肝癌家族史与肝癌关系的20年前瞻性队列研究  

Family history of liver cancer increases the risk of liver cancer incidence： a 20-year prospective cohort study in Qidong, China

作　　者：孙燕[1] 屠红[2] 陆培新[1] 王金兵[1] 吴燕[1] 张启南[1] 钱耕荪[2] 陈陶阳[1] 

机构地区：[1]江苏启东肝癌防治研究所病因室,江苏226200 [2]上海交通大学医学院附属仁济医院上海市肿瘤研究所癌基因及相关基因国家重点实验室

出　　处：《中华肝脏病杂志》2014年第10期752-756,共5页Chinese Journal of Hepatology

摘　　要：目的探讨肝癌高发区肝癌家族史与肝癌发生的关系。方法用1992年在江苏省启东市建立的由1438名参加者组成的肝癌前瞻性研究队列，分析1992年5月至2012年11月20年间一级亲属肝癌家族史与肝癌发生的关系。率的组间差异比较采用z。检验，均数差异比较采用t检验，危险度评估计算相对危险度（RR）及95％可信区间（CI）。结果队列合计随访25753人年。有一级亲属肝癌家族史[FH（＋）]325人，发生肝癌69例，发病率1244.36／10万人年；无一级亲属肝癌家族史[FH（-）]1113人，发生肝癌103例，发病率509.70／10万人年，两组差异有统计学意义（x2=35.40，P〈0.01），RR=2.44，95％CI为1.80～3.31。FH（＋）／HBsAg（＋）、FH（-）／HBsAg（＋）、FH（＋）／HBsAg（-）、FH（-）／HBsAg（-）组肝癌累积发生率分别为32.21％、19.80％、1.71％、0.65％。FH（＋）／HBsAg（＋）者发生肝癌的危险眭显著高于FH（-）／HBsAg（＋）者（x2=12.97，P〈0.01），RR=1.75,95％CI为1.29～2.38；与HBsAg（-）／FH（-）者相比，RR高达59.59。HBsAg（-）／FH（＋）者的肝癌发病率是HBsAg（-）／FH（-）人群的2.60倍，但差异无统计学意义（x2=1.310，P=0.252）。母亲患肝癌者的肝癌发病率显著高于父亲患肝癌者（x2=4.393，P=0.036），RR=1.86，95％CI为1.03～3.36。FH（＋）肝癌患者中，56.52％（39／69）的发病年龄小于50岁，与FH（-）肝癌（40.78％，42／103）相比，差异有统计学意义（x2=4.111，P=0.043）。结论一级亲属肝癌家族史与肝癌发生密切相关，在肝癌发生中与HBsAg存在协同作用。肝癌发生的遗传学机制值得进一步深入研究。Objective To evaluate whether first-degree family history of liver cancer plays a role in liver cancer incidence by prospective evaluation of a patient cohort in Qidong, China over a 20-year period. Methods In May 1992,708 hepatitis B surface antigen （HBsAg） carriers and 730 HBsAg-negative controls from Qidong city were enrolled for participation in a prospective cohort study ending in November 2012. Follow-up was carried out every 6 to 12 months, and evaluations included serum assays to measure concentrations of alpha fetoprotein （AFP）, HBsAg and alanine aminotransferase （ALT）, as well as abdominal ultrasound to assess liver disease. The relationship between baseline （study entry） information of patients with first-degree family history of liver cancer and liver cancer incidence during the two decades of study was statistically assessed. Results There were 172 newly diagnosed liver cancer cases in the cohort during 25 753 person-years （py） of follow-up, representing an incidence of 667.88/100 000 py. The incidence rates of liver cancer among particioants with or without liver cancerfamily history were 1 244.36/100 000 py and 509.70/100 000 py respectively, and the between-group difference reached the threshold for statistical significance （P 〈 0.01, Relative Risk （RR）： 2.44, 95% Confidence Interval （C/）： 1.80-3.31）. The incidence rates of liver cancer among participants who had a sibling with liver cancer and participants who had a parent with liver cancer were not significantly different （P 〉 0.05）, but the liver cancer incidence among participants who had a mother with liver cancer was significantly higher than that of participants who had a father with liver cancer （P 〈 0.05, RR： 1.86, 95% CI： 1.03-3.36）. Among the participants with liver cancer family history, 56.52% 09/69） were diagnosed before 50 years old, and this rate was significantly higher than that of participants without a family history of liver cancer （40.78%, 42/103, P 〈 0.05）. The in

关 键 词：前瞻性队列研究 肝癌发生 癌家族史 HBSAG(+) 一级亲属 癌发病率 肝癌高发区 相对危险度 

分 类 号：R735.7[医药卫生—肿瘤]