Bass Adam J, Meyerhardt Jeffrey A, Chan Jennifer A, Giovannucci Edward L, Fuchs Charles S
Department of Medical Oncology, Dana Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts 02115, USA.
Cancer. 2008 Mar 15;112(6):1222-9. doi: 10.1002/cncr.23294.
A history of colorectal cancer in a first-degree relative is a recognized risk factor for developing this malignancy. The influence of a family history of colorectal cancer on survival after a diagnosis of colorectal cancer was examined in a large cohort of women.
We analyzed data from 1001 women diagnosed with colorectal cancer while participating in a prospective cohort study. Data on family history were obtained before cancer diagnosis. We computed Cox proportional hazards for cancer-specific and overall mortality according to a family history of colorectal cancer, adjusting for other predictors for survival.
Before diagnosis, 16% of colorectal patients reported a history of colorectal cancer in a first-degree relative. Patients with a history of colorectal cancer in 1 or more first-degree relatives experienced an adjusted hazard ratio (HR) for overall mortality of 1.32 (95% confidence interval [CI], 1.01-1.72) and colorectal cancer-specific mortality of 1.38 (95% CI, 1.02-1.86) when compared with those without a family history. Moreover, patients with 2 or more affected relatives had an HR for overall mortality of 2.07 (95% CI, 1.14-3.76) and cancer-specific mortality of 2.19 (95% CI, 1.10-4.38). The significant deleterious effect of family history was limited to patients with advanced disease at presentation and cancers originating in the colon.
Among women with colorectal cancer, a history of colorectal cancer in a first-degree relative was associated with a significant decrease in survival. Additional study is needed to validate these findings and determine whether specific germline polymorphisms correlate with clinical outcomes.
一级亲属有结直肠癌病史是公认的发生这种恶性肿瘤的危险因素。在一大群女性中研究了结直肠癌家族史对结直肠癌诊断后生存的影响。
我们分析了1001名在参与一项前瞻性队列研究期间被诊断为结直肠癌的女性的数据。家族史数据在癌症诊断前获得。我们根据结直肠癌家族史计算癌症特异性和总死亡率的Cox比例风险，同时对其他生存预测因素进行校正。
诊断前，16%的结直肠癌患者报告有一级亲属患结直肠癌的病史。与无家族史的患者相比，有1个或更多一级亲属患结直肠癌病史的患者，其总死亡率的校正风险比（HR）为1.32（95%置信区间[CI]，1.01 - 1.72），结直肠癌特异性死亡率的校正HR为1.38（95% CI，1.02 - 1.86）。此外，有2个或更多受影响亲属的患者，其总死亡率的HR为2.07（95% CI，1.14 - 3.76），癌症特异性死亡率的HR为2.19（95% CI，1.10 - 4.38）。家族史的显著有害影响仅限于初诊时患有晚期疾病的患者以及起源于结肠的癌症患者。
在患有结直肠癌的女性中，一级亲属有结直肠癌病史与生存率显著降低相关。需要进一步研究来验证这些发现，并确定特定的种系多态性是否与临床结局相关。
