Iijima Katsunori, Koike Tomoyuk, Abe Yasuhiko, Inomata Yoshifumi, Sekine Hitoshi, Imatani Akira, Nakaya Naoki, Ohara Shuichi, Shimosegawa Tooru
Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Am J Gastroenterol. 2007 Aug;102(8):1603-9. doi: 10.1111/j.1572-0241.2007.01257.x. Epub 2007 May 3.
A recent study in Sweden has reported that gastric atrophy is associated with an increased risk for esophageal squamous cell carcinoma. However, this finding needs to be confirmed in other ethnic groups due to the wide geographic variation of this cancer.
To investigate whether gastric atrophy is associated with a risk for esophageal squamous cell carcinoma using a case-control study in Japanese subjects, a population known to have a high prevalence of H. pylori infection and accompanying gastric atrophy.
Seventy-three patients who had undergone endoscopic mucosal resection for superficial esophageal squamous cell carcinoma, and 73 sex- and age-matched controls, were enrolled prospectively. Gastric fundic atrophy was evaluated by histology of biopsy specimens and serum pepsinogen I level (cutoff level 25 ng/mL). Conditional logistic regression model with adjustment for potential confounding factors was used to assess the associations.
Gastric atrophy, defined histologically or serologically, was independently associated with an increased risk for esophageal squamous cell carcinoma and the risk seemed to increase with the progression of the atrophy. Multivariate odds ratio (95% confidence interval) for histological fundic atropy, fundic intestinal metaplasia, and serological atrophy are 4.2 (1.5-11.7), 10.7 (2.3-50.4), and 8.2 (2.2-30.4), respectively.
Gastric atrophy, a newly recognized risk factor for esophageal squamous cell carcinoma in Sweden, is likely to be a risk factor in other areas. Further studies are warranted to explore the causal relationship.
瑞典最近的一项研究报告称，胃萎缩与食管鳞状细胞癌风险增加有关。然而，由于这种癌症在地理上存在广泛差异，这一发现需要在其他种族群体中得到证实。
在日本受试者中开展一项病例对照研究，以调查胃萎缩是否与食管鳞状细胞癌风险相关。日本人群幽门螺杆菌感染率高且伴有胃萎缩。
前瞻性纳入73例因浅表食管鳞状细胞癌接受内镜黏膜切除术的患者以及73例年龄和性别匹配的对照。通过活检标本组织学检查和血清胃蛋白酶原I水平（临界值25 ng/mL）评估胃底萎缩情况。采用条件逻辑回归模型并对潜在混杂因素进行调整，以评估两者之间的关联。
组织学或血清学定义的胃萎缩与食管鳞状细胞癌风险增加独立相关，且风险似乎随着萎缩进展而增加。组织学胃底萎缩、胃底肠化生和血清学萎缩的多因素比值比（95%置信区间）分别为4.2（1.5 - 11.7）、10.7（2.3 - 50.4）和8.2（2.2 - 30.4）。
胃萎缩在瑞典是新发现的食管鳞状细胞癌风险因素，在其他地区可能也是风险因素。有必要进一步开展研究以探索因果关系。
