PO.PS01.03 · 人群科学
稳态负荷评分在结直肠癌中的判别能力：一项试点病例对照研究
Discriminatory capacity of allostatic load score in colorectal cancer: A pilot case-control study
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
结直肠癌（CRC）是波多黎各癌症相关死亡的首要原因。稳态负荷（AL）反映了炎症、神经内分泌和代谢系统的累积性失调。它可以作为区分CRC病例与对照的综合指标。与单个标志物不同，AL捕捉了CRC患者中观察到的多系统生理失调。本研究旨在评估由炎症、神经内分泌和代谢生物标志物衍生的综合AL评分在区分居住于波多黎各的西班牙裔个体（HPR）样本中的CRC患者与健康对照方面的判别能力。这项病例对照研究使用了来自波多黎各家族性结直肠癌登记处（PURIFICAR）的血浆样本，包括18例CRC病例和18例健康对照。AL评分采用基于对照的百分位评分法（第75百分位截断值，IGF-1为第25百分位）构建，涵盖8个标志物：IL-1beta、TNF-alpha、IL-8、MCP-1、CRP（炎症）、皮质醇（神经内分泌）以及IGF-1和BMI（代谢）。逻辑回归模型评估了判别能力，并逐步校正人口学和社会人口学因素。使用DeLong检验进行曲线下面积（AUC）比较。分析在Stata 18中进行。参与者的中位年龄为48岁（范围：34-65岁），44%为男性。与对照相比，CRC病例的BMI显著较低（中位数23.8对28.2，p=0.016）、受教育程度较高（50%对33%，p=0.31）、私人保险覆盖率较低（33%对56%，p=0.18）。AL评分在病例中的中位值高于对照。在未校正分析中，较高的AL评分与CRC几率增加相关（OR=1.26，p=0.295），在校正年龄和性别后略有增强（OR=1.30，p=0.247）。在完整模型中纳入教育和保险类型后，该关联仍然相似（OR=1.25，p=0.362）。私人保险表现出边缘显著的保护性关联（OR=0.20，p=0.075）。AL单独的判别能力较为一般（AUC=0.619），在人口学校正后保持相似（AUC=0.590），但在完全校正后有所改善（AUC=0.713）。DeLong检验表明各模型之间的差异不显著（模型1对2：p=0.626；模型1对3：p=0.329；模型2对3：p=0.171）。这项试点研究显示AL评分与CRC之间的关联不显著，但判别能力随社会人口学校正而改善。私人保险边缘显著的保护效应表明，医疗可及性可能独立于生理应激负荷影响CRC风险。这些发现支持了在HPR人群中进行AL测量的可行性，并强调了在CRC风险评估中考虑健康的结构性决定因素的重要性。有必要在更大样本中进行验证。
查看英文原文 English abstract
Colorectal cancer (CRC) represents the leading cause of cancer-related deaths in Puerto Rico. Allostatic load (AL) reflects a cumulative dysregulation across inflammatory, neuroendocrine, and metabolic systems. It may serve as a composite index for distinguishing CRC cases from controls. Unlike individual markers, AL captures multi-system physiological dysregulation observed in CRC patients. This study aimed to assess the discriminatory capacity of a composite AL score derived from inflammatory, neuroendocrine, and metabolic biomarkers for distinguishing CRC patients from healthy controls in a sample of Hispanics individuals living in Puerto Rico (HPR).This case-control study used plasma samples from the Puerto Rico Familial Colorectal Cancer Registry (PURIFICAR) including 18 CRC cases and 18 healthy controls. AL score was constructed using control derived percentile scoring (75th percentile cutoffs, 25th for IGF-1) across 8 markers: IL-1beta, TNF-alpha, IL-8, MCP-1, CRP (inflammatory), cortisol (neuroendocrine), and IGF-1 and BMI (metabolic). Logistic regression models evaluated discriminatory capacity with progressive adjustment for demographic and sociodemographic factors. Area under the curve (AUC) comparisons were performed using DeLong's test. Analyses were performed in Stata 18. Participants had a median age of 48 years (range: 34-65) and 44% were male. CRC cases had significantly lower BMI (median 23.8 vs 28.2, p=0.016), higher educational attainment (50% vs 33%, p=0.31), and lower private insurance coverage (33% vs 56%, p=0.18) than controls. The AL score showed higher median values in cases versus controls. Higher AL scores were associated with increased odds of CRC in unadjusted analysis (OR=1.26, p=0.295), which strengthened slightly after adjusting for age and sex (OR=1.30, p=0.247). When including education and insurance type for the full model, the association remained similar (OR=1.25, p=0.362). Private insurance demonstrated a marginally significant protective association (OR=0.20, p=0.075). Discriminatory capacity was modest for AL alone (AUC=0.619) and remained similar after demographic adjustment (AUC=0.590) but improved with full adjustment (AUC=0.713). DeLong's test indicated non-significant differences between models (Model 1 vs 2: p=0.626; Model 1 vs 3: p=0.329; Model 2 vs 3: p=0.171). This pilot study demonstrated non-significant associations between AL score and CRC, though discriminatory capacity improved with sociodemographic adjustment. The marginally significant protective effect of private insurance suggests healthcare access may influence CRC risk independent of physiological stress burden. These findings support the feasibility of AL measurement in HPR populations and highlight the importance of considering structural determinants of health in CRC risk assessment. Validation in larger samples is warranted.
利益披露 Disclosure
H. Centeno-Girona, None..
M. Gonzalez-Pons, None..
E. V. Caraballo-Rivera, None.