食管鳞癌患者上消化道肿瘤家族史与其临床病理特征及预后的关系

Relationship Between Family History of Upper Gastrointestinal Cancer and Clinicopathological Features and Prognosis in Patients with Esophageal Squamous Cell Carcinoma

目的探讨食管鳞癌(ESCC)患者上消化道肿瘤(UGIC)家族史与其临床病理特征及预后的关系。方法回顾性分析郑州大学第一附属医院2008—2015年行根治性食管鳞癌切除术的923例ESCC患者的临床病例资料,其中一级亲属UGIC家族史阴性741例,UGIC家族史阳性182例。采用双侧χ^2检验分析ESCC患者UGIC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。采用Cox比例风险回归模型分析UGIC家族史对ESCC患者预后的影响。结果家族史阳性患者的肿瘤为T1期、中低分化高于家族史阴性患者,大体类型为溃疡型和髓质型者的比例低于家族史阴性患者,差异有统计学意义(均P<0.05)。家族史阳性患者的总生存时间(OS)与家族史阴性患者比较,差异无统计学意义(P>0.05)。但是,家族史阳性患者中,一级亲属仅为同胞的患者的OS低于其他家族史阳性患者(P<0.05)。Cox比例风险模型显示,影响UGIC家族史阳性患者OS的独立预后因素为T分期和亲属类型(均P<0.05),影响UGIC家族史阴性患者OS的独立预后因素为T分期和淋巴结转移率(均P<0.05)。结论有、无UGIC家族史的ESCC患者之间临床病理特征存在差异,且UGIC家族史与ESCC患者预后存在相关性,但其不是影响ESCC患者预后的独立因素。UGIC家族史阳性患者中,一级亲属仅为同胞的患者的OS低于其他家族史阳性患者。

Objective To explore the relationship between the family history of upper gastrointestinal cancer(UGIC)in patients with esophageal squamous cell carcinoma(ESCC)and its clinicopathological characteristics and prognosis.Methods The clinical data of 923 patients with ESCC who underwent radical resection from 2008 to 2015 in the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively.Among of them,741 cases had negative family history of UGIC and 182 cases had positive family history of UGIC.Bilateralχ^2 test was used to analyze the relationship between the family history of UGIC in patients with ESCC and its clinicopathological characteristics.Kaplan-Meier method was used for survival analysis,and Log-rank test was used.Cox proportional risk regression model was used to analyze the influence of the family history of UGIC on the prognosis of patients with ESCC.Results T1 stage,poorly differentiated of the proportion of patients with positive family history were higher than those of patients with negative family history,and the proportion of patients with ulcerative medullary type was lower than that of patients with negative family history(all P<0.05).There was no difference in overall survival time(OS)between patients with and without family history(P>0.05).However,in the family history positive patients,the OS of the patients whose first-degree relatives were only compatriots was lower than that of the other family history positive patients(P<0.05).Cox proportional risk model showed that the independent prognostic factors of OS in patients with family history of UGIC were T stage and relative type(all P<0.05),the independent prognostic factors of OS in patients without family history of UGIC were T stage and lymph node metastasis rate(all P<0.05).Conclusion There are differences in clinicopathological characteristics between patients with and without UGIC family history,and UGIC family history is related to the prognosis of patients with ESCC,but it is not an independent factor of patients with ESCC.Among the patients with the family history of UGIC,the OS of patients whose first-degree relatives are only compatriots is lower than that of others with family history.