Wen Denggui, Shan Baoen, Wang Shijie, Zhang Liwei, Wei Lizhen, Zhou Wendi, Peng Qing
Epidemiology, Hebei Cancer Institute and The Fourth Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, China.
Eur J Med Genet. 2010 Sep-Oct;53(5):250-5. doi: 10.1016/j.ejmg.2010.06.011. Epub 2010 Jul 16.
To find a genetic component in gastric cardia adenocarcinomas (GCA).
Age at onset (AO) and rate of another synchronous primary upper gastrointestinal carcinoma (RASPUGIC) were compared among the three GCA groups with positive (N = 766), negative (N = 2167), and missing family history of upper gastrointestinal cancer (FHUGIC) (N = 198). These 3131 GCAs were diagnosed on 3128 primary GCA patients of a consecutive surgical cohort treated from 1973 through 1994 at the Department of Thoracic Surgery in the 4th Hospital of Hebei Medical University in a high-risk region in northern China.
Overall, GCAs of positive FHUGIC showed a significantly younger AO and a significantly higher RASPUGIC than the negative group (54.68 ± 7.35 vs 55.94 ± 7.47 years old, Pt-test = 0.000; 3.1% vs 1.3%, χ2 = 11.02, P = 0.001). The difference in AO and RASPUGIC between the positive and the negative FHUGIC GCAs is significant or nearly significant in most subgroups; minimizing the possibility of a false association due to bias or confounding (e.g. significant stage-specific differences in AO between familial and sporadic GCAs observed in the subgroup of T2,3N0M0 (P = 0.000) and T2,3,4N1M0 (P = 0.03) exclude the possibility of ascertainment bias towards an earlier diagnosis in familial cases), and the association between FHUGIC and RASPUGIC is statistically significant for GCAs of younger AO (<55 yr old, RASPUGIC 3.8% vs 1.6% vs 1.1% for the positive, negative and missing FHUGIC GCAs respectively, χ2 = 6.50, P = 0.04), but not significant for the later onset GCAs (≥55 yr old, RASPUGIC 2.5%, 1.1%, 1.9% for the positive, negative and missing FHUGIC respectively, χ2 = 4.22, P = 0.12).
These findings suggest a genetic component in GCA in the Chinese high-risk region, and genetic predisposition may determine the age at onset and number of primary upper gastrointestinal cancer.
探寻贲门腺癌（GCA）中的遗传因素。
比较了3组贲门腺癌患者的发病年龄（AO）和另一种同步原发性上消化道癌的发生率（RASPUGIC），这3组分别为有上消化道癌家族史阳性（N = 766）、阴性（N = 2167）以及家族史缺失（N = 198）的贲门腺癌患者。这3131例贲门腺癌来自于1973年至1994年在中国北方一个高风险地区的河北医科大学第四医院胸外科接受连续手术治疗的3128例原发性贲门腺癌患者。
总体而言，有上消化道癌家族史阳性的贲门腺癌患者的发病年龄显著低于阴性组，且另一种同步原发性上消化道癌的发生率显著高于阴性组（分别为54.68±7.35岁和55.94±7.47岁，t检验P = 0.000；3.1%和1.3%，χ2 = 11.02，P = 0.001）。在大多数亚组中，有上消化道癌家族史阳性和阴性的贲门腺癌患者在发病年龄和另一种同步原发性上消化道癌的发生率上的差异显著或接近显著；将因偏倚或混杂因素导致假关联的可能性降至最低（例如，在T2,3N0M0亚组（P = 0.000）和T2,3,4N1M0亚组（P = 0.03）中观察到家族性和散发性贲门腺癌在发病年龄上存在显著的分期特异性差异，排除了家族性病例中因确诊偏倚导致早期诊断的可能性），并且对于发病年龄较小（<55岁）的贲门腺癌患者，有上消化道癌家族史与另一种同步原发性上消化道癌的发生率之间的关联具有统计学意义（有上消化道癌家族史阳性、阴性和缺失的贲门腺癌患者的另一种同步原发性上消化道癌的发生率分别为3.8%、1.6%和1.1%，χ2 = 6.50，P = 0.04），但对于发病较晚（≥55岁）的贲门腺癌患者则不显著（有上消化道癌家族史阳性、阴性和缺失的贲门腺癌患者的另一种同步原发性上消化道癌的发生率分别为2.5%、1.1%和1.9%，χ2 = 4.22，P = 0.12）。
这些发现提示在中国高风险地区的贲门腺癌中存在遗传因素，并且遗传易感性可能决定发病年龄和原发性上消化道癌的数量。
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