Insulin, Insulin-like Growth Factor-I, Endogenous Estradiol, and Risk of Colorectal Cancer in Postmenopausal Women

作者：Marc J. Gunter, Donald R. Hoover, Herbert Yu, Sylvia Wassertheil‐Smoller, Thomas E. Rohan, JoAnn E. Manson, Barbara V. Howard, Judith Wylie‐Rosett, Garnet L. Anderson, Gloria Ho, Robert C. Kaplan, Jixin Li, Xiaonan Xue, Tiffany G. Harris, Robert D. Burk, Howard D. Strickler · 发表于：Cancer Research · 年份：2008 · DOI：10.1158/0008-5472.can-07-2946 · 被引用次数：229 · 研究领域：Growth Hormone and Insulin-like Growth Factors、Metabolism, Diabetes, and Cancer、Cancer Risks and Factors

Obesity is a risk factor for colorectal cancer, and hyperinsulinemia, a common condition in obese patients, may underlie this relationship. Insulin, in addition to its metabolic effects, has promitotic and antiapoptotic activity that may be tumorigenic. Insulin-like growth factor (IGF)-I, a related hormone, shares sequence homology with insulin, and has even stronger mitogenic effects. However, few prospective colorectal cancer studies directly measured fasting insulin, and none evaluated free IGF-I, or endogenous estradiol, a potential cofactor in postmenopausal women. Therefore, we conducted a case-cohort investigation of colorectal cancer among nondiabetic subjects enrolled in the Women's Health Initiative Observational Study, a prospective cohort of 93,676 postmenopausal women. Fasting baseline serum specimens from all incident colorectal cancer cases (n = 438) and a random subcohort (n = 816) of Women's Health Initiative Observational Study subjects were tested for insulin, glucose, total IGF-I, free IGF-I, IGF binding protein-3, and estradiol. Comparing extreme quartiles, insulin [hazard ratio (HR)(q4-q1), 1.73; 95% confidence interval (CI), 1.16-2.57; P(trend) = 0.005], waist circumference (HR(q4-q1), 1.82; 95% CI, 1.22-2.70; P(trend) = 0.001), and free IGF-I (HR(q4-q1), 1.35; 95% CI, 0.92-1.98; P(trend) = 0.05) were each associated with colorectal cancer incidence in multivariate models. However, these associations each became nonsignificant when adjusted for one anot...