顺德地区不同性别人群的肝癌影响因素分析

  目的  探讨顺德地区不同性别人群肝癌的影响因素，并了解男性肝癌影响因素的交互作用。  方法  应用交互效应超额相对危险度（relative excess risk of interaction，RERI）等指标评价两因素的交互作用，应用分类回归树（classification and regression tree，CART）模型评价多因素的交互作用。  结果  共纳入1 037例男性病例、1 069男性对照以及166例女性病例、185例女性对照。乙型肝炎病毒（hepatitis B virus，HBV）慢性感染和肝癌家族史均与男女性肝癌发病风险增高有统计学关联（均有P<0.001）。男性中，HBV慢性感染与吸烟、饮酒以及吸烟与饮酒之间存在正相加交互作用，其中HBV慢性感染与吸烟的RERI为121.90（95%CI:52.85%~190.95%）。运动与HBV慢性感染、吸烟之间有负相加交互作用。CART分析表明吸烟且饮酒的HBV慢性感染男性的肝癌风险最高。  结论  HBV慢性感染和肝癌家族史是男女性肝癌的共同危险因素。HBV慢性感染、吸烟和饮酒协同促进男性肝癌发病。运动可拮抗HBV慢性感染和吸烟的促肝癌效应。

Analysis of influencing factors for liver cancer by gender in Shunde region

  Objective  To investigate the influencing factors for liver cancer by gender in Shunde region, and to explore the potential interactions among influencing factors for liver cancer in males.  Methods  The relative excess risk of interaction (RERI) and other indices were used to evaluate the pair-wise interaction, and the classification and regression tree (CART) model was applied to explore the potential multi-factors interaction.  Results  This study included 1 037 male cases and 1 069 controls, together with 166 female cases and 185 controls. Chronic hepatitis B virus infection (CHB) and family history of liver cancer were significantly associated with increased risk of liver cancer both in males and females (both P<0.001). In males, positive additive interactions were observed between CHB and smoking or alcohol drinking, as well as between smoking and drinking. The RERI for CHB and smoking was 121.90(95% CI: 52.85%-190.95%). Negative additive interactions were observed between exercise and CHB or smoking. Further, the CART analysis suggested that the CHB males who smoked and drank alcohol had the highest risk of liver cancer.  Conclusions  CHB and family history of liver cancer are important risk factors for liver cancer in both males and females. CHB, smoking, and alcohol drinking synergistically promote the incidence of liver cancer for males. Exercise can antagonize the hepatocarcinogenic effect of CHB and smoking.