家族史、BMI、吸烟、饮酒与贲门癌发病风险及预后的关系

Influence of family history,BMI,smoking,and alcohol drinking on risk and prognosis of gastric cardia cancer

目的:探讨家族史、BMI、吸烟、饮酒与贲门癌发病风险及预后的关系。方法:采用问卷调查记录16605例贲门癌患者和26053例非癌就诊者的家族史、吸烟、饮酒情况,并测量其身高和体质量。对贲门癌患者中电话或住址明确的2000例进行电话或入户随访,以死亡或搬迁为随访中止事件。生存分析及死亡风险评估采用Kaplan-Meier法和Cox模型。结果:家族史阳性明显增加贲门癌的发病风险(P<0.001,OR=2.012,95%CI=1.874～2.160);不同BMI患癌风险有较大差异,低体质量组的患癌风险是正常组的近4倍(OR=3.864,95%CI=3.459～4.317),超重组的患癌风险低于正常组(OR=0.323,95%CI=0.293～0.357);吸烟明显提升贲门癌的发病风险(P<0.001,OR=1.979,95%CI=1.785～2.194),而饮酒对贲门癌发病风险的影响较小(P<0.001,OR=0.749,95%CI=0.678～0.827)。家族史阳性患者生存期优于阴性者(P=0.010,RR=0.677,95%CI=0.502～0.912)。结论:家族史阳性、吸烟和低体质量均提示较高的贲门癌发病风险,而饮酒的作用较弱;家族史阳性可能是贲门癌患者预后较好的独立影响因素。

Aim：To explore the influence of family history （FH）,body mass index （BMI）,smoking,and alcohol drinking on the risk and prognosis of gastric cardia cancer（GCC）.Methods：A total of 16 605 patients with GCC and 26 053 controls were enrolled for retrospective investigation on FH,smoking,alcohol drinking,and BMI.Out of the 16 605 cases,2 000 subjects were followed-up by telephone or interviewed at home until November 2011.Survival analysis and hazard ratio（HR） estimated using Kaplan-Meier and multivariate Cox proportional hazard regression model were perfomed.Results：Positive FH was strikingly related with the high risk for GCC（P0.001,OR=2.012,95%CI =1.874~2.160）; the underweight group had nearly 4-folds elevated GCC risk than the normal weight group （OR=3.864,95%CI=3.459~4.317）,and it was noteworthy that overweight was a protective factor for GCC（OR=0.323,95%CI=0.293~0.357）;smoking was closely related with high risk for GCC（P0.001,OR=1.979,95%CI=1.785~2.194）; otherwise,the role of alcohol drinking was weak for GCC risk （P0.001,OR=0.749,95%CI=0.678~0.827）.Further analysis of the relationship between FH,BMI,smoking,alcohol drinking and survival showed that only FH was related with longer survival of patients with GCC（P=0.010,RR=0.677,95%CI=0.502~0.912）.Conclusion：Positive FH,smoking and underweight are related with the higher risk for GCC,while alcohol drinking is a weak risk factor for GCC;positive FH could be an independent factor for better prognosis of GCC.