Lagergren J, Bergström R, Lindgren A, Nyrén O
Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden.
Int J Cancer. 2000 Feb 1;85(3):340-6.
While tobacco and alcohol are established risk factors for oesophageal squamous-cell carcinoma, their roles in the aetiology of the increasingly common oesophageal adenocarcinoma remains uncertain. We tested the association between tobacco, snuff and alcohol use and the risk of oesophageal and cardia cancer in a nationwide, population-based case-control study in Sweden. Face-to-face interviews were conducted with 618 (81% of all eligible) patients (189 oesophageal adenocarcinoma, 262 cardia adenocarcinoma and 167 oesophageal squamous-cell carcinoma) and 820 control subjects. Odds ratios (OR) were calculated by logistic regression with multivariate adjustments for potential confounding. The risk of oesophageal adenocarcinoma was not associated with snuff or alcohol use, and the association with smoking was weak or absent. Gastric cardia adenocarcinoma was dose-dependently associated with smoking (OR=4.2, 95% CI=2.5-7.0 among heavy smokers compared with never-smokers), but not with alcohol or snuff use. Oesophageal squamous-cell carcinoma was strongly associated with tobacco, moderately with alcohol, but not with snuff use; combined use of tobacco and alcohol entailed a strongly increased risk (OR=23.1, 95% CI=9.6-56.0 among heavy users compared with never-users). We conclude that tobacco smoking, a strong risk factor for oesophageal squamous-cell carcinoma and cardia adenocarcinoma, does not play an important role in the aetiology of oesophageal adenocarcinoma. None of the studied exposures can explain the increasing incidence of oesophageal adenocarcinoma.
虽然烟草和酒精是食管鳞状细胞癌已确定的风险因素，但它们在日益常见的食管腺癌病因学中的作用仍不确定。在瑞典一项全国性、基于人群的病例对照研究中，我们测试了烟草、鼻烟和酒精使用与食管癌和贲门癌风险之间的关联。对618名患者（占所有符合条件者的81%）（189例食管腺癌、262例贲门腺癌和167例食管鳞状细胞癌）和820名对照者进行了面对面访谈。通过逻辑回归计算比值比（OR），并对潜在混杂因素进行多变量调整。食管腺癌的风险与鼻烟或酒精使用无关，与吸烟的关联较弱或不存在。胃贲门腺癌与吸烟呈剂量依赖性相关（与从不吸烟者相比，重度吸烟者的OR=4.2，95%CI=2.5-7.0），但与酒精或鼻烟使用无关。食管鳞状细胞癌与烟草密切相关，与酒精中度相关，但与鼻烟使用无关；烟草和酒精联合使用会使风险大幅增加（与从不使用者相比，重度使用者的OR=23.1，95%CI=9.6-56.0）。我们得出结论，吸烟是食管鳞状细胞癌和贲门腺癌的一个强风险因素，但在食管腺癌的病因学中并不起重要作用。所研究的暴露因素均无法解释食管腺癌发病率的上升。
