日本血吸虫病对胃癌和结直肠癌发生的影响

目的探讨日本血吸虫病对胃癌及结直肠癌发生发展的影响。方法收集2014年1月-2018年12月皖南医学院弋矶山医院收治的合并血吸虫病及不合并血吸虫病的胃癌和结直肠癌患者临床资料,分成血吸虫病胃癌组和非血吸虫病胃癌组、血吸虫病结直肠癌组和非血吸虫病结直肠癌组。采用单因素分析和多因素logistic回归分析对胃癌和结直肠癌发病危险因素进行分析,探索血吸虫病对胃癌和结直肠癌发生发展的影响。对32例血吸虫病合并结直肠癌患者以及68例非血吸虫病结直肠癌患者进行电话随访,获取患者生存情况,计算并比较两组患者生存率。结果血吸虫病胃癌组患者113例、非血吸虫病胃癌组患者3741例,两组患者性别构成比、年龄、幽门螺杆菌感染率差异均有统计学意义(P均<0.05)。logistic回归分析表明,年龄、幽门螺杆菌感染和合并血吸虫病是胃癌发病的独立危险因素(P均<0.05)。血吸虫病结直肠癌组患者184例、非血吸虫病结直肠癌组患者2205例,两组年龄、性别构成比、有饮酒史者比例、粪便隐血阳性者比例差异均有统计学意义(P均<0.05);两组结直肠癌表型均以溃疡型居多,但非血吸虫病结直肠癌组浸润型和隆起型患者比例明显高于血吸虫病结直肠癌组(P=0.003)。logistic回归分析结果显示,年龄(P=0.003)、性别(P=0.002)、表型(P=0.005)以及合并血吸虫病(P=0.029)是结直肠癌的独立危险因素。经随访,血吸虫病结直肠癌患者5年生存率(68.90%)高于非血吸虫病结直肠癌患者(46.40%),其死亡患者平均年龄(66.33±3.08)岁]亦高于后者(56.29±1.94)岁],差异均有统计学意义(P均<0.05)。结论血吸虫病可能改变结直肠癌发病机制,导致血吸虫病和非血吸虫病结直肠癌患者在流行病学、临床特征以及5年生存率方面存在差异。血吸虫病流行区年龄>60岁的男性,且伴有不明原因贫血者,应定期进行消化道内镜检查和其他检查,以排除消化道肿瘤的可能性。

Effect of schistosomiasis japonica on the development of gastric and colorectal cancer

Objective To examine the effect of schistosomiasis on the development of gastric cancer and colorectal cancer.Methods The clinical data of patients with gastric cancer and colorectal cancer with and withoiut schistosomiasis japonica that were admitted to the Yijishan Hospital Affiliated to Wannan Medical College from January 2014 to December 2018 were collected.All cases were divided into schistosomal gastric cancer group and non-schistosomal gastric cancer group,schistosomal colorectal cancer group and non-schistosomal colorectal cancer group.The risk factors of gastric cancer and colorectal cancer were identified using univariate analysis and multivariate logistic regression analysis,and the effects of schistosomiasis on the development and progression of gastric cancer and colorectal cancer were evaluated.In addition,the survival of 32 patients with schistosomal colorectal cancer and 68 cases with non-schistosomal colorectal were estimated using telephone follow-up,and compared.Results There were 113 patients with schistosomal gastric cancer and 3741 cases with non-schistosomal gastric cancer enrolled in this study,and there were significant differences between them in terms of sex ratio,age and prevalence of Helicobacter pylori infection(all P values<0.05).Logistic regression analysis revealed that age,H.pylori infection,and schistosomiasis were independent risk factors for gastric cancer(all P values<0.05).There were 184 patients with schistosomal colorectal cancer and 2205 cases with non-schistosomal colorectal cancer recruited in this study,and there were significant differences between them in terms of age,sex ratio,rate of history of alcohol consumption and rate of positive fecal occult blood test(all P values<0.05).The phenotypes of both schistosomal and non-schistosomal colorectal cancer were predominantly ulcerative;however,the proportion of patients with invasive and protruded colorectal cancer was significantly greater than that of patients with nonschistosomal colorectal cancer(P=0.003).Logistic regression analysis revealed that age(P=0.003),gender(P=0.002),phenotype(P=0.005)and schistosomiasis(P=0.029)were independent risk factors for colorectal cancer.The 5-year survival rate was significantly higher in patients Mwith schistosomal colorectal cancer(68.90%)than in those with non-schistosomal colorectal cancer(46.40%),and the dead patients with schistosomal colorectal cancer had a significantly greater mean age than those with non-schistosomal colorectal cancer(66.33±3.08)years vs.(56.29±1.94),P<0.05].Conclusions Schistosomiasis may alter the pathogenesis of colorectal cancer,resulting in the differences in the epidemiology,clinical characteristics and s-year survival rate between patients with schistosomal and non-schistosomal colorectal cancer.Periodical gastrointestinal endoscopy and other examinations are recommended to exclude the likelihood of gastrointestinal cancers in men with anemia of unknown causes and at ages of 60 years living in schistosomiasis-endemic areas.