Hirata Kenro, Yokoyama Akira, Nakamura Rieko, Omori Tai, Kawakubo Hirofumi, Mizukami Takeshi, Maruyama Katsuya, Kanai Takanori, Yokoyama Tetsuji
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Japan.
Cancer Sci. 2017 May;108(5):1058-1064. doi: 10.1111/cas.13207. Epub 2017 Apr 24.
Soft palatal melanosis can be detected by visual inspection during routine physical examination or even personally in a mirror. The aim of this study was to evaluate the association between squamous cell neoplasia in the upper aerodigestive tract (UAT) and soft palatal melanosis. We reviewed digitized records of high-quality endoscopic images of the soft palate of 1786 Japanese alcoholic men who underwent endoscopic screening. Soft palatal melanosis was observed in 381 (21.3%) of the subjects (distinct, 6.3%). Older age, an inactive heterozygous aldehyde dehydrogenase-2 genotype, smoking, and a high mean corpuscular volume were positively associated with the presence of soft palatal melanosis. The age-adjusted odds ratio (95% confidence interval) for UAT neoplasia was 1.92 (1.40-2.64) in the group with melanosis and 2.51 (1.55-4.06) in the group with distinct melanosis, compared with the melanosis-free group. A multivariate analysis showed that the presence of soft palatal melanosis was independently associated with a high risk of UAT neoplasia. We calculated the individual number of risk factors out of four easily identifiable and significant factors: age ≥55 years, current/former alcohol flushing, mean corpuscular volume ≥106 fL, and distinct soft palatal melanosis. Compared with the risk-factor-free condition, the odds ratio (95% confidence interval) values of UAT neoplasia for one, two, three, and four risk factors were 1.49 (0.97-2.30), 3.14 (2.02-4.88), 4.80 (2.71-8.51), and 7.80 (2.17-28.1), respectively. The presence of soft palatal melanosis provides a simple new strategy for identifying heavy drinkers with a high risk for UAT neoplasia.
软腭黑变病可在常规体格检查期间通过视诊检测到，甚至患者本人对着镜子也能发现。本研究的目的是评估上消化道（UAT）鳞状细胞瘤变与软腭黑变病之间的关联。我们回顾了1786名接受内镜筛查的日本男性饮酒者软腭的高质量内镜图像数字化记录。381名（21.3%）受试者观察到软腭黑变病（明显者占6.3%）。年龄较大、无活性杂合醛脱氢酶-2基因型、吸烟和高平均红细胞体积与软腭黑变病的存在呈正相关。与无黑变病组相比，黑变病组UAT肿瘤形成的年龄调整优势比（95%置信区间）为1.92（1.40 - 2.64），明显黑变病组为2.51（1.55 - 4.06）。多变量分析表明，软腭黑变病的存在与UAT肿瘤形成的高风险独立相关。我们计算了四个易于识别且显著的因素（年龄≥55岁、当前/既往酒精性脸红、平均红细胞体积≥106 fL和明显的软腭黑变病）中的个体风险因素数量。与无风险因素情况相比，UAT肿瘤形成的优势比（95%置信区间）值，一个、两个、三个和四个风险因素分别为1.49（0.97 - 2.30）、3.14（2.02 - 4.88）、4.80（2.71 - 8.51）和7.80（2.17 - 28.1）。软腭黑变病的存在为识别有UAT肿瘤形成高风险的重度饮酒者提供了一种简单的新策略。
