胃癌的危险因素：一项大规模、基于人群的病例对照研究。

Risk factors for gastric cancer: a large-scale, population-based case-control study.

机构信息

Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing 100021, China.

Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

出版信息

Chin Med J (Engl). 2021 Jul 22;134(16):1952-1958. doi: 10.1097/CM9.0000000000001652.

DOI:10.1097/CM9.0000000000001652

PMID:34310399

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8382323/

Abstract

BACKGROUND

Early detection of gastric cancer (GC) has been the topic of major efforts in China. This study aimed to explore the risk factors associated with GC and to provide evidence for the selection of a high-risk population of GC.

METHODS

Based on the cancer screening cohort of the National Cancer Screening Program in Urban China, GC patients diagnosed by endoscopy and pathological examinations constituted the case group, and controls were 1:3 matched by sex and age (±5 years) individually. The variables were selected by univariable analysis of factors such as body mass index (BMI), dietary habits, lifestyle, stomach disease history, and family history of GC; and multivariable logistic regression was used to analyze the influencing factors of GC and to calculate the odds ratio (OR) of related factors and its 95% confidence interval (CI).

RESULTS

A total of 215 GC cases and 645 matched healthy controls were included in the final analysis, with a median age of 61 years for the case and control groups. Overall analysis showed that high educational level (above primary school) (OR = 0.362, 95% CI = 0.219-0.599, P < 0.001), overweight/obesity (BMI ≥24 kg/m2; OR = 0.489, 95% CI = 0.329-0.726, P < 0.001), cigarette smoking (OR = 3.069, 95% CI = 1.700-5.540, P < 0.001), alcohol consumption (OR = 1.661, 95% CI = 1.028-2.683, P = 0.038), history of stomach disease (OR = 6.917, 95% CI = 4.594-10.416, P < 0.001), and family history of GC in first-degree relatives (OR = 4.291, 95% CI = 1.661-11.084, P = 0.003) were significantly correlated with the occurrence of GC. Subgroup analyses by age and gender indicated that GC risk was still increased in the presence of a history of stomach disease. A history of chronic gastritis, gastric ulcer, or gastric polyposis was positively associated with GC, with adjusted ORs of 4.155 (95% CI = 2.711-6.368), 1.839 (95% CI = 1.028-3.288), and 2.752 (95% CI = 1.197-6.326).

CONCLUSIONS

Subjects who smoke, drink, with history of stomach disease and family history of GC in first-degree relatives are the high-risk populations for GC. Therefore, attention should be paid to these subjects for GC screening.

摘要

背景

早期发现胃癌（GC）一直是中国的主要研究课题。本研究旨在探讨与 GC 相关的危险因素，为 GC 高危人群的选择提供依据。

方法

基于中国城市癌症筛查队列研究，经内镜和病理检查诊断为 GC 的患者为病例组，按性别和年龄（±5 岁）1：3 配对选择对照组。采用单因素分析 BMI、饮食习惯、生活方式、胃病史和 GC 家族史等因素，采用多因素 logistic 回归分析 GC 的影响因素，并计算相关因素的比值比（OR）及其 95%置信区间（CI）。

结果

共纳入 215 例 GC 病例和 645 例匹配的健康对照，病例组和对照组的中位年龄分别为 61 岁。总体分析显示，高学历（小学以上）（OR=0.362，95%CI=0.219-0.599，P<0.001）、超重/肥胖（BMI≥24kg/m2；OR=0.489，95%CI=0.329-0.726，P<0.001）、吸烟（OR=3.069，95%CI=1.700-5.540，P<0.001）、饮酒（OR=1.661，95%CI=1.028-2.683，P=0.038）、胃病史（OR=6.917，95%CI=4.594-10.416，P<0.001）和一级亲属 GC 家族史（OR=4.291，95%CI=1.661-11.084，P=0.003）与 GC 的发生显著相关。按年龄和性别进行的亚组分析表明，存在胃病史的 GC 风险仍然增加。慢性萎缩性胃炎、胃溃疡或胃息肉的病史与 GC 呈正相关，调整后的 OR 分别为 4.155（95%CI=2.711-6.368）、1.839（95%CI=1.028-3.288）和 2.752（95%CI=1.197-6.326）。