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目的:探讨家族史、BMI、吸烟、饮酒与贲门癌发病风险及预后的关系。方法:采用问卷调查记录16605例贲门癌患者和26053例非癌就诊者的家族史、吸烟、饮酒情况,并测量其身高和体质量。对贲门癌患者中电话或住址明确的2000例进行电话或入户随访,以死亡或搬迁为随访中止事件。生存分析及死亡风险评估采用Kaplan-Meier法和Cox模型。结果:家族史阳性明显增加贲门癌的发病风险(P<0.001,OR=2.012,95%CI=1.874～2.160);不同BMI患癌风险有较大差异,低体质量组的患癌风险是正常组的近4倍(OR=3.864,95%CI=3.459～4.317),超重组的患癌风险低于正常组(OR=0.323,95%CI=0.293～0.357);吸烟明显提升贲门癌的发病风险(P<0.001,OR=1.979,95%CI=1.785～2.194),而饮酒对贲门癌发病风险的影响较小(P<0.001,OR=0.749,95%CI=0.678～0.827)。家族史阳性患者生存期优于阴性者(P=0.010,RR=0.677,95%CI=0.502～0.912)。结论:家族史阳性、吸烟和低体质量均提示较高的贲门癌发病风险,而饮酒的作用较弱;家族史阳性可能是贲门癌患者预后较好的独立影响因素。
Objective: To investigate the relationship between family history, BMI, smoking, drinking and cardia cancer risk and prognosis. Methods: A total of 16605 patients with cardia cancer and 26053 non-cancer patients were enrolled in this study. Family history, smoking, alcohol consumption were recorded and their height and body weight were measured. On the cardia cancer patients in the telephone or address clearly 2000 cases of telephone or home visit, death or relocation as a follow-up stop event. Survival analysis and risk assessment of death were performed using Kaplan-Meier method and Cox model. Results: Positive family history increased the incidence of cardia cancer (P <0.001, OR = 2.012, 95% CI = 1.874-2.160). There was a significant difference in the risk of cancer between different BMI groups. The risk of cancer in the low-body-weight group was normal (OR = 3.864,95% CI = 3.459 ~ 4.317). The risk of cancer in the overweight group was lower than that in the normal group (OR = 0.323, 95% CI = 0.293-0.357); smoking significantly increased the incidence of cardia cancer (P <0.001, OR = 1.979, 95% CI = 1.785 ~ 2.194). However, the effect of alcohol consumption on the incidence of cardia cancer was insignificant (P <0.001, OR = 0.749, 95% CI = 0.678-0.827). Patients with positive family history had longer survival than those with negative (P = 0.010, RR = 0.677, 95% CI = 0.502-0.912). Conclusion: The positive family history, smoking and low body weight all indicate the higher risk of cardia cancer, but the effect of drinking is weak. Positive family history may be the independent prognostic factor of cardia cancer.