Department of Health and Nutrition Sciences, Montclair State University, Montclair, NJ.
Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT.
Ann Epidemiol. 2014 Jan;24(1):50-7. doi: 10.1016/j.annepidem.2013.10.009. Epub 2013 Oct 18.
Although risk factors for squamous cell carcinoma of the esophagus and adenocarcinomas of the esophagus (EA), gastric cardia (GC), and other (noncardia) gastric (OG) sites have been identified, little is known about interactions among risk factors. We sought to examine interactions of diet, other lifestyle, and medical factors with risks of subtypes of esophageal and gastric cancers.
We used classification tree analysis to analyze data from a population-based case-control study (1095 cases, 687 controls) conducted in Connecticut, New Jersey, and western Washington State.
Frequency of reported gastroesophageal reflux disease symptoms was the most important risk stratification factor for EA, GC, and OG, with dietary factors (EA, OG), smoking (EA, GC), wine intake (GC, OG), age (OG), and income (OG) appearing to modify the risk of these cancer sites. For esophageal squamous cell carcinoma, smoking was the most important risk stratification factor, with gastroesophageal reflux disease, income, race, noncitrus fruit, and energy intakes further modifying risk.
Various combinations of risk factors appear to interact to affect risk of each cancer subtype. Replication of these data mining analyses are required before suggesting causal pathways; however, the classification tree results are useful in partitioning risk and mapping multilevel interactions among risk variables.
尽管已经确定了食管鳞癌和食管腺癌（EA）、胃贲门（GC）以及其他（非贲门）胃部（OG）部位的危险因素，但对于这些危险因素之间的相互作用知之甚少。我们试图研究饮食、其他生活方式和医疗因素与食管和胃癌亚型风险之间的相互作用。
我们使用分类树分析方法分析了在康涅狄格州、新泽西州和华盛顿州西部进行的一项基于人群的病例对照研究的数据（1095 例病例，687 例对照）。
报告的胃食管反流病症状的频率是 EA、GC 和 OG 的最重要的风险分层因素，饮食因素（EA、OG）、吸烟（EA、GC）、饮酒（GC、OG）、年龄（OG）和收入（OG）似乎改变了这些癌症部位的风险。对于食管鳞癌，吸烟是最重要的风险分层因素，胃食管反流病、收入、种族、非柑橘类水果和能量摄入进一步改变了风险。
各种危险因素组合似乎相互作用，影响每种癌症亚型的风险。在提出因果途径之前，需要对这些数据挖掘分析进行复制；然而，分类树结果在划分风险和映射风险变量之间的多层次相互作用方面是有用的。
