2003-06-11 13:54:00阿國
心血
我來美國四年多，被系上各家師傅趕來趕去的，當了三年多的「學術孤兒」（系上一百二十多個專任老師，沒人願意指導我），所以都沒有什麼著作可以發表。我們流病不像其他學科，沒資料就是什麼也做不了（Data is the king！），如果我是醫師，還可以用自己醫院或門診的病人資料拿來玩玩，可是我什麼也不是啊？！不過我雖老是被無情地趕出來（一共是三次），我不是回家哭哭就算了，我可是有偷偷學幾招起來準備「報仇」的呦！我綜合了在兩家打雜期間所學到的東西，提出了一套自己的理論，主張探討糖尿病是否為大腸直腸癌的病因時，應該要考慮治療的方式與病人對治療的反應，否則的話，用流病的術語來講：是一種「衡量暴露的錯誤分組」（exposure measurement misclassification）。現在的相關流行病學病研究，都不足以正確回答這個問題。我抱著這個理論去問了很多很多專家（主要美國東西岸和英國各大學），大家都說好主意！可是我們系上還是沒人願意指導我，既要求學生要有自己的idea，卻又沒人肯收，這是為什麼呢？所以我只好跟一個同為外籍學生的學姐（德國來的）合作，寫成一篇文獻回顧（review article）去投稿，以免有人把這個概念拿去做實際的研究（我把這個概念和有相關資源做這種研究的學者都討論過了），那我的原創權利就沒了。我們的文章終於在今年三月份被歐洲糖尿病研究學會（European Association for the Study of Diabetes - EASD）的機關刊物Diabetologia所接受，將在近期內刊出。才剛被接受而在五月廿三日電子出刊（e-pub），就已經有法國巴斯德研究所和德國的學者來要抽印本喔！希望大家多多引用我的文章啦！呵呵。俗話說得好：「小孩再醜，還是自己的好。」所以就把摘要（abstract）刊登上來，跟大家分享喜悅。（不過其實我個人並沒有版權，版權是屬於那家雜誌的，我這樣做其實有小小犯罪的嫌疑喔！不過民法是「不告不理」的，他們要越洋來台灣告身在美國的作者，好像是有點給他那個不太可能啦！）
Review
Hyperinsulinaemia and hyperglycaemia: possible risk factors of colorectal cancer among diabetic patients
C. K. Chang1, 2 and C. M. Ulrich1, 2, 3
(1) Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA 98195, USA
(2) Epidemiology Program, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
(3) Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, PO Box 19024, MP-900, Seattle, WA 98109, USA
Abstract: Hyperinsulinaemia and hyperglycaemia are two possible risk factors for colorectal cancer, which constitutes the third leading cause of cancer death in Western countries. Molecular evidence as well as animal models provide support for these associations: Insulin has been shown to be an important growth factor for colonic carcinoma cells, and both insulin and insulin-like growth factor-1 receptors have been detected in colon cancer tissue. The insulin-signal transduction pathway is involved in the regulation of gene expression and apoptosis. The role of hyperglycaemia in carcinogenesis could include pathways via luminal factors (related to fecal bile acid concentrations, stool bulk, and prolonged transit time) or circulatory factors (via glucose as the only energy source for neoplastic cells). This review summarizes the epidemiologic literature with respect to hyperinsulinaemia and hyperglycaemia as risk factors for colorectal cancer, and aims to integrate the biological and epidemiological evidence. Epidemiologic findings to date indicate a slightly increased risk of colorectal cancer for diabetic patients; however, there are some inconsistencies. Possible explanations for these inconsistencies include inadequate information about patients’ diabetic disease and treatment states. We suggest that future studies should take medical history, staging and treatment for hyperinsulinaemia and hyperglycaemia into account to further our understanding of the role of hyperglycaemia and hyperinsulinaemia in colorectal carcinogenesis.
Keywords: Diabetes mellitus - colorectal cancer - carcinogenesis - hyperglycaemia - hyperinsulinaemia - insulin resistance - IGF-1 - epidemiology - review
Abbreviations:
DCCT: Diabetes Control and Complications Trial
IGFBP-3: IGF binding protein-3
NSAIDs: Nonsteroidal anti-inflammatory drugs
OTC: Over the counter
UKPDS: United Kingdom Prospective Diabetes Study
Review
Hyperinsulinaemia and hyperglycaemia: possible risk factors of colorectal cancer among diabetic patients
C. K. Chang1, 2 and C. M. Ulrich1, 2, 3
(1) Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA 98195, USA
(2) Epidemiology Program, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
(3) Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, PO Box 19024, MP-900, Seattle, WA 98109, USA
Abstract: Hyperinsulinaemia and hyperglycaemia are two possible risk factors for colorectal cancer, which constitutes the third leading cause of cancer death in Western countries. Molecular evidence as well as animal models provide support for these associations: Insulin has been shown to be an important growth factor for colonic carcinoma cells, and both insulin and insulin-like growth factor-1 receptors have been detected in colon cancer tissue. The insulin-signal transduction pathway is involved in the regulation of gene expression and apoptosis. The role of hyperglycaemia in carcinogenesis could include pathways via luminal factors (related to fecal bile acid concentrations, stool bulk, and prolonged transit time) or circulatory factors (via glucose as the only energy source for neoplastic cells). This review summarizes the epidemiologic literature with respect to hyperinsulinaemia and hyperglycaemia as risk factors for colorectal cancer, and aims to integrate the biological and epidemiological evidence. Epidemiologic findings to date indicate a slightly increased risk of colorectal cancer for diabetic patients; however, there are some inconsistencies. Possible explanations for these inconsistencies include inadequate information about patients’ diabetic disease and treatment states. We suggest that future studies should take medical history, staging and treatment for hyperinsulinaemia and hyperglycaemia into account to further our understanding of the role of hyperglycaemia and hyperinsulinaemia in colorectal carcinogenesis.
Keywords: Diabetes mellitus - colorectal cancer - carcinogenesis - hyperglycaemia - hyperinsulinaemia - insulin resistance - IGF-1 - epidemiology - review
Abbreviations:
DCCT: Diabetes Control and Complications Trial
IGFBP-3: IGF binding protein-3
NSAIDs: Nonsteroidal anti-inflammatory drugs
OTC: Over the counter
UKPDS: United Kingdom Prospective Diabetes Study