Research Report
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World J Med Genet. May 27, 2014; 4(2): 39-45
Published online May 27, 2014. doi: 10.5496/wjmg.v4.i2.39
Earlier onset and multiple primaries in familial as opposed to sporadic esophageal cancer
Xiao-Duo Wen, Deng-Gui Wen, Yi Yang, Bao-En Shan, Shi-Jie Wang
Xiao-Duo Wen, Yi Yang, Department of Diagnosis and Image, 4th Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
Deng-Gui Wen, Bao-En Shan, Shi-Jie Wang, Cancer Center, 4th Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
Author contributions: Wen XD and Wen DG performed data collection, analysis, and drafting the manuscript; Yang Y, Shan BE and Wang SJ established the cohort and designed the study.
Correspondence to: Dr. Shi-Jie Wang, MD, Cancer Center, 4th Hospital of Hebei Medical University, Jiankanglu 12, Shijiazhuang 050011, Hebei Province, China. wshjw136@aliyun.com
Telephone: +86-311-86095337 Fax: +86-311-86077634
Received: July 30, 2013
Revised: October 17, 2013
Accepted: November 15, 2013
Published online: May 27, 2014
Abstract

AIM: To study the differences in onset age and multiple primary cancers between familial and sporadic esophageal squamous cell carcinoma (ESCC).

METHODS: The differences in onset age and multiple primary cancers were analyzed between ESCC patients with (n = 766) and without (n = 1776) a family history of the cancer. The cases analyzed constituted all consecutive patients who had undergone cure-intent surgery at the Department of Thoracic Surgery of the 4th Hospital of Hebei Medical University from January 1 1975 to December 31 1989. Because we also originally aimed to examine the difference in survival time, only older subjects with a long follow-up period were selected.

RESULTS: Overall, patients with ESCC and a positive family history of the cancer had a significantly younger age at onset and more multiple primary cancers than those without a positive family history (51.83 ± 8.39 vs 53.49 ± 8.23 years old, P = 0.000; 5.50% vs 1.70%, P = 0.000). Both of these differences were evident in subgroup analyses, however, no correlations were observed. While age at onset differed significantly by family history in males, smokers, and drinkers, the difference in multiple primary cancers by family history was significant in nonsmoking, nondrinking, and younger onset patients. In multivariate analysis, age over 50 years, tobacco smoking, and multiple primary cancers were found to be significant predictors of familial cancer: the corresponding OR (95%CI) and P-value were 0.974 (0.963-0.985) and 0.000; 1.271 (1.053-1.535) and 0.012; and 4.265 (2.535-7.176) and 0.000, respectively.

CONCLUSION: Patients with ESCC and a positive family history of the cancer had a significantly younger onset age and more multiple primary cancers than those without a positive family history. Sub-group analyses indicated that younger onset age may be due to the interaction of genetic predisposition and environmental hazards, and multiple primary cancers may only be due to genetic predisposition.

Keywords: Esophageal squamous cell carcinoma, Familial cancer, Sporadic cancer, Age at onset, Synchronous primary carcinoma

Core tip: Patients with esophageal squamous cell carcinoma (ESCC) and a positive family history had a significantly younger onset age and more multiple primary cancers than those without a positive family history (51.83 ± 8.39 vs 53.49 ± 8.23 years old, P = 0.000; 5.50% vs 1.70%, P = 0.000). Both of these differences were evident in sub-group analyses, however, no correlations were observed. While age at onset differed significantly by family history in males, smokers, and drinkers, the difference in multiple primary cancers by family history was significant in nonsmoking, nondrinking, and younger onset patients. These results suggest a genetic component in ESCC. Furthermore, a younger onset age may be due to the interaction of genetic predisposition and environmental hazards, and multiple primary cancers may only be due to genetic predisposition.