Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
PLoS One. 2011;6(7):e22152. doi: 10.1371/journal.pone.0022152. Epub 2011 Jul 21.
Golestan Province in northern Iran is an area with a high incidence of esophageal squamous cell carcinoma (ESCC). We aimed to investigate prognostic factors for ESCC and survival of cases in Golestan, on which little data were available. We followed-up 426 ESCC cases participating in a population-based case-control study. Data were analyzed using the Kaplan-Meier method and the Cox proportional hazard models. Median survival was 7 months. Age at diagnosis was inversely associated with survival, but the association was disappeared with adjustment for treatment. Residing in urban areas (hazard ratio, HR = 0.70; 95% CI 0.54-0.90) and being of non-Turkmen ethnic groups (HR = 0.76; 95% CI 0.61-0.96) were associated with better prognosis. In contrast to other types of tobacco use, nass (a smokeless tobacco product) chewing was associated with a slightly poorer prognosis even in models adjusted for other factors including stage of disease and treatment (HR = 1.38; 95% CI 0.99-1.92). Opium use was associated with poorer prognosis in crude analyses but not in adjusted models. Almost all of potentially curative treatments were associated with longer survival. Prognosis of ESCC in Golestan is very poor. Easier access to treatment facilities may improve the prognosis of ESCC in Golestan. The observed association between nass chewing and poorer prognosis needs further investigations; this association may suggest a possible role for ingestion of nass constituents in prognosis of ESCC.
伊朗北部的戈勒斯坦省是食管鳞状细胞癌（ESCC）高发地区。我们旨在研究戈勒斯坦 ESCC 的预后因素和病例生存情况，因为这方面的数据很少。我们对参与基于人群的病例对照研究的 426 例 ESCC 病例进行了随访。使用 Kaplan-Meier 方法和 Cox 比例风险模型进行数据分析。中位生存期为 7 个月。诊断时的年龄与生存呈负相关，但在调整治疗后，这种关联消失了。居住在城市地区（风险比，HR = 0.70；95%置信区间 0.54-0.90）和非土库曼族裔（HR = 0.76；95%置信区间 0.61-0.96）与更好的预后相关。与其他类型的烟草使用相比，咀嚼 nass（一种无烟烟草制品）即使在调整了包括疾病分期和治疗在内的其他因素的模型中，也与稍差的预后相关（HR = 1.38；95%置信区间 0.99-1.92）。在粗分析中，鸦片使用与较差的预后相关，但在调整后的模型中则不然。几乎所有潜在的治愈性治疗都与更长的生存期相关。戈勒斯坦 ESCC 的预后非常差。更容易获得治疗设施可能会改善戈勒斯坦 ESCC 的预后。观察到的咀嚼 nass 与较差预后之间的关联需要进一步研究；这种关联可能表明 nass 成分的摄入在 ESCC 的预后中可能起作用。
