Winawer S J, Zauber A G, Gerdes H, O'Brien M J, Gottlieb L S, Sternberg S S, Bond J H, Waye J D, Schapiro M, Panish J F
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
N Engl J Med. 1996 Jan 11;334(2):82-7. doi: 10.1056/NEJM199601113340204.
The adenoma-adenocarcinoma sequence in colorectal cancer suggests an increased risk of colorectal cancer in the families of patients with adenomatous polyps.
A random sample of participants in the National Polyp Study who had newly diagnosed adenomatous polyps were interviewed for information on the history of colorectal cancer in their parents and siblings. The risk of colorectal cancer in family members was analyzed according to the characteristics of the patients with adenomas and in comparison with a sample of patients' spouses, who served as controls.
Among the patients with adenomas, 1199 provided information on whether they had a family history of colorectal cancer. After the exclusion of families for which information was incomplete and of 48 patients who had been referred for colonoscopy solely because they had a family history of colorectal cancer, there were 1031 patients with adenomas, 1865 parents, 2381 siblings, and 1411 spouse controls. The relative risk of colorectal cancer, adjusted for the year of birth and sex, was 1.78 for the parents and siblings of the patients with adenomas as compared with the spouse controls (95 percent confidence interval, 1.18 to 2.67). The relative risk for siblings of patients in whom adenomas were diagnosed before 60 years of age was 2.59 (95 percent confidence interval, 1.46 to 4.58) as compared with the siblings of patients who were 60 or older at the time of diagnosis and after adjustment for the sibling's year of birth and sex and a parental history of colorectal cancer. The risk increased with decreasing age at the time of the diagnosis of adenoma (P for trend < 0.001). The relative risk for the siblings of patients who had a parent with colorectal cancer, as compared with those who had no parent with cancer, was 3.25 (95 percent confidence interval, 1.92 to 5.52), after adjustment for the sibling's year of birth and sex and the patient's age at diagnosis.
Siblings and parents of patients with adenomatous polyps are at increased risk for colorectal cancer, particularly when the adenoma is diagnosed before the age of 60 or--in the case of siblings--when a parent has had colorectal cancer.
结直肠癌的腺瘤-腺癌序列提示腺瘤性息肉患者的家族成员患结直肠癌的风险增加。
对国家息肉研究中随机抽取的新诊断为腺瘤性息肉的参与者进行访谈，了解其父母和兄弟姐妹的结直肠癌病史。根据腺瘤患者的特征分析家庭成员患结直肠癌的风险，并与作为对照的患者配偶样本进行比较。
在腺瘤患者中，1199人提供了他们是否有结直肠癌家族史的信息。在排除信息不完整的家庭以及仅因有结直肠癌家族史而被转诊进行结肠镜检查的48名患者后，有1031名腺瘤患者、1865名父母、2381名兄弟姐妹和1411名配偶对照。在调整出生年份和性别后，腺瘤患者的父母和兄弟姐妹患结直肠癌的相对风险为1.78，而配偶对照为1.18至2.67（95%置信区间）。与诊断时年龄在60岁及以上的患者的兄弟姐妹相比，在调整兄弟姐妹的出生年份、性别和结直肠癌家族史后，腺瘤在60岁之前被诊断出的患者的兄弟姐妹的相对风险为2.59（95%置信区间，1.46至4.58）。风险随着腺瘤诊断时年龄的降低而增加（趋势P<0.001）。在调整兄弟姐妹的出生年份、性别和患者诊断时的年龄后，有结直肠癌父母的患者的兄弟姐妹与没有患癌父母的患者的兄弟姐妹相比，相对风险为3.25（95%置信区间，1.92至5.52）。
腺瘤性息肉患者的兄弟姐妹和父母患结直肠癌的风险增加，特别是当腺瘤在60岁之前被诊断出时，或者在兄弟姐妹的情况下，当父母患有结直肠癌时。
