恶性肿瘤家族史与胃癌患者临床病理特征及预后的关系

Relationship between family history of malignant tumor and clinicopathological features and prognosis of patients with gastric cancer

目的探讨一级亲属恶性肿瘤家族史与胃癌患者临床病理特征及预后的关系。方法回顾性分析中山大学附属第一医院2008年至2015年行根治性胃癌切除术的1065例胃癌患者的临床病例资料,其中一级亲属无恶性肿瘤家族史者954例,有恶性肿瘤家族史者111例,包括有胃癌家族史者53例,有其他恶性肿瘤家族史且无胃癌家族史者58例。采用双侧χ~2检验和Wilcoxon秩和检验分析胃癌患者一级亲属恶性肿瘤家族史与其临床病理特征的关系;采用Kaplan-Meier法进行生存分析,并行Log-rank检验;用Cox比例风险回归模型分析一级亲属恶性肿瘤家族史对胃癌患者预后的影响。结果有恶性肿瘤家族史胃癌患者的发病年龄和肿瘤长径显著低于无恶性肿瘤家族史的患者(P<0.05)。有恶性肿瘤家族史患者的总生存期(OS)和无进展生存期(PFS)均呈现高于无恶性肿瘤家族史患者的趋势。其中,有胃癌家族史患者的OS和PFS与无恶性肿瘤家族史患者无明显差异。但有其他恶性肿瘤家族史且无胃癌家族史的患者,OS和PFS均显著高于无恶性肿瘤家族史患者(P<0.05)。采用Cox比例风险回归模型校正年龄、性别、肿瘤位置、肿瘤最大径,分化程度,T分期和N分期后,胃癌家族史和其他恶性肿瘤家族史与患者的肿瘤复发和死亡风险均无显著相关。结论有、无一级亲属恶性肿瘤家族史的胃癌患者之间存在临床病理特征的差异,并且恶性肿瘤家族史与胃癌患者预后存在相关性,但其并不是影响胃癌患者预后的独立因素。

Objective To investigate the relationship between first-degree family history of malignant tumor and clinicopathological features and its impact on prognosis of patients with gastric cancer.Methods The clinical data of 1065 patients with gastric cancer who underwent radical gastric cancer resection from 2008 to 2015 in the First Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. 954 patients had no first-degree family history of malignant tumor and 111 patients had family history of malignant tumor, including 53 patients with a family history of gastric cancer and 58 patients with family history of all other cancers excluding gastric cancer. The relationship between history of malignant tumor and clinicopathological features of patients with gastric cancer was analyzed by bilateral χ~2 test and Wilcoxon rank test. Survival analysis were performed by Kaplan-Meier method. Cox proportional hazards regression model was employed to analyze the influence of family history of malignant tumor on the prognosis of patients with gastric cancer. Results The age of onset and the size of tumor in patients with gastric cancer with a family history of malignant tumor were significantly lower than those without(P<0.05). The overall survival(OS) and progress-free survival(PFS) of patients with a family history of malignant tumor were higher than those with no family history of malignant tumor. No significant difference in OS and PFS were detected between patients with a family history of gastric cancer and other patients without family history of malignant tumor. However, patients with a family history of all other cancers excluding gastric cancer had better OS and PFS(P<0.05). Cox proportional hazards regression model was used to minimize the influence of age, gender, tumor location, tumor maximum diameter, differentiation, T-stage and N-stage. There was no obvious correlation between family history of malignant tumor and OS or PFS. Conclusion There are clinical and pathological features between gastric cancer patients with and without first-degree family history of malignant tumor. The family history of malignant tumor is related to the prognosis of gastric cancer patients,but it is not an independent factor affecting the prognosis of gastric cancer patients.