Tobacco, alcohol, and socioeconomic status and adenocarcinomas of the esophagus and gastric cardia
Tobacco, alcohol, and socioeconomic status and adenocarcinomas of the esophagus and gastric cardia
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DOI：
10.1093/jnci/89.17.1277
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发表时间：
1997-09-03
影响因子：
10.3
通讯作者：
Fraumeni, JF
中科院分区：
文献类型：
--
作者：
Gammon, MD;Schoenberg, JB;Fraumeni, JF
背景资料：在过去的几十年里，食管和贲门腺癌的发病率急剧上升，为了确定这些肿瘤的危险因素，我们进行了一项多中心、基于人群的病例对照研究。方法：该研究包括554名新诊断为食管或贲门腺癌的受试者，589名新诊断为食管鳞状细胞癌或其他胃腺癌的受试者，和695个对照组。分别计算四种肿瘤类型和食管贲门腺癌合并的风险估计值（比值比[OR]和相应的95%置信区间[CI]）。结果如下：目前吸烟者食管和贲门腺癌合并的风险增加（OR = 2.4; 95% = 1.7-3.4），直到戒烟后30年才观察到几乎没有减少;这种风险随着吸烟强度和持续时间的增加而增加。这些肿瘤的风险与啤酒无关（OR = 0.8; 95% CI = 0.6-1.1）或白酒（OR = 1.1; 95%CI = 0.8-1.4），但饮用葡萄酒会降低（OR = 0.6; 95%CI = 0.5-0.8），非贲门部胃腺癌的发生与吸烟和饮酒相关的OR相似，但食管鳞状细胞癌的OR值更高，对于所有四种肿瘤类型，低收入或低教育程度的患者风险更高，结论：吸烟是食管和贲门腺癌的主要危险因素，约占病例的40%，含义：由于在戒烟者中，这些肿瘤的风险降低之前有很长的滞后时间，吸烟可能会影响早期癌症的发生，在本世纪的前三分之二，吸烟流行率的增加可能反映在过去几年这些肿瘤发病率的上升上。最近吸烟人数的减少可能还没有产生影响。
Background: Incidence rates for adenocarcinomas of the esophagus and gastric cardia have risen steeply over the last few decades, To determine risk factors for these tumors, we conducted a multicenter, population-based, case-control study, Methods: The study included 554 subjects newly diagnosed with esophageal or gastric cardia adenocarcinomas, 589 subjects newly diagnosed with esophageal squamous cell carcinoma or other gastric adenocarcinomas, and 695 control subjects. Estimates of risk (odds ratios [ORs] and corresponding 95% confidence intervals [CIs]) were calculated for the four tumor types separately and for esophageal and gastric cardia adenocarcinomas combined. Results: Risk of esophageal and gastric cardia adenocarcinomas combined was increased among current cigarette smokers (OR = 2.4; 95% = 1.7-3.4), with little reduction observed until 30 years after smoking cessation; this risk rose with increasing intensity and duration of smoking. Risk of these tumors was not related to beer (OR = 0.8; 95% CI = 0.6-1.1) or liquor (OR = 1.1; 95% CI = 0.8-1.4) consumption, but it was reduced for drinking wine (OR = 0.6; 95% CI = 0.5-0.8), Similar ORs were obtained for the development of noncardia gastric adenocarcinomas in relation to tobacco and alcohol use, but higher ORs were obtained for the development of esophageal squamous cell carcinomas, For all four tumor types, risks were higher among those with low income or education, Conclusions: Smoking is a major risk factor for esophageal and gastric cardia adenocarcinomas, accounting for approximately 40% of cases, Implications: Because of the long lag time before risk of these tumors is reduced among exsmokers, smoking may affect early stage carcinogenesis, The increase in smoking prevalence during the first two thirds of this century may be reflected in the rising incidence of these tumors in the past few decades among older individuals, The recent decrease in smoking may not yet have had an impact.