婚育因素对中国女性食管鳞状细胞癌患者的生存影响

Effects of reproductive and menstrual factors on survival of women with esophageal squamous cell carcinoma

目的:探讨婚育因素对中国女性食管鳞状细胞癌患者术后生存预后影响.方法:12041例女性食管癌患者信息均来自河南省食管癌重点开放实验室食管癌数据库,患者均经组织病理学证实为食管鳞状细胞癌且有翔实婚育史记录及完整临床病理资料.通过调查问卷、家访、电话问询方式进行患者生存随访.Kaplan-Meier生存曲线及Cox生存分析模型分析不同婚育因素对女性食管鳞癌患者预后影响.结果:校正年龄、职业、吸烟、饮酒、体质量指数和肿瘤病理分期等可能混杂因素后Cox多因素生存分析显示怀孕次数多女性预后较好(RR=1.49,95%CI:1.16-1.92),分层分析发现该生存优势也存在于高发区女性(RR=1.41,95%CI:1.03-1.86)及食管癌家族史阴性女性(RR=1.21,95%CI:1.04-1.41).绝经前期女性预后明显优于围绝经期和绝经后期女性患者(P=0.00),尤其是来自于高发区(RR=0.73,95%CI:0.62-0.86)和家族史阴性绝经前期女性(RR=0.70,95%CI:0.58-0.85).结论:怀孕次数和经期状态可能是中国女性食管鳞癌患者术后预后影响因素,怀孕次数多女性及绝经前期女性患者术后预后较好.

AIM：To determine the effects of reproductive and menstrual factors on the survival of women with esophageal squamous cell carcinoma（ESCC）.METHODS：A total of 12041 Chinese women with ESCC were enrolled in this study,and their median age was 61 years.All patients’ information was retrieved from the esophageal cancer database of Henan Key Laboratory for Esophageal Cancer Research based on the records of reproduction and menstrual history.The menopausal status was categorized as pre-,peri- and post-menopausal.Questionnaire,home interview and/or telephone were performed for survival follow-up.Cox proportional hazards regression models were used for analysis of relative risks（RRs）and 95%confidence intervals（95%CIs） to determine the effects of reproductive and menstrual factors on ESCC survival.RESULTS：Survival analysis demonstrated that patients with increased number of pregnancy had a longer survival（RR = 1.49,95%CI：1.16-1.92）;the prolonged survival remained in patients from the high incidence area（RR = 1.41,95%CI：1.03-1.86） and in patients with a negative family history（RR = 1.21,95%CI：1.04-1.41）.Pre-menopausal patients had a longer survival than peri- and postmenopausal patients（P =0.00）;this remained in patients from the high incidence area（RR for post- vs pre-menopausal,0.73,95%CI：0.62-0.86） and in patients with a negative family history（RR = 0.70,95%CI：0.58-0.85）.CONCLUSION：Increasing number of pregnancy and premenopausal status may be favorable factors for ESCC survival in Chinese women with ESCC.