Abstract：
OBJECTIVE: Long-term GH/IGF-1 excess could increase risk of cancer in acromegaly, but individual levels of these hormones do not relate to this risk. Therefore, we newly investigated longitudinally-measured IGF-1 levels as a potential predictor of cancer in a large NYC acromegaly cohort.
METHODS: We conducted a prospective, longitudinal study of 598 acromegaly (309 men, 289 women) and 292 clinically nonfunctioning pituitary adenoma (CNFPA)(140 women, 152 men) patients from the same underlying population. GH and IGF-1 levels were measured longitudinally and outcomes were observed during long-term follow-up. Cumulative exposure to IGF-1 excess was tested as a predictor of cancer. We compared cancer prevalence in acromegaly and CNFPA cohorts and incidence in each to that expected from SEER data.
RESULTS: Cancer prevalence by last follow up was 22.6% in acromegaly and 12.7% in CNFPAs (OR = 1.99 (95% CI, 1.34, 2.97)(P=0.0005). Overall SIR for cancer was 1.78 (1.51, 1.81) in the acromegaly and 1.26 (0.89, 1.70) in the CNFPA cohorts. Cumulative exposure to IGF-1 excess, OR=1.278 (1.060, 1.541)(P = 0.01), years from acromegaly diagnosis to cancer or last follow up, OR= 1.03 (1.004, 1.057)(P=0.024), and age at follow up, OR =1.064 (1.047, 1.082)(P<0.001), were predictors of cancer.
CONCLUSIONS: Cancer risk is increased in acromegaly, but not in CNFPA patients. Cumulative exposure to IGF-1 excess is a predictor of cancer in acromegaly. Our data suggest that cancer risk in acromegaly relates to the degree and duration of IGF-1 excess and that full appreciation of this risk requires long-term follow up.
METHODS: We conducted a prospective, longitudinal study of 598 acromegaly (309 men, 289 women) and 292 clinically nonfunctioning pituitary adenoma (CNFPA)(140 women, 152 men) patients from the same underlying population. GH and IGF-1 levels were measured longitudinally and outcomes were observed during long-term follow-up. Cumulative exposure to IGF-1 excess was tested as a predictor of cancer. We compared cancer prevalence in acromegaly and CNFPA cohorts and incidence in each to that expected from SEER data.
RESULTS: Cancer prevalence by last follow up was 22.6% in acromegaly and 12.7% in CNFPAs (OR = 1.99 (95% CI, 1.34, 2.97)(P=0.0005). Overall SIR for cancer was 1.78 (1.51, 1.81) in the acromegaly and 1.26 (0.89, 1.70) in the CNFPA cohorts. Cumulative exposure to IGF-1 excess, OR=1.278 (1.060, 1.541)(P = 0.01), years from acromegaly diagnosis to cancer or last follow up, OR= 1.03 (1.004, 1.057)(P=0.024), and age at follow up, OR =1.064 (1.047, 1.082)(P<0.001), were predictors of cancer.
CONCLUSIONS: Cancer risk is increased in acromegaly, but not in CNFPA patients. Cumulative exposure to IGF-1 excess is a predictor of cancer in acromegaly. Our data suggest that cancer risk in acromegaly relates to the degree and duration of IGF-1 excess and that full appreciation of this risk requires long-term follow up.
摘要：
目的：长期GH/IGF-1过量可增加肢端肥大症的癌症风险，但是这些激素的个体水平与这种风险无关。因此,我们新研究了一项大型NYC肢端肥大症队列中纵向测量的IGF-1水平作为癌症的潜在预测因子.
方法：我们进行了前瞻性，598例肢端肥大症的纵向研究(309名男性，289名妇女）和292名临床无功能垂体腺瘤（CNFPA）（140名妇女，152名男性)来自同一基础人群的患者。纵向测量GH和IGF-1水平，并在长期随访中观察结果。对过量IGF-1的累积暴露作为癌症的预测因子进行测试。我们比较了肢端肥大症和CNFPA队列中的癌症患病率以及每个队列中的发病率与根据SEER数据预期的发病率。
结果：末次随访时肢端肥大症的癌症患病率为22.6%，CNFPA为12.7%（OR=1.99（95%CI，1.34，2.97）（P=0.0005）。在肢端肥大症中，癌症的总SIR为1.78（1.51，1.81），在CNFPA队列中为1.26（0.89，1.70）。累积暴露于过量的IGF-1，OR=1.278（1.060，1.541）（P=0.01），从肢端肥大症诊断到癌症或最后一次随访，OR=1.03（1.004，1.057）（P=0.024），和随访时的年龄，OR=1.064（1.047，1.082）（P<0.001），是癌症的预测因子。
结论：肢端肥大症的癌症风险增加，但在CNFPA患者中没有。过量IGF-1的累积暴露是肢端肥大症中癌症的预测因子。我们的数据表明，肢端肥大症的癌症风险与IGF-1过量的程度和持续时间有关，并且完全了解这种风险需要长期随访。
方法：我们进行了前瞻性，598例肢端肥大症的纵向研究(309名男性，289名妇女）和292名临床无功能垂体腺瘤（CNFPA）（140名妇女，152名男性)来自同一基础人群的患者。纵向测量GH和IGF-1水平，并在长期随访中观察结果。对过量IGF-1的累积暴露作为癌症的预测因子进行测试。我们比较了肢端肥大症和CNFPA队列中的癌症患病率以及每个队列中的发病率与根据SEER数据预期的发病率。
结果：末次随访时肢端肥大症的癌症患病率为22.6%，CNFPA为12.7%（OR=1.99（95%CI，1.34，2.97）（P=0.0005）。在肢端肥大症中，癌症的总SIR为1.78（1.51，1.81），在CNFPA队列中为1.26（0.89，1.70）。累积暴露于过量的IGF-1，OR=1.278（1.060，1.541）（P=0.01），从肢端肥大症诊断到癌症或最后一次随访，OR=1.03（1.004，1.057）（P=0.024），和随访时的年龄，OR=1.064（1.047，1.082）（P<0.001），是癌症的预测因子。
结论：肢端肥大症的癌症风险增加，但在CNFPA患者中没有。过量IGF-1的累积暴露是肢端肥大症中癌症的预测因子。我们的数据表明，肢端肥大症的癌症风险与IGF-1过量的程度和持续时间有关，并且完全了解这种风险需要长期随访。
