苏州队列人群的胃癌发病状况及其危险因素

Incidence of gastric cancer and risk factors in Suzhou cohort

目的描述苏州队列人群胃癌发病状况,探索苏州市胃癌发病的环境危险因素,为预防胃癌提供科学依据。方法研究对象来自中国慢性病前瞻性研究苏州队列,2004-2008年开展基线调查,随后进行长期随访至2013年12月31日,剔除自报既往诊断消化性溃疡、恶性肿瘤以及入组半年内罹患胃癌者,共纳入50136名研究对象。采用Cox比例风险回归模型筛选并确定苏州地区胃癌各类危险因素及其风险比(HR),同时分析性别在其他危险因素与胃癌关联中是否存在效应修饰作用。结果研究对象中位随访时间为7.19年,共374人罹患胃癌,标化发病率为94.57/10万人年。多因素Cox比例风险回归模型分析结果显示,年龄(10岁为1组,HR=2.20,95%CI:1.92~2.53,P<0.001)、现在吸烟(HR=1.84,95%CI:1.10~3.07,P=0.020)、每周(HR=2.28,95%CI:1.28~4.07,P=0.005)和每天(HR=2.05,95%CI:1.16~3.61,P=0.013)食用腌制蔬菜是胃癌危险因素,女性(HR=0.44,95%CI:0.25~0.76,P=0.003)和使用冰箱(10年为1组,HR=0.85,95%CI:0.74~0.97,P=0.016)是胃癌保护因素。进一步分析发现,冰箱使用年限与胃癌的关联在男女性中存在异质性(P=0.009),性别与使用冰箱在对胃癌发病的关联中存在交互作用(P=0.010)。结论苏州队列人群胃癌发病率高,胃癌危险因素众多。性别与冰箱使用年限在对胃癌发病的作用中存在协同交互作用。

Objective To describe gastric cancer incidence in Suzhou cohort,explore the environmental risk factors of gastric cancer in Suzhou,and provide appropriate suggestions for gastric cancer prevention and control.Methods The participants were from the Suzhou cohort of China Kadoorie Biobank.Baseline survey was conducted from 2004 to 2008,followed by long-term follow-up until December 31,2013.After the exclusion of those who had been previously diagnosed with peptic ulcer and malignant tumor reported at baseline survey and gastric cancer within six months after enrollment,a total of 50,136 participants were included.Cox proportional risk models were used to identify risk factors of gastric cancer and their hazard ratios in Suzhou.The effect modifications of gender on the association between risk factors and gastric cancer were analyzed.Results In the follow-up of 7.19 years(median),374 gastric cancers cases occurred.The standardized incidence was 94.57 per 100000 person-years.Multivariate Cox proportional risk model analysis found that age(10 years old as a age group,HR=2.20,95%CI:1.92-2.53,P<0.001),current smoking(HR=1.84,95%CI:1.10-3.07 P=0.020),consumption of preserved vegetables weekly(HR=2.28,95%CI:1.28-4.07,P=0.005)and daily(HR=2.05,95%CI:1.16-3.61,P=0.013)were risk factors for gastric cancer.Female(HR=0.44,95%CI:0.25-0.76,P=0.003)and refrigerator use(10 years as a limit,HR=0.85,95%CI:0.74-0.97,P=0.016)were protective factors for gastric cancer.Further analysis showed that there was heterogeneity between males and females in the association between refrigerator use years and the incidence of gastric cancer(P=0.009),and there was an interaction effect between gender and refrigerator use on the incidence of gastric cancer(P=0.010).Conclusions The incidence of gastric cancer in Suzhou cohort was high.The risk factors of gastric cancer varied.There was a synergistic interaction effect between gender and refrigerator use years on the incidence of gastric cancer.