Yokoyama Akira, Yokoyama Tetsuji, Muramatsu Taro, Omori Tai, Matsushita Sachio, Higuchi Susumu, Maruyama Katsuya, Ishii Hiromasa
National Institute on Alcoholism, Kurihama National Hospital, Yokosuka, Kanagawa 239-0841, Japan.
Carcinogenesis. 2003 Nov;24(11):1773-8. doi: 10.1093/carcin/bgg142. Epub 2003 Aug 29.
Early esophageal squamous cell carcinoma detected by esophageal iodine staining can be easily treated by endoscopic mucosectomy, and identifying its predictors is important in better selecting candidates to screen for this high-mortality cancer. The common etiologies of elevated mean corpuscular volume (MCV) and esophageal cancer, including folate deficiency, smoking, drinking and high acetaldehyde exposure, suggest testing MCV as such a predictor. Japanese alcoholic men with (n = 65) and without (n = 206) esophageal squamous cell carcinomas, excluding those with liver cirrhosis, were assessed for MCV within 7 days of their last drink, alone or in combination with findings from either the alcohol flushing questionnaire or genotyping to identify inactive aldehyde dehydrogenase-2 (ALDH21/22) and the less-active form of alcohol dehydrogenase-2 (ADH21/21), which pose risks for esophageal squamous cell carcinoma. MCV was higher in cancer patients than in the control group. MCV was higher in both groups in those who were heavier smokers, had lower body mass index (BMI), experienced alcohol flushing, and had ALDH21/22. After adjusting for age, drinking and smoking habits, BMI and ALDH2/ADH2 genotypes, macrocytosis of MCV > or =106 fl was associated with increased risk for esophageal cancer (OR = 2.75). Men with both MCV > or =106 fl and alcohol flushing had an even higher cancer risk (OR = 5.51). The combinations of MCV > or =106 fl with ALDH21/22 or ADH21/21 alone, and both ALDH21/22 and ADH21/21 (ORs = 11.44, 21.22 and 319.7, respectively) showed consistently higher risk than the corresponding group with MCV <106 fl (ORs = 7.24, 4.71 and 27.01, respectively). In conclusion, MCV measurement, alone or in combination with the markers of alcohol sensitivity, provides a new means of predicting risk for esophageal squamous cell carcinoma in Japanese alcoholic men.
通过食管碘染色检测出的早期食管鳞状细胞癌可通过内镜下黏膜切除术轻松治疗，识别其预测指标对于更好地筛选这种高死亡率癌症的候选者至关重要。平均红细胞体积（MCV）升高与食管癌的常见病因，包括叶酸缺乏、吸烟、饮酒和高乙醛暴露，提示将MCV作为这样一个预测指标进行检测。对65例患有食管鳞状细胞癌和206例未患食管鳞状细胞癌的日本男性饮酒者（不包括肝硬化患者）在其最后一次饮酒后7天内评估MCV，单独或结合酒精潮红问卷结果或基因分型来识别无活性醛脱氢酶-2（ALDH21/22）和活性较低的酒精脱氢酶-2（ADH21/21），它们会增加患食管鳞状细胞癌的风险。癌症患者的MCV高于对照组。在吸烟量更大、体重指数（BMI）较低、有酒精潮红且携带ALDH21/22的两组人群中，MCV均较高。在调整年龄、饮酒和吸烟习惯、BMI以及ALDH2/ADH2基因型后，MCV≥106 fl的大细胞性与食管癌风险增加相关（比值比[OR]=2.75）。MCV≥106 fl且有酒精潮红的男性患癌风险更高（OR=5.51）。MCV≥106 fl分别与ALDH21/22或ADH21/21单独组合，以及ALDH21/22和ADH21/21两者组合（OR分别为11.44、21.22和319.7）显示出的风险始终高于MCV<106 fl的相应组（OR分别为7.24、4.71和27.01）。总之，单独测量MCV或与酒精敏感性标志物联合测量，为预测日本男性饮酒者患食管鳞状细胞癌的风险提供了一种新方法。
