A prospective study of tobacco, alcohol, and the risk of esophageal and gastric cancer subtypes
A prospective study of tobacco, alcohol, and the risk of esophageal and gastric cancer subtypes
复制标题
DOI：
10.1093/aje/kwm051
复制
发表时间：
2007-06-15
影响因子：
5
通讯作者：
Schatzkin, Arthur
中科院分区：
文献类型：
--
作者：
Freedman, Neal D.;Abnet, Christian C.;Schatzkin, Arthur
食管腺癌和贲门腺癌的发生率增加，而食管鳞状细胞癌（ESCC）和胃非贲门腺癌的发生率下降，提示不同的病因。作者使用Cox模型对474,606名美国参与者进行了前瞻性研究，研究了酒精和烟草与这些癌症的关系，该模型对潜在的混杂因素进行了调整。1995/1996 - 2000年，ESCC 97例，食管腺癌205例，贲门癌188例，非贲门癌187例。与不吸烟者相比，当前吸烟者发生ESCC(风险比（HR) = 9.27, 95%可信区间（CI）： 4.04, 21.29）、食管腺癌（HR = 3.70, 95% CI: 2.20, 6.22）、贲门（HR = 2.86, 95% CI: 1.73, 4.70）和贲门非贲门（HR = 2.04, 95% CI: 1.32, 3.16）的风险增加。假设因果关系，吸烟对ESCC的人群归因风险为77% (95% CI: 0.55, 0.89)，对食管癌的人群归因风险为58% (95% CI: 0.38, 0.72)，对贲门的人群归因风险为47% (95% CI: 0.27, 0.63)，对贲门外人群归因风险为19% （95% CI: 0.00, 0.37）。作者发现，对于每天饮用三杯以上酒精饮料的饮酒者，与每天饮用最多一杯的饮酒者相比，酒精摄入量与ESCC风险之间存在显著关联（HR = 4.93, 95% CI: 2.69, 9.03），但与食管癌、贲门癌或胃非贲门腺癌的风险无关。
Rates of esophageal adenocarcinoma and gastric cardia adenocarcinoma have increased, while rates of esophageal squamous cell carcinoma (ESCC) and gastric noncardia adenocarcinoma have decreased, suggesting distinct etiologies. The authors prospectively investigated the associations of alcohol and tobacco with these cancers in 474,606 US participants using Cox models adjusted for potential confounders. Between 1995/1996 and 2000, 97 incident cases of ESCC, 205 of esophageal adenocarcinoma, 188 of gastric cardia, and 187 of gastric noncardia cancer occurred. Compared with nonsmokers, current smokers were at increased risk for ESCC (hazard ratio (HR) = 9.27, 95% confidence interval (CI): 4.04, 21.29), esophageal adenocarcinoma (HR = 3.70, 95% CI: 2.20, 6.22), gastric cardia (HR = 2.86, 95% CI: 1.73, 4.70), and gastric noncardia (HR = 2.04, 95% CI: 1.32, 3.16). Assuming causality, ever smoking had population attributable risks of 77% (95% CI: 0.55, 0.89) for ESCC, 58% (95% CI: 0.38, 0.72) for esophageal adenocarcinoma, 47% (95% CI: 0.27, 0.63) for gastric cardia, and 19% (95% CI: 0.00, 0.37) for gastric noncardia. For drinkers of more than three alcoholic beverages per day, compared with those whose intake was up to one drink per day, the authors found significant associations between alcohol intake and ESCC risk (HR = 4.93, 95% CI: 2.69, 9.03) but not risk for esophageal, gastric cardia, or gastric noncardia adenocarcinoma.