食管癌高/低发区1975～2011年42082例食管鳞状细胞癌患者年龄、性别和家族史分析

目的比较食管癌高/低发区1975～2011年食管鳞状细胞癌患者年龄、性别和家族史的变化。方法通过大规模现场入户流调和问卷调查及住院病例复核等方法收集患者信息,记录食管癌高/低发区1975～2011年42 082例食管鳞状细胞癌患者年龄、性别和家族史,并根据病例首次确诊的时间分布,将患者分为3组:Ⅰ组(1975～1989年),Ⅱ组(1990～1999年),Ⅲ组(2000～2011年)。采用卡方检验分析各组间的差异。结果对42 082例食管鳞状细胞癌患者的资料分析显示:食管癌发病男性多于女性(性别比1.6:1),50～59岁年龄组发病率最高(占38%),食管癌家族史阳性率为31%(13 173/42 030);高发区患者31 664例,其中男性18 708(平均年龄58岁±9岁),女性12 956(平均年龄58岁±9岁);低发区患者10 232例,其中男性6 886(平均年龄59岁±9岁),女性3 346(平均年龄60岁±9岁)。3个组别间由远及近男性患者所占比例逐步升高(χ2=9.945,P<0.05),老年患者比例逐步升高(χ2=1 546.984,P<0.05),低发区患者比例逐步升高(χ2=285.084,P<0.05),而家族史阳性率有降低趋势(χ2=42.990,P<0.05);Ⅰ组患者随着不同年龄段的增高,其家族史阳性率逐步降低(χ2=108.665,P<0.05);Ⅱ和Ⅲ组患者50岁以后均随着不同年龄段的增高,其女性患者比例逐步升高(χ2=13.369,P<0.05;χ2=68.849,P<0.05)、家族史阳性率逐渐降低(χ2=125.394,P<0.05;χ2=66.849,P<0.05)。结论食管鳞癌在三十余年的变迁中,其男性、老年患者比例逐步增多,提示食管癌发病仍以男性为主,且有老龄化趋势;50岁以后随着不同年龄段的增高,其女性患者比例逐步升高,提示体内激素水平的差异可能是食管鳞癌男女发病率差异的原因之一。

The study of age,gender and family history on 42,082 cases of patients with esophageal squamous cell carcinoma at 36 years(1975-2011) in high/low-incidence areas for esophageal cancer

Objective To compare the changes of age,gender and family history in patients with esophageal squamous cell carcinoma during 36 years(1975-2011) in high / low-incidence areas of esophageal cancer.Methods The age,gender and family history of 42,082 patients with esophageal squamous cell carcinoma within 36 years in high / low-incidence areas of esophageal cancer were recorded through large-scale field epidemiological study by entering house-hold,the questionnaire,and in-patient case review.The patients were divided into three groups: group Ⅰ(1975-1989),group Ⅱ(1990-1999),group Ⅲ(2000-2011) based on the first time of diagnosis.The chi-square test was used to analyze the differences among these groups.Results The data analysis on 42,082 patients with esophageal squamous cell carcinoma showed that the numbers ofmale patients were more than those of women(the sex ratio was 1.6:1),the 50-59 age group had the highest incidence(38%),the positive ra-te of family history with esophageal cancer was 31%(13,173 / 42,030);among the 31,664 patients in high incidence areas,18,708 cases were male(the average age were 58 ± 9 years),and 12,956 cases were female(the average age was 58 ± 9 years);among the 10,232 patients in low-incidence areas,12,956 cases were male(the average age was 59 ± 9 years),and 3,346 cases were female(the average age was 60 ± 9 years).The proportion of male patients among the three groups were increased gradually from far to near(χ2=9.945,P<0.05),the proportion of elderly patients were increased gradually(χ2=1546.984,P<0.05),and the proportion of patients in low-inci-dence areas were increased gradually(χ2=285.084,P<0.05),while the positive rate of family history were decreased(χ2=42.990,P<0.05);among group I patients,the positive rate of family history was decreased gradually with age increase(χ2=108.665,P<0.05);among group II and III patients,the proportion of female patients were increased gradually with the age increase after 50 years of age(χ2=13.369,P<0.05;χ2=68.849,P<0.05),and the positive rate of family history were decreased(χ2=125.394,P<0.05;χ2=66.849,P<0.05).Conclusion The proportion of male and elderly patients increased gradually with the changes of the esophageal sq-uamous cell carcinoma in 30 years;these suggested that esophageal cancer is still male-dominated,and has a trend of aging.The propor-tion of female patients increase gradually with the ages increase after 50 years of age,and this suggested that the difference of sex hormone levels may be one of the reasons for the difference of the incidence of esophageal squamous cell carcinoma between men and women.