Abstract
BackgroundObesity has been positively associated with upper gastrointestinal cancers, but prospective data by subtype/subsite are limited. Obesity influences hormonal factors, which may play a role in these cancers. We examined anthropometry, body fat and reproductive factors in relation to oesophageal and gastric cancer by subtype/subsite in the UK Biobank cohort.MethodsAmong 458,713 UK Biobank participants, 339 oesophageal adenocarcinomas, 124 oesophageal squamous cell carcinomas, 137 gastric cardia and 92 gastric non-cardia cancers were diagnosed during a mean of 6.5 years follow-up. Cox models estimated multivariable hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsBody mass index (BMI), hip circumference, waist circumference, waist-to-hip ratio, waist-to-height ratio, total body fat and trunk fat were positively associated with oesophageal adenocarcinoma (highest vs lowest category: HR = 2.33, 95%-CI:1.65–3.28; HR = 1.56, 95%-CI:1.15–2.13; HR = 2.30, 95%-CI:1.47–3.57; HR = 1.71, 95%-CI:1.01–2.90; HR = 2.87, 95%-CI:1.88–4.38; HR = 1.96, 95%-CI:1.30–2.96; HR = 2.34, 95%-CI:1.70–3.22, respectively). Although there were no statistically significant associations in combined sex analyses, BMI (HR = 1.83, 95%-CI:1.00–3.37), waist circumference (HR = 2.21, 95%-CI:1.27–3.84) and waist-to-hip ratio (HR = 1.92, 95%-CI:1.11–3.29) were associated with gastric cardia cancer in men; however, mutual adjustment attenuated the associations for BMI and waist-to-hip ratio. For oesophageal squamous cell carcinoma, statistically significant inverse associations were observed among women for BMI, hip circumference, waist circumference, waist-to-height ratio, total body fat and trunk fat, although they were based on small numbers. In addition, older age at first (HR = 0.44, 95%-CI:0.22–0.88) and last live birth (HR = 0.44, 95%-CI:0.22–0.87) were inversely associated with oesophageal squamous cell carcinoma and having a stillbirth/miscarriage/termination was positively associated (HR = 1.84, 95%-CI:1.10–3.07).ConclusionsObesity and abdominal obesity specifically may be a risk factor for oesophageal adenocarcinoma and gastric cardia cancer in men. Some reproductive factors may be associated with oesophageal squamous cell carcinoma in women.
Highlights
Oesophageal and gastric cancers are the seventh and fifth most common cancers, with an estimated 572,000 and 1,000,000 cases in 2018, respectively [1]
Body mass index (BMI), hip circumference, waist circumference, waist-to-hip ratio, waist-toheight ratio, total body fat and trunk fat were positively associated with oesophageal adenocarcinoma
There were no statistically significant associations in combined sex analyses, body mass index (BMI) (HR = 1.83, 95%-confidence interval (CI):1.00–3.37), waist circumference (HR = 2.21, 95%-CI:1.27– 3.84) and waist-to-hip ratio (HR = 1.92, 95%-CI:1.11–3.29) were associated with gastric cardia cancer in men; mutual adjustment attenuated the associations for BMI and waist-to-hip ratio
Summary
Oesophageal and gastric cancers are the seventh and fifth most common cancers, with an estimated 572,000 and 1,000,000 cases in 2018, respectively [1]. Both cancer types are more common in men than in women [1]. The aetiology of oesophageal cancer differs by the two main histological subtypes of adenocarcinoma and squamous cell carcinoma. Gastrooesophageal reflux disease, smoking and obesity are recognized risk factors for oesophageal adenocarcinoma, whereas smoking and alcohol are well-known risk factors for oesophageal squamous cell carcinoma [2]. Smoking and obesity are known risk factors for gastric cardia cancer, while Helicobacter Pylori infection and smoking are risk factors for gastric non-cardia cancer [3]. Body fat and reproductive factors in relation to oesophageal and gastric cancer by subtype/subsite in the UK Biobank cohort
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