尽管存在共同的易感基因座，但在中国华北太行山高危地区，食管鳞状细胞癌比贲门腺癌具有更多的家族性癌症。

Despite shared susceptibility loci, esophageal squamous cell carcinoma embraces more familial cancer than gastric cardia adenocarcinoma in the Taihang Mountains high-risk region of northern central China.

机构信息

Department of Oncology, Hebei Tumor Hospital and the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, China.

出版信息

Chin Med J (Engl). 2013 Jan;126(1):55-60.

PMID:23286478

Abstract

BACKGROUND

In China, esophageal squamous cell carcinoma (ESCC) and gastric cardia adenocarcinoma (GCA) share susceptibility loci, but different rates of multiple primary cancer and male/female ratio suggest the proportion of familial cancer is not equal.

METHODS

The percent of cases with a positive family history, median onset age, rate of multiple primary cancer, and male/female ratio associated with upper, middle, lower third ESCC and GCA were compared to reveal the proportion of familial cancer. The 7267 subjects analyzed constituted all ESCC and GCA cases in whom the cancer was resected with cure intention between 1970 and 1994 at the 4th Hospital of Hebei Medical University.

RESULTS

A positive family history for cancer was most often associated with the multiple primary ESCC and/or GCA cases, e.g. with 42% of the males and 59% of the females. For upper, middle, lower third ESCC and GCA, the percent of cases with a positive family history decreased by 38.5%, 26.3%, 26.5%, and 11.2% in males (P < 0.000) and 25.0%, 22.3%, 23.9%, and 9.8% in females (P < 0.0001). Median onset age increased from 49, 52, 55, to 56 years old in males and from 50, 53, 55, to 56 years old in females ( both P < 0.0001) for upper, middle, lower third ESCC and GCA. Male/female ratio increased from 2.2, 2.1, 2.2, to 6.2:1 for upper, middle, lower third ESCC and GCA (P < 0.0001). For upper, middle, lower third ESCC and GCA, the percent of multiple primary cancers decreased from 21.2%, 2.3%, 2.2%, to 1.5% in males and from 14.3%, 2.4%, 3.4%, to 3.1% in females. The preponderance of males, smoking, drinking, or onset-age ≥ 50 years was significantly higher in GCA than in ESCC, and the difference in the rates of multiple primary cancers between the preponderant and the non-preponderant cases was significant in GCA, but not in ESCC, suggesting non-equal requirement for genetic susceptibility when environmental hazards did not exist.

CONCLUSIONS

The proportion of familial cancer in upper gastrointestinal carcinomas decreases by the primary site of upper, middle, lower third esophagus and gastric cardia. Considering familial and sporadic cancers differ in preventability, screening strategy and recurrence, our findings have basic and clinical implications.

摘要

背景

在中国，食管鳞癌（ESCC）和贲门腺癌（GCA）具有共同的易感基因座，但多种原发性癌症的发生率和男女比例不同，提示家族性癌症的比例并不相同。

方法

比较上、中、下段 ESCC 和 GCA 中阳性家族史病例的比例、中位发病年龄、多种原发性癌症的发生率和男女比例，以揭示家族性癌症的比例。分析的 7267 例患者均为 1970 年至 1994 年间在河北医科大学第四医院接受根治性手术切除的 ESCC 和 GCA 患者。

结果

阳性家族史与多种原发性 ESCC 和/或 GCA 病例最相关，例如男性中 42%和女性中 59%的病例。在上、中、下段 ESCC 和 GCA 中，男性阳性家族史病例的比例分别下降 38.5%、26.3%、26.5%和 11.2%（P<0.000），女性分别下降 25.0%、22.3%、23.9%和 9.8%（P<0.0001）。男性上、中、下段 ESCC 和 GCA 的中位发病年龄分别从 49、52、55 岁增加到 56 岁，女性分别从 50、53、55 岁增加到 56 岁（均 P<0.0001）。男性上、中、下段 ESCC 和 GCA 的男女比例分别从 2.2、2.1、2.2 增加到 6.2:1（P<0.0001）。在上、中、下段 ESCC 和 GCA 中，男性的多种原发性癌症发生率从 21.2%、2.3%、2.2%下降到 1.5%，女性从 14.3%、2.4%、3.4%下降到 3.1%。GCA 中的男性优势、吸烟、饮酒或发病年龄≥50 岁显著高于 ESCC，而在 GCA 中，优势病例和非优势病例的多种原发性癌症发生率差异显著，但在 ESCC 中则不显著，提示在不存在环境危害时，遗传易感性的要求并不相同。