林奇综合征(LS)是由DNA错配修复(MMR)基因之一的生殖系致病变异引起的，它会增加许多类型癌症的风险，特别是结肠直肠癌(结直肠癌)，但也会增加子宫内膜、卵巢、胃、小肠、胰腺、胆管、尿道、大脑和皮肤的癌症。

研究纳入LS患者随机双盲分为RS组(n=463)及安慰剂组(n=455)，RS组每天30克抗性淀粉(RS)，长达4年。两组患者接受20年随访。CAPP2试验旨在探究阿司匹林和抗性淀粉对Lynch综合征(LS)患者癌症发病率的长期影响。

结果表明：接受RS治疗的患者患非结直肠癌LS癌的风险显著降低，特别是上消化道癌症。

Abstract

The CAPP2 trial investigated the long-term effects of aspirin and resistant starch on cancer incidence in patients with Lynch syndrome (LS). Participants with LS were ran_x0002_domized double-blind to 30 g resistant starch (RS) daily or placebo for up to 4 years. We present long-term cancer outcomes based on the planned 10-year follow-up from recruitment, supplemented by National Cancer Registry data to 20 years in England, Wales, and Finland. Overall, 463 participants received RS and 455 participants received pla_x0002_cebo. After up to 20 years follow-up, there was no difference in colorectal cancer incidence (n ¼ 52 diagnosed with colorectal cancer among those randomized to RS against n ¼ 53 on placebo) but fewer participants had non-colorectal

LS cancers in those randomized to RS (n ¼ 27) compared with placebo (n ¼ 48); intention-to-treat (ITT) analysis [HR, 0.54; 95% confidence interval (CI), 0.33–0.86; P ¼ 0.010]. In ITT analysis, allowing for multiple primary cancer diagnoses among participants by calculating incidence rate ratios (IRR) confirmed the protective effect of RS against non–colorectal cancer LS cancers (IRR, 0.52; 95% CI, 0.32–0.84; P ¼ 0.0075).

These effects are particularly pronounced for cancers of the upper GI tract; 5 diagnoses in those on RS versus 21 diagnoses on placebo. The reduction in non–colorectal cancer LS cancers was detectable in the first 10 years and continued in the next decade. For colorectal cancer, ITT analysis showed no effect of RS on colorectal cancer risk (HR,0.92; 95% CI, 0.62–1.34; P ¼ 0.63). There was no interaction between aspirin and RS treatments. In conclusion, 30 g daily RS appears to have a substantial protective effect against non–colorectal cancer cancers for patients with LS.

原文链接

https://doi.org/10.1158/1940-6207.CAPR-22-0044

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