顺德地区不同性别人群的肝癌影响因素分析
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摘要
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。
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 was121. 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.
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 was121. 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.
引文
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[17]Nakajima S,Ohsawa I,Ohta S,et al.Regular voluntary exercise cures stress-induced impairment of cognitive function and cell proliferation accompanied by increases in cerebral IGF-1 and GST activity in mice[J].Behav Brain Res,2010,211(2):178-184.DOI:10.1016/j.bbr.2010.03.028.
[2]林子博,祁永芬,周新凤,等.广东顺德地区原发性肝癌发病危险因素研究[J].中华疾病控制杂志,2017,21(10):993-996.DOI:10.16462/j.cnki.zhjbkz.2017.10.006,1001.Lin ZB,Qi YF,Zhou XF,et al.Analysis of the risk factors for primary liver cancer in Shunde region,Guangdong[J].Chin JDis Control Pre,2017,21(10):993-996,1001.DOI:10.16462/j.cnki.zhjbkz.2017.10.006.
[3]Saran U,Humar B,Kolly P,et al.Hepatocellular carcinoma and lifestyles[J].J Hepatol,2016,64(1):203-214.DOI:10.1016/j.jhep.2015.08.028.
[4]Torre LA,Bray F,Siegel RL,et al.Global cancer statistics,2012[J].CA Cancer J Clin,2015,65(2):87-108.DOI:10.3322/caac.21262.
[5]Lee SA,Kim H,Won YS,et al.Male-specific hepatitis B virus large surface protein variant W4P potentiates tumorigenicity and induces gender disparity[J].Mol Cancer,2015,14:23.DOI:10.1186/s12943-015-0303-7.
[6]Zheng B,Zhu YJ,Wang HY,et al.Gender disparity in hepatocellular carcinoma(HCC):multiple underlying mechanisms[J].Sci China Life Sci,2017,60(6):575-584.DOI:10.1007/s11427-016-9043-9.
[7]廖玉宜,陈思东,黄芊芊,等.HBV感染、饮酒与吸烟对原发性肝癌的协同作用[J].现代预防医学,2014,41(18):3366-3368,3372.Liao YY,Chen SD,Huang QQ,et al.Interaction of HBV infection,drinking,and smoking on the incidence of primary liver cancer[J].Modern Preventive Medicine,2014,41(18):3366-3368,3372.
[8]中华人民共和国卫生部.原发性肝癌诊疗规范(2011年版)[J].临床肿瘤学杂志,2011,16(10):929-946.Ministry of Health of the People’s Republic of China.Diagnosis,management,and treatment of hepatocellular carcinoma(V2011)[J].Journal of Clinical Hepatology,2011,16(10):929-946.
[9]中国预防医学科学院.1996年全国吸烟行为的流行病学调查[M].北京:中国科学技术出版社,1997.Chinese Academy of Preventive Medicine.Epidemiological survey of smoking behaviors nationwide in 1996[M].Beijing:China Science and Technology Press,1997.
[10]黄培新,王娜,钱俊华,等.江苏省海门市原发性肝癌队列随访结果分析[J].中华流行病学杂志,2017,38(10):1376-1379.DOI:10.3760/cma.j.issn.0254-6450.2017.10.016.Huang PX,Wang N,Qian JH,et al.A 22-year-follow-up cohort study on primary liver cancer in Haimen city of Jiangsu province[J].Chinese Journal of Epidemiology,2017,38(10):1376-1379.DOI:10.3760/cma.j.issn.0254-6450.2017.10.016.
[11]王娜.江苏省海门市原发性肝癌时间趋势及相关危险因素队列研究[D].上海:复旦大学,2010.Wang N.Cohort study on time trend and effect of associated factors for primary liver cancer,Haimen,China[D].Shanghai:Fudan University,2010.
[12]IARC.IARC Monographs on the Evaluation of Carcinogenic Risks to Humans Volume 83:Tobacco Smoke and Involuntary Smoking[C].IARC Monogr Eval Carcinog Risks Hum,2004.
[13]IARC.IARC Monographs on the Evaluation of Carcinogenic Risks to Humans Volume 96:Alcohol Consumption and Ethyl Carbamate[C].IARC Monogr Eval Carcinog Risks Hum,2010.
[14]Bellamri M,Le Hegarat L,Turesky RJ,et al.Metabolism of the Tobacco Carcinogen 2-Amino-9H-pyrido[2,3-b]indole(AαC)in Primary Human Hepatocytes[J].Chem Res Toxicol,2017,30(2):657-668.DOI:10.1021/acs.chemrestox.6b00394.
[15]Shlomai A,de Jong YP,Rice CM.Virus associated malignancies:The role of viral hepatitis in hepatocellular carcinoma[J].Semin Cancer Biol,2014,26:78-88.DOI:10.1016/j.semcancer.2014.01.004
[16]Ramadori P,Cubero FJ,Liedtke C,et al.Alcohol and Hepatocellular Carcinoma:Adding Fuel to the Flame[J].Cancers(Basel),2017,9(12):piiE130.DOI:10.3390/cancers9100130.
[17]Nakajima S,Ohsawa I,Ohta S,et al.Regular voluntary exercise cures stress-induced impairment of cognitive function and cell proliferation accompanied by increases in cerebral IGF-1 and GST activity in mice[J].Behav Brain Res,2010,211(2):178-184.DOI:10.1016/j.bbr.2010.03.028.