照试验中,平均干预5.6年,平均随访11.6年,结果显示与服用安慰剂的女性相比,接受联合激素治疗的女性癌症诊断分期较晚(区域性或远处转移性),但结直肠癌引起的死亡人数并无显著增加
s302 Sentence The 2010 analysis analyzed long-term follow-up data from four RCTs, finding that allocation to ASA for 5 or more years reduced the 20-year incidence and mortality of proximal colon cancer (adjusted incidence HR = 0.35; 95% CI, 0.20–0.63; adjusted mortality HR = 0.24; 95% CI, 0.11–0.52) and also reduced the 20-year risk of rectal cancer (RR = 0.58; 95% CI, 0.36–0.92) but not distal colon cancer 2010年分析报道了4项RCT的长期随访数据,服用水杨酸至少5年可降低近端结肠癌的20年发病率与死亡率(调整发病率HR=0.35;95%CI,0.20-0.63;调整死亡率HR=0.24;95%CI,0.11-0.52),亦可降低20年直肠癌风险(RR=0.58;95%CI,0.36-0.92),但不影响远端结肠癌风险
s303 Sentence In a randomized, double-blind, placebo-controlled study of 77 patients with familial adenomatous polyposis, patients receiving 400 mg of celecoxib twice a day had a 28.0% reduction in the mean number of colorectal adenomas ( P = .003 for the comparison with placebo) and a 30.7% reduction in the polyp burden (sum of polyp diameters; P = .001) as compared with reductions of 4.5% and 4.9%, respectively, in the placebo group 一项随机、双盲、以安慰剂作对照的研究,纳入77例家族性腺瘤性息肉病患者,在每日2次服用塞来昔布400 mg的患者组中,结直肠腺瘤的平均数目减少28.0%(与安慰剂组比,P=0.003),息肉负荷(息肉直径总和)降低30.7%(与安慰剂组比,P=0.001),而安慰剂组结直肠腺瘤平均数目减少4.5%,息肉负荷减少4.9%
s304 Sentence A prospective cohort study observed that higher energy-adjusted folate intake in the form of multivitamins containing folic acid was related to a lower risk for colon cancer (RR = 0.69; 95% CI, 0.52–0.93) for intake of more than 400 µg/day compared with intake of 200 µg/day or less after controlling for age, family history of CRC, ASA use, smoking, body mass, physical activity, and intakes of red meat, alcohol, methionine, and fiber 一项前瞻性队列研究对能量摄入进行校正后发现,多摄入含叶酸的复合维生素可降低结肠癌发生风险,经年龄、结直肠癌家族史、水杨酸用药史、吸烟史、体重、体育活动量、红肉摄入情况、饮酒、蛋氨酸与纤维调整,每日服用超过400 µg/天与服用不超过200 µg/天相比,RR为0.69(95%CI,0.52-0.93)
s305 Sentence Among women in the combined estrogen plus progestin group of the WHI, an extended follow-up (mean, 11.6 years) confirmed that fewer CRC were diagnosed in the combined hormone therapy group than in the placebo group (HR = 0.72; 95% CI, 0.56–0.94); the CRCs in women in the combined group were more likely to have lymph node involvement than the CRCs in women in the placebo group (50.5% vs 28.6%; P &lt; .001) and were classified at higher stages (regional and distant) (68.8% vs 51.4%; P = .003) WHI雌孕激素联合治疗组延长随访(平均11.6年)研究发现,与安慰剂组相比,激素联合治疗组的结直肠癌发病率更低(HR=0.72;95%CI,0.56-0.94);患结直肠癌后淋巴结更易受累(分别50.5%与28.6%;P<0.001);结直肠癌诊断分期较晚(局部与远处转移)(分别68.8%与51.4%;P=0.003)