肿瘤家族史与癌症患者预后相关性的Meta分析  

Correlation of family history with prognosis of patients with cancer:a Meta analysis

作　　者：崔熙娟 陈硕[2] 金犇 杨薇粒 单涛[2] 龙泳 

机构地区：[1]第四军医大公共卫生学院流行病学教研室,西安710032 [2]西安交通大学医学院第二附属医院普外科

出　　处：《山西医科大学学报》2017年第1期47-53,共7页Journal of Shanxi Medical University

摘　　要：目的采用Meta分析方法对肿瘤家族史及癌症患者术后生存率的相关性进行研究。方法检索Cochrane Library、MEDLINE、CANCERLIT和EMBASE数据库截止2014年6月收录的相关文献资料。利用Reman5.0软件分析计算总生存率(overall survival,OS)、无复发生存率(recurrence-free survival,RFS)和无病进展率(the disease-free survival,DFS)及95%置信区间(95%CI),I2检验数据间的异质性。结果本研究最终纳入30项研究。分析显示肿瘤家族史对肿瘤患者的总生存率(OS)有一定影响,但达不到统计学差异(HR=0.94,95%CI 0.87-1.02);若一级亲属有1个有肿瘤史,其HR=0.99,95%CI 0.84-1.17;若一级亲属有≥2个有肿瘤史,其HR=1.10,95%CI 0.75-1.62。提示患者的生存率与具有癌症家族史的一级亲属的人数无明显相关。此外,无病进展率(DFS)和无复发生存率(RFS)的HR值分别为0.79(95%CI 0.55-1.15)和0.83(95%CI 0.63-1.08)。相对于欧美(HR=0.96,95%CI0.91-1.01),阳性家族史对亚洲人预后有保护作用(HR=0.93,95%CI 0.90-0.97),但没有统计学差异。类似的,阳性消化系统(HR=0.94,95%CI 0.84-1.05)、泌尿系统(HR=1.22,95%CI1.00-1.48)和呼吸系统肿瘤家庭史(HR=0.88,95%CI 0.72-1.08)对生存率没有显著性影响。结论本研究提示阳性肿瘤家族史及癌症家族史阳性人数与术后生存率无明显相关。肿瘤家族史患者对无病进展率(DFS)和无复发生存率(RFS)并无显著影响。就人群分布而言,有肿瘤家族史的亚洲人比欧美人的生存率高。有无肿瘤家族史对不同类型肿瘤术后生存无显著影响。Objective To evaluate the effect of family history of cancer on survival.Methods MEDLINE,CANCERLIT,and Cochrane library were searched of retrieving the studies up to June 2014.Meta analysis was performed to estimate hazard ratio（ HR） and95% confidence interval（ CI） for overall survival（ OS）,recurrence-free survival（ RFS）,or the disease-free survival（ DFS） with random-effects model.Sensitivity and subgroup analyses were also conducted in the Meta analysis.Homogeneity of effects across studies was assessed using χ~2 test and quantified by I2.Results A total of 30 studies were eligible for the Meta analysis.Patients with a family history of cancer had better overall survival（ HR = 0.94,95% CI 0.87- 1.02）.When there was one affected family member in a first-degree family history of cancer,HR was 0.99（ 95% CI 0.84- 1.17）; and when there were≥2 affected family members in a first-degree family history of cancer,HR was 1.10（95% CI 0.75- 1.62）.In addition,HR was 0.79（95% CI 0.55- 1.15） for DFS and 0.83（95% CI 0.63- 1.08） for RFS.In population distribution,compared with the American and European（ HR = 0.96,95% CI 0.91- 1.01）,the positive family history was a protective factor for the Asian（ HR = 0.93,95% CI 0.90- 0.97）.Similarly,the survival showed no difference in patients with family history of gastric cancer（ HR = 0.94,95% CI 0.84- 1.05）,urinary cancer（ HR = 1.22,95% CI 1.00- 1.48） or respiratory cancer（ HR = 0.88,95% CI 0.72- 1.08）.Conclusion This Meta analysis of observational studies provides strong evidence that family history of cancer and the number of affected family members are not significantly associated with survival of cancer patients after surgery.While,it suggests that patients with family history of cancer have no effects on survival of DFS and RFS.In population distribution,family history of cancer is a better survival mark in the Asian than those in the American and European.Family history of cancer does not affect the survival of patients w

关 键 词：肿瘤家族史 META分析 预后 生存率 

分 类 号：R73-31[医药卫生—肿瘤]