食管鳞状细胞癌高/低发区肿瘤家族史流行病学病例对照分析

A case-control epidemiological study on family history of esophageal squamous cell carcinoma(ESCC) in high-and low-incidence areas for ESCC

目的探讨高/低发区肿瘤家族史与食管鳞状细胞癌患病风险、性别和发病年龄的关系。方法采用大规模人群流行病学病例-对照研究方法,对住院患者或胃镜受检者面对面调查,病例及对照资料来自全国食管癌高/低发区45家单位,病例组39 833例、对照组9 242例进入最终分析。结果高发区和低发区病例组家族史阳性率均高于对照组(分别为34%,23%,P<0.05;21%,5%,P<0.05);高发区男性患者家族史阳性率高于女性(34%,33%,P<0.05);高发区和低发区肿瘤家族史阳性食管鳞癌患者平均发病年龄均低于家族史阴性患者(分别为57.6岁±9岁,58.4岁±10岁,P<0.05;58.7岁±9岁,59.7岁±9岁,P<0.05);高发区和低发区病例组小年龄组(≤45岁)家族史阳性率均高于大年龄组(≥66岁)(分别为35%,31%,P<0.05;22%,18%,P<0.05)。结论肿瘤家族史阳性者ESCC发病风险明显高于肿瘤家族史阴性者,尤以高发区男性为甚,且发病年龄偏低;遗传因素在ESCC发生中起重要作用,食管鳞癌的发生是遗传因素、环境因素交互作用的结果。

Objective To characterize the family history for patients with esophageal squamous cell carcinoma（ESCC） from high-and low-incidence areas and to correlate the family history with the risk of ESCC,gender and the age at onset.Methods With a large population epidemiological case-control study,face to face investigation was performed in inpatients or endoscopic subjects,and case and control data came from 45 units of the ESCC high-and low-incidence areas.All the subjects in control group were free of early ESCC or other upper gastrointestinal malignant diseases based on endoscopic examination.39833 cases with ESCC and 9242 subjects without cases were enrolled into final analyses based on clinical data.Results The positive rate of cancer family history for ESCC cases from high-and low-incidence areas was higher than controls（34%,23%,P〈0.05;21%,5%,P〈0.05）.In high-incidence areas,the positive rate of family history in the male was higher than those in the female cases（34%,33%,P〈0.05,OR=1.06,95%CI=1.01-1.11）.The average age in positive family history patients was younger than that in negative family history patients（57.6±9 years,58.4±10 years,P〈0.05;58.7±9 years,59.7±9 years）.In high-and low-incidence areas,the positive rate of family history in the young（≤45 years） was higher than that in the old（≥66 years）（35%,31%,P〈0.05;22%,18%,P〈0.05）.Conclusions The positive family history in ESCC patients from the ESCC high-incidence area was apparently higher than in those from the ESCC low-incidence area,especially in males of the high incidence areas was significant,espicially for cases with younger age.The present results indicated that genetic factor may play an important role in ESCC.The incidence of ESCC is the result of interaction between genetic factors and environmental factors