Park Yehyun, Park Soo Jung, Cheon Jae Hee, Kim Won Ho, Kim Tae Il
Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
Cancer Prevention Center, Yonsei Cancer Center, Seoul, Korea.
J Cancer Prev. 2019 Mar;24(1):1-10. doi: 10.15430/JCP.2019.24.1.1. Epub 2019 Mar 30.
The influence of family history (FH) on cancer recurrence and survival among patients with established colorectal cancer (CRC) remains uncertain. This study aimed to evaluate the association of FH with cancer recurrence, survival, and the incidence of colorectal adenomas in patients with CRC.
Consecutive patients with stage III CRC diagnosed between 2004 and 2009 and followed-up in Severance Hospital were retrospectively enrolled and followed until December 2014. Overall survival (OS) and disease-free survival (DFS) according to FH of CRC or colorectal neoplasm were evaluated using Cox proportional hazards regression and Kaplan-Meier curve.
Among analyzed 979 patients, 69 (7.0%) was identified as having a FH of CRC in a first-degree relative. During a median follow-up of 9.6 years, mortality occurred in 14 of 69 patients (20.3%) with a FH of CRC and 348 of 910 patients (38.2%) without a FH. Compared with patients without a FH, a first-degree FH of CRC, first or second-degree FH of CRC, and first-degree FH of colorectal neoplasm (CRC or polyps) were associated with a significant reduction in the risk of overall mortality, with adjusted hazard ratios (HRs) of 0.52 (95% CI, 0.29-0.92), 0.51 (95% CI, 0.30-0.88), and 0.48 (95% CI, 0.28-0.82), respectively. However, DFS improvement was significant only when the definition of FH was FH of colorectal neoplasm (adjusted HR 0.57; 95% CI, 0.36-0.89). The incidence of adenoma and advanced adenoma was not different according to the FH.
Among patients with stage III CRC receiving curative surgery, a FH of colorectal neoplasm was associated with a reduction in cancer recurrence and mortality. The larger scaled studies are needed.
家族史（FH）对已确诊的结直肠癌（CRC）患者癌症复发及生存的影响仍不明确。本研究旨在评估FH与CRC患者癌症复发、生存及结直肠腺瘤发生率之间的关联。
回顾性纳入2004年至2009年间在Severance医院确诊并随访的III期CRC连续患者，随访至2014年12月。采用Cox比例风险回归和Kaplan-Meier曲线评估根据CRC或结直肠肿瘤家族史的总生存（OS）和无病生存（DFS）情况。
在分析的979例患者中，69例（7.0%）被确定有一级亲属患CRC的家族史。在中位随访9.6年期间，69例有CRC家族史的患者中有14例（20.3%）死亡，910例无家族史的患者中有348例（38.2%）死亡。与无家族史的患者相比，CRC一级家族史、CRC一级或二级家族史以及结直肠肿瘤（CRC或息肉）一级家族史与总死亡风险显著降低相关，调整后的风险比（HR）分别为0.52（95%CI，0.29 - 0.92）、0.51（95%CI，0.30 - 0.88）和0.48（95%CI，0.28 - 0.82）。然而，仅当家族史定义为结直肠肿瘤家族史时DFS改善显著（调整后HR 0.57；95%CI，0.36 - 0.89）。腺瘤和高级别腺瘤的发生率根据家族史无差异。
在接受根治性手术的III期CRC患者中，结直肠肿瘤家族史与癌症复发和死亡率降低相关。需要开展更大规模的研究。
