Brown L M, Silverman D T, Pottern L M, Schoenberg J B, Greenberg R S, Swanson G M, Liff J M, Schwartz A G, Hayes R B, Blot W J
Epidemiology and Biostatistics Program, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892.
Cancer Causes Control. 1994 Jul;5(4):333-40. doi: 10.1007/BF01804984.
In the United States, the incidence of adenocarcinoma of the esophagus, including the esophagogastric (EG) junction, has been increasing rapidly over the past two decades. Except for an association with Barrett's esophagus, little is known about the etiology of these cancers. A population-based case-control interview study of 174 White men with adenocarcinoma of the esophagus and 750 controls living in three areas of the United States offered the opportunity to investigate the relationship of these cancers with smoking, alcohol drinking, socioeconomic factors, and history of ulcer. There were significantly elevated risks for men who smoked cigarettes (odds ratio [OR] = 2.1) or drank liquor (OR = 1.6). For both cigarette smoking and liquor drinking, there were significant dose gradients with amount consumed. No reduction in risk was observed following smoking cessation. Subjects who switched from nonfilter to filter cigarettes experienced half the risk of those who only smoked nonfilter cigarettes. Inverse risk gradients were seen with increasing recent annual income, with the highest risk (OR = 3.4) for the lowest category. The risk for a history of ulcer (OR = 1.7), especially of the duodenum (OR = 2.2), was also significantly elevated. These data suggest that tobacco and alcohol may be etiologic factors for adenocarcinoma of the esophagus and EG junction, but these factors do not appear to explain the rapid rise in incidence of these tumors. The associations with low social class and history of ulcer need to be explored in greater detail along with other factors that may account for the temporal trends in esophageal adenocarcinomas.
在美国，过去二十年来，包括食管胃（EG）交界处在内的食管腺癌发病率一直在迅速上升。除了与巴雷特食管有关外，人们对这些癌症的病因知之甚少。一项基于人群的病例对照访谈研究，对174名患有食管腺癌的白人男性和750名居住在美国三个地区的对照者进行了调查，以研究这些癌症与吸烟、饮酒、社会经济因素和溃疡病史之间的关系。吸烟（比值比[OR]=2.1）或饮酒（OR=1.6）的男性患癌风险显著升高。对于吸烟和饮酒，随着消费量的增加都存在显著的剂量梯度。戒烟后未观察到风险降低。从非过滤嘴香烟改为过滤嘴香烟的受试者，其风险是只吸非过滤嘴香烟者的一半。随着近期年收入的增加，呈现出相反的风险梯度，收入最低组的风险最高（OR=3.4）。溃疡病史（OR=1.7），尤其是十二指肠溃疡病史（OR=2.2）的风险也显著升高。这些数据表明，烟草和酒精可能是食管腺癌和EG交界处腺癌的病因，但这些因素似乎无法解释这些肿瘤发病率的快速上升。需要更详细地探讨低社会阶层和溃疡病史与其他可能解释食管腺癌时间趋势的因素之间的关联。
