Yokoyama A, Muramatsu T, Ohmori T, Makuuchi H, Higuchi S, Matsushita S, Yoshino K, Maruyama K, Nakano M, Ishii H
National Institute on Alcoholism, Kurihama National Hospital, Kanagawa, Japan.
Cancer. 1996 May 15;77(10):1986-90. doi: 10.1002/(SICI)1097-0142(19960515)77:10<1986::AID-CNCR4>3.0.CO;2-F.
Multiple intraesophageal primary cancer and upper aerodigestive tract (UADT) cancer associated with esophageal cancer are common diseases, especially in heavy drinkers. They are often explained by the concept of field cancerization, which suggests a similar etiology. However, little is known about the nature of the hypothesized etiology.
Among 901 Japanese male alcoholics systematically screened by upper gastrointestinal endoscopy (with esophageal iodine staining), 33 had squamous cell carcinoma of the esophagus. The multiplicity of their esophageal carcinoma and their concurrent UADT cancer was compared with their genotype for aldehyde dehydrogenase-2 (ALDH2), the major determinant of blood acetaldehyde concentration after drinking.
Of 17 patients with inactive ALDH2, 13 (76.5%) had multiple primary carcinoma of the esophagus, whereas 5 of 16 (31.3%) with active ALDH2 had multiple carcinomas (P < 0.01). The prevalence of concurrent UADT cancer was 29.4% in those patients with inactive ALDH2, compared with 6.3% in those patients with active ALDH2.
Inactive ALDH2 is a risk factor for multiple carcinoma of the esophagus in alcoholics. Acetaldehyde, a recognized animal carcinogen, appears to play a critical role in field cancerization.
多原发性食管癌以及与食管癌相关的上消化道（UADT）癌是常见疾病，在重度饮酒者中尤为常见。它们常被用“场癌化”概念来解释，这意味着病因相似。然而，对于假定病因的本质知之甚少。
在901名接受上消化道内镜检查（食管碘染色）系统筛查的日本男性酗酒者中，33人患有食管鳞状细胞癌。将他们食管癌的多发性及其并发的UADT癌与他们的乙醛脱氢酶-2（ALDH2）基因型进行比较，ALDH2是饮酒后血液乙醛浓度的主要决定因素。
在17名ALDH2无活性的患者中，13人（76.5%）患有多原发性食管癌，而在16名ALDH2有活性的患者中，5人（31.3%）患有多原发性癌（P<0.01）。ALDH2无活性的患者并发UADT癌的患病率为29.4%，而ALDH2有活性的患者为6.3%。
ALDH2无活性是酗酒者发生多原发性食管癌的危险因素。乙醛是一种公认的动物致癌物，似乎在“场癌化”中起关键作用。
