《柳叶刀肿瘤》：癌症治疗效果也可遗传

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瑞典科学家进行的一项研究表明，如果父母曾经战胜某种癌症，子女患上同类疾病时治愈的可能性便相应增加，这说明抗癌的特质可以遗传。
　　2007年第11期《柳叶刀肿瘤学》杂志刊登了这一研究结果，称良好的存活案例是指在乳腺癌、肺癌、前列腺癌和直肠癌等癌症确诊后存活１０年以上的病例，这其中基因与环境因素都可能发挥一定作用。
　　但是，如果病人在癌症确诊后１０年内死亡，那他们罹患相同癌症的子女的生存前景也相对暗淡，其中死于乳腺癌、前列腺癌、直肠癌和肺癌的风险分别增加７５％、１０７％、４４％和３９％。
　　耶路撒冷哈达萨－希伯来大学医学研究中心的研究员奥拉·帕尔蒂尔评论说，这项研究结果若经证实，将对家庭成员和医生有实际的指导意义。例如，如果父母中一方因癌症迅速扩散而死亡，现在子女就能获得额外的有用信息，这将成为决定使用特殊疗法和预防性措施的基础。

英文摘要：

Familial concordance in cancer survival: a Swedish population-based study

Dr Linda S Lindström MSca, , , Prof Per Hall PhDa, Mikael Hartman MDa, b, Fredrik Wiklund PhDa, Prof Henrik Grönberg PhDa and Kamila Czene PhDa
aDepartment of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
bDepartment of Surgery, Stockholm Söder Hospital, Stockholm, Sweden

Available online 24 October 2007. Volume 8, Issue 11, November 2007, Pages 1001-1006  

Background
Nowadays, the fact that cancers can aggregate in families is generally accepted. The aim of this study was to complete a comprehensive **ysis of cancer-survival concordance in parents and their children diagnosed with the same cancer.

Methods
We used a population-based Swedish family database, that included about three million families and data for more than a million individuals with cancer. We **ysed survival in children in relation to parental survival by use of the Kaplan-Meier method. We then modelled the risk in children in relation to parental survival by use of two multivariate proportional hazard (Cox) models adjusting for possible confounders of survival.

Findings
In our univariate Kaplan-Meier **ysis, children with the same cancer as their parent and whose parent had died within 10 years of diagnosis showed significantly worse survival for breast (log rank p=0·01), colorectal (p=0·04), and prostate cancer (p=0·05) than those whose parents were alive at 10 years from diagnosis. By use of Cox modelling, we noted an increased hazard ratio for death from cancer in children with poor parental survival compared with those with good parental survival for colorectal cancer (hazard ratio [HR] 1·44 [95% CI 1·01–2·01]), lung cancer (1·39 [1·00–1·94]), breast cancer (1·75 [1·13–2·71]), ovarian cancer (2·23 [0·78–6·34]), and prostate cancer (2·07 [1·13–3·79]). All hazard-ratio estimates, except for ovarian cancer, were significant, with significant trends of increasing risk of death in children by degree of worsening survival outcome in parents defined in quartiles of survival (ie, good [best quartile], expected [middle two quartiles], or poor [worst quartile]).

Interpretation
Our findings suggest that cancer-specific survival in parents predicts survival from the same cancer in their children. Consequently, data on survival in a parent might have the potential to guide treatment decisions and genetic counselling. Finally, molecular studies to highlight the genetic determinants of cancer survival are now warranted.

Correspondence to: Dr Linda S Lindström, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-17177 Stockholm, Sweden

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