Yokoyama Akira, Omori Tai, Yokoyama Tetsuji, Sato Yasuo, Mizukami Takeshi, Matsushita Sachio, Higuchi Susumu, Maruyama Katsuya, Ishii Hiromasa, Hibi Toshifumi
National Hospital Organization Kurihama Alcoholism Center, 5-3-1 Nobi, Yokosuka, Kanagawa 239-0841, Japan.
Cancer Epidemiol Biomarkers Prev. 2006 Nov;15(11):2209-15. doi: 10.1158/1055-9965.EPI-06-0435.
Asian case-control studies have shown a strong relationship between the development of squamous cell carcinoma (SCC) of the esophagus and alcohol consumption combined with inactive aldehyde dehydrogenase-2 (ALDH2*1/2), less-active alcohol dehydrogenase-1B (ADH1B1/1), high mean corpuscular volume (MCV), and self-reported facial flushing in response to alcohol. However, little is known about whether these risk factors prospectively influence cancer development in cancer-free alcoholics. Between 1993 and 2005, 808 Japanese alcoholic men diagnosed as cancer-free by an initial endoscopic screening examination received follow-up examinations ranging from 1 to 148 months (median, 31 months) later, and SCC of the upper aerodigestive tract was diagnosed in 53 of them (esophagus in 33 and oropharyngolarynx in 30). Cox proportional hazards analysis showed that the age-adjusted relative hazard for SCC was 11.55 [95% confidence interval (95% CI), 5.73-23.3] in ALDH21/2 heterozygotes compared with ALDH21/1 homozygotes, 2.02 (95% CI, 1.02-4.02) in ADH1B1/1 homozygotes compared with ADH1B1/*2 heterozygotes or *2/*2 homozygotes, 2.64 (95% CI, 1.49-4.67) in patients with flushing compared with those who had never experienced flushing, 2.91 (95% CI, 1.63-5.20) in those with an MCV >or= 106 compared with those with an MCV < 106, 2.52 (95% CI, 1.22-5.22) in those who smoked >or=30 cigarettes per day compared with those who smoked 0 to 19 cigarettes per day, 7.26 (95% CI, 3.99-13.23) in those with esophageal dysplasia compared with those without distinct iodine-unstained lesions >or=5 mm, and 0.28 (95% CI, 0.09-0.85) in those with body mass index >or= 23.2 (highest quartile) compared with those with body mass index < 19.0 (lowest quartile). These predictors are useful for selecting appropriately patients for careful follow-up examinations.
亚洲的病例对照研究表明，食管鳞状细胞癌（SCC）的发生与饮酒、醛脱氢酶2不活跃（ALDH2*1/2）、乙醇脱氢酶1B活性较低（ADH1B1/1）、平均红细胞体积较高（MCV）以及饮酒后自我报告的面部潮红之间存在密切关系。然而，对于这些危险因素是否会对无癌酗酒者的癌症发展产生前瞻性影响，人们知之甚少。在1993年至2005年期间，808名通过初次内镜筛查被诊断为无癌的日本男性酗酒者在1至148个月（中位数为31个月）后接受了随访检查，其中53人被诊断为上消化道SCC（33例为食管癌，30例为口咽和喉癌）。Cox比例风险分析显示，与ALDH21/1纯合子相比，ALDH21/2杂合子发生SCC的年龄调整相对风险为11.55[95%置信区间（95%CI），5.73 - 23.3]；与ADH1B1/2杂合子或2/2纯合子相比，ADH1B1/*1纯合子的相对风险为2.02（95%CI，1.02 - 4.02）；与从未经历过潮红的人相比，有潮红症状的患者相对风险为2.64（95%CI，1.49 - 4.67）；与MCV<106的人相比，MCV≥106的人相对风险为2.91（95%CI，1.63 - 5.20）；与每天吸烟0至19支的人相比，每天吸烟≥30支的人相对风险为2.52（95%CI，1.22 - 5.22）；与无明显碘不着色病变≥5mm的人相比，有食管发育异常的人相对风险为7.26（95%CI，3.99 - 13.23）；与体重指数<19.0（最低四分位数）的人相比，体重指数≥23.2（最高四分位数）的人相对风险为0.28（95%CI，0.09 - 0.85）。这些预测指标有助于选择合适的患者进行仔细的随访检查。
