Hu N, Taylor P R, Rao J Y, Hemstreet G P, Liu S F, Zou X N, Mark S D, Dawsey S M
National Cancer Institute, Bethesda, Maryland 20892, USA.
Cancer Epidemiol Biomarkers Prev. 1998 Jan;7(1):59-64.
The highest incidences of esophageal and gastric cardia cancer in the world occur in northern China. Chinese scientists have developed esophageal balloon cytology screening to detect these cancers, but traditional cytology is sometimes inadequate to find some early, curable lesions. Several studies suggest that quantitative fluorescence image analysis (QFIA) of DNA ploidy and nuclear morphology may be able to improve upon traditional cytology results. In October 1987, esophageal balloon cytology was performed on 1331 adults in Linxian, China, and all samples were evaluated both by traditional cytology and QFIA. From 1987 to May 1991, 62 new squamous esophageal cancers and 44 new adenocarcinomas of the cardia were identified in this cohort. Proportional hazards models were used to evaluate the relationship of cytological diagnoses and six QFIA variables to subsequent cancer risk. These models showed significant trends for increasing esophageal cancer risk, with increasing values in five of the QFIA variables and with increasing severity of the traditional cytological diagnoses. A comparison of models with only cytology variables versus models with both cytology and QFIA variables indicated that the QFIA provided an important additional predictive value. Persons with both cytological dysplasia and high cellular DNA were 8 times more likely to develop esophageal cancer than were individuals with neither of these conditions. For cardia cancer, associations between QFIA variables or cytological diagnoses and later cancer were more limited. This study suggests that the QFIA variables evaluated here are independent predictors of squamous esophageal cancer and that combining QFIA with traditional cytology can improve prediction of esophageal cancer risk.
世界上食管癌和贲门癌发病率最高的地区在中国北方。中国科学家已研发出食管气囊细胞学筛查方法来检测这些癌症，但传统细胞学有时不足以发现一些早期可治愈的病变。多项研究表明，对DNA倍体和细胞核形态进行定量荧光图像分析（QFIA）或许能够改进传统细胞学检查结果。1987年10月，对中国林县的1331名成年人进行了食管气囊细胞学检查，所有样本均通过传统细胞学和QFIA进行评估。从1987年至1991年5月，在该队列中发现了62例新的食管鳞状细胞癌和44例新的贲门腺癌。使用比例风险模型来评估细胞学诊断和六个QFIA变量与后续癌症风险之间的关系。这些模型显示，随着QFIA五个变量值的增加以及传统细胞学诊断严重程度的增加，食管癌风险呈显著上升趋势。仅包含细胞学变量的模型与同时包含细胞学和QFIA变量的模型的比较表明，QFIA提供了重要的额外预测价值。同时患有细胞学发育异常和高细胞DNA的人患食管癌的可能性是既无这两种情况的人的8倍。对于贲门癌，QFIA变量或细胞学诊断与后来患癌之间的关联更为有限。这项研究表明，此处评估的QFIA变量是食管鳞状细胞癌的独立预测因子，并且将QFIA与传统细胞学相结合可以改善对食管癌风险的预测。
