广东地区前列腺癌发病与家族史和婚育史关系的病例对照研究

背景与目的:前列腺癌(prostate cancer)是欧美发达国家老年男性的常见恶性肿瘤之一,中国前列腺癌的发病率较低,但逐年上升.国内前列腺癌的病因学研究主要集中于上海、武汉和北京等地区,而来自广东地区的报道较少.本研究旨在探讨广东地区前列腺癌与家族史和婚育史的病因学关联.方法:在中山大学4所附属医院开展一项病例对照研究(1:2配对),匹配条件为年龄组(±5岁)、性别、民族和居住地类型相同.调查以面谈为主,辅以调查病历记录,采用条件Logistic回归法分析数据.结果:本次调查共获得有效资料186份,其中前列腺癌患者62例,良性前列腺增生的患者62例和其他疾病对照62例.以前列腺增生为对照,遗精年龄小于15岁者患前列腺癌的危险是18岁以上者的6.37倍(95%CI=0.63～63.95);与30岁以上首次进行性生活者相比,首次性生活年龄小者患前列腺癌的危险增高,20～24岁组OR=2.25(95%CI=0.75～6.71),25～29岁组OR=2.34(95%CI=0.89～6.13);60岁以后失去性生活者是前列腺癌的保护因素,60～69岁OR=0.51(95%CI=0.20～1.27),70岁及以上组OR=0.31(95%CI=0.08～1.24).以其它疾病为对照,有一个一级亲属患恶性肿瘤者患前列腺癌的危险是无恶性肿瘤家族史的2.25倍(95%CI=0.69～7.31);首次性生活年龄小于20岁者患前列腺癌的危险是30岁及以上者的5.07倍(95%CI=0.50～51.46);而60岁以后失去性生活者是前列腺癌发生的保护因素,60～69岁组OR=0.55(95%CI=0.24～1.26),70岁及以上组OR=0.41(0.11～1.47).结论:首次遗精年龄和首次性生活年龄较早均为前列腺癌的危险因素,有恶性肿瘤家族史者患前列腺癌的危险增加.

Etiologic correlations of prostate cancer in Guangdong, China to family history of cancers, and sexual and marital factors-a case-control study

BACKGROUND & OBJECTIVE: Prostate cancer is a common cancer in American and European men. The incidence of prostate cancer is low in China, but increases year by year. The previous etiologic studies on prostate cancer in China were mainly conducted in Shanghai, Wuhan, and Beijing, but rarely in Guangdong. This study was to explore the etiologic correlations of prostate cancer to sexual and marital factors and family history of cancers among Cantonese. METHODS: A hospital-based case-control study was conducted from 2005 through 2006 in 4 affiliated hospitals of Sun Yat-sen University. The cases and controls were matched by age (+/-5 years), sex, race and resident location. All the subjects were interviewed by experienced investigators. The data were analyzed with conditional Logistic regression model. RESULTS: A total of 186 subjects were investigated in this study, including 62 patients with prostate cancer, 62 with benign prostatic hyperplasia (BPH) and 62 with other diseases as controls. When BPH was referred to, an increased prostate cancer risk was seen for the men with the age at the first spermatorrhea of less than 15 as compared with those with the age of over 18 odds ratio (OR) = 6.37, 95% confidence interval (CI) = 0.63-63.95]. The men with the first sexual activity in early age were at higher risk of prostate cancer than those in the age of over 30 (in the age of 20-24, OR = 2.25, 95% CI = 0.75-6.71; in the age of 25-29, OR = 2.34, 95% CI= 0.89-6.13). A decreased risk of prostate cancer was found among those men who lost sexual activity after 60 years (in the age of 60-69, OR = 0.51, 95% CI = 0.20-1.27; in the age of over 70, OR = 0.31, 95% CI = 0.08-1.24). When other diseases were referred to, the men with 1 first-degree relative suffered from cancer had greater risk to develop prostate cancer than those without family history of cancers (OR = 2.25, 95% CI = 0.69-7.31). Compared with the age of over 30, an earlier age of the first sexual activity increased the risk of prostate cancer (in the age of less than 20, OR = 5.07, 95% CI = 0.50-51.46); A decreased risk of prostate cancer was also found in the men without sexual activities after 60 years (in the age of 60-69, OR = 0.55, 95% CI = 0.24-1.26; in the age of over 70, OR = 0.41, 95% CI = 0.11-1.47). CONCLUSIONS: Earlier age of the first spermatorrhea and the first sexual activity may increase the risk of prostate cancer. Positive family history of cancers in first-degree relatives can promote the incidence of prostate cancer.