内镜切除治疗在早期食管癌和贲门癌及其癌前病变中的应用价值

目的 评价内镜套帽法切除早期食管癌、贲门癌及癌前病变的长期疗效和应用价值.方法 采用内镜套帽法切除早期食管癌、贲门癌及癌前病变147例(154个病灶),其中早期食管癌64例(69个病灶),癌前病变45例(47个病灶),病灶直径3～40 nm,平均(14.8±6.1)mm;早期贲门癌23例,癌前病变15例(均为单灶),病灶直径5～25 mm,平均(8.2±4.3)mm.全组病例均经病理证实.结果 全组有139个病灶被完全切除,完全切除率为90.3%.食管和贲门病灶的完全切除率均与病灶大小有关,病灶越大,完全切除率越低(P=0.001和P=0.014).147例患者中,内镜随访不足3年者66例,3～5年者31例,5～10年者43例,10年以上者7例.全组死亡11例,其中肿瘤复发死亡1例.早期食管癌和贲门痈的5年生存率分别为96.2%和100.0%.本组有5例(3.4%)患者发生术中出血,1例(0.7%)患者发生狭窄,无穿孔发生.结论 内镜黏膜切除治疗早期食管癌和贲门癌,符合其生物学特点,可达到传统手术治疗相同的长期疗效,亦适用于重度不典型增生的治疗.     

NATURAL HISTORY OBSERVATION FOR ESOPHAGEAL AND CARDIA PRECURSORS BY REPETITIVE ENDOSCOPIC SCREENING OF 301 SUBJECTS IN SHEXIAN

OBJECTIVE To investigate the natural history of fast developing esophageal and cardia precursors. METHODS Repetitive endoscopic screenings were performed among 40-69-year-olds in the high-incidence areas for esophageal cancer in Shexian. RESULTS The initial diagnosis and the lag-time for 7 subsequently identified severe dysplasia （SD） subjects were as follows： in one subject 13 months after a baseline diagnosis of normal epithelium, in another subject 7 months after a baseline diagnosis of base cell hyperplasia （BCH）, in four subjects 3, 4, 4, and 10.5 months after baseline diagnosis of mild dysplasia （mD）, and in one subject 12.5 months after a baseline diagnosis of moderate dysplasia （MD）. The initial diagnosis and the lag-time for 6 subsequently identified carcinomas in situ or intramucosal carcinoma cases were： in one case 48 months after a baseline diagnosis of mD, in 2 cases 4 and 13 months after baseline diagnoses of MD, and in the other 3 cases 3.5, 9, and 17.5 months after baseline diagnoses of SD. The initial diagnosis and lag-time for 3 subsequently identified invasive cancer cases, were： in one case 50 months after a baseline diagnosis of MD, in 2 cases 14 and 19 months after baseline diagnoses of SD. In addition, during a 4-year-follow-up of 18 subjects after endoscopic mucosa resection, 9 of them were found to have developed precursors again at other sites, and also additional findings were obtained for 11 of the 16 dysplasia cases by repetitive biopsy in less than 2 months after the initial endoscopy. CONCLUSION A 5-year screening interval for BCH and mD, and a 3-year interval for MD may be too long for the fast developing precursors. Periodic screenings with shorter intervals should be considered to control the number of interval cases due to fast development, multifocal carcinogenesis, and false negative results inherent in one-time endoscopic biopsy sampling.     

食管癌高发区贲门癌、胃癌流行强度分析及其对内镜筛查的启示

 目的 分析涉县等食管癌高发区贲门癌、胃癌的流行强度，明确其防治任务，探讨具体控制途径。方法 对比分析涉县、林县、磁县全人群肿瘤登记的食管癌、贲门癌、胃癌发病率与死亡率以及内镜筛查6233例40-69岁人群三种癌及癌前病变的检出率。结果 太行山南麓食管癌高发区食管癌、贲门癌和胃癌发病率或死亡率的合计占到全身恶性肿瘤的70％～80％。涉县2000-2004年贲门癌发病率男女性分别为69．9／10万和41．5／10万，死亡率男女性分别为54．3／10万和33．2／10万。高发区运用内镜碘染色指导活检技术筛查，食管鳞状上皮癌前病变及早期癌的检出率高，但贲门和胃腺上皮癌前病变及早期癌的检出率相对较低。结论 太行山南部食管癌高发区存在贲门癌和胃癌共同高发的现象，要想通过旱诊早治从整体上降低该地区上消化道癌的死亡率，必须加强内镜对贲门和胃腺上皮癌前病变及早期癌检出的研究。     

FACTORS INFLUENCING SERUM PEPSINOGEN LEVELS IN A CHINESE POPULATION AT HIGH RISK OF STOMACH CANCER

The relationships between serum pepsinogen (PG) levels and age, sex, ABO blood type, cigarette smoking and diet were studied among over 3, 000 residents selected at random in an area with high risk of stomach cancer in Shandong Province, China. Males had significantly higher median PG Ⅰ and Ⅱ levels than feamles. PG Ⅰ tended to decrease and PG Ⅱ to rise with age. Subjects with blood type A had a higher PG Ⅱ level than subjects with other blood types. Both PG Ⅰ and Ⅱ levels rose with dally consumption of cigarettes. Alcohol consumption was not related to PG levels. The PG Ⅰ/Ⅱ ratio declined with increasing consumption of sour pancakes, a fermented staple food found to contain N-nitroso compounds and to be a risk factor for stomach cancer in this population.     

Distribution of cervical and breast cancer risk factors in women and their screening behaviours

Breast cancer and cervical cancer are important causes of cancer‐related mortality in women all over the world. The present study was conducted in order to investigate the distribution of cervical and breast cancer risk factors in women and their knowledge and behaviours about cancer screening methods. The study is cross‐sectional in nature. It was conducted with the participation of 1,886 women in Turkey. Data were collected through a questionnaire. The knowledge and behaviours of women aged 40 and over about breast cancer or cervical cancer screening methods were investigated according to the education level; results showed that the rates of those who knew and did breast self‐examination were significantly lower in illiterate women. Besides, the rates of women who did breast self‐examination were significantly lower in those who were aged 40 and over, and the rates of those who had clinical breast examination and Pap smear test were significantly lower in women aged 39 and below (p < 0.01). This study identified the most notable breast and cervical cancer risk factors as low education levels, high number of deliveries, short breastfeeding period, obesity and low socio‐economic level. For this reason, public health policies should be developed to minimise these risk factors.     

贲门癌高发位点的内镜研究

目的 观察和研究贲门癌的高发位点及其临床意义。方法 分析417例早期贲门癌和451例中晚期贲门癌,发现贲门癌有高发位点存在后,在高发现场重复内镜普查205例,验证该高发位点的真实性。结果 417例早期贲门癌中的327例（78.4%)和451例中晚期贲门癌中的336例（74.5%）,始发部位均在贲门黏膜脊根部,在验证性普查的205例中,发现11例贲门癌,其中9例（81.8%)始发部位也在贲门黏膜脊根部。结论 贲门癌的高发位点在贲门黏膜脊根部,它具有重要的临床意义。     

Clinicopathologic study of esophageal cancer associated with simultaneous metastatic lesions in the stomach

Between 1965 and 1985, 89 Japanese patients with esophageal squamous cell carcinoma underwent esophagectomy. In five of them (5.6%), a simultaneous metastatic lesion from the esophageal cancer was detected within the stomach in the resected specimens. Preoperative diagnosis of the gastric lesions had been made in none of the five patients because of an obstruction that was due to esophageal cancer. All gastric lesions were located at the gastric cardia, close to the esophagocardial junction, with a mean distance of 6.9 +/- 2.0 cm from the primary esophageal lesions. Provision of a gastric tube that contains metastatic lesions, for reconstruction of a new alimentary tract after esophagectomy, must be avoided. In cases of inadequate preoperative gastric examination, gastric lesions should be searched for intraoperatively, not only by serosal inspection and palpation, but also by mucosal inspection and palpation after partial proximal gastrectomy.     

癌症大规模人群普查对研究肿瘤发病趋势的影响

目的:探讨大规模人群癌症早期普查对研究自然发病趋势变化的影响。方法:利用肿瘤登记处统计的肿瘤发病资料。抽样两个乡镇(驸马沟、固义乡)1998-2008年间食管癌发病率情况,计算发病粗率进行描述分析,对产生趋势变化原因予以讨论。结果:1998-2003年间驸马沟乡的食管癌发病率波动在75-149/10万之间,2005年发病率陡然升高至350.17/10万,超出历年发病最高水平的2.4倍多。固义乡的发病趋势情况亦类似,只是发病最高在2006年,为263.57/10万。次年,发病率急剧下降至61.50/10万。两年发病波动较大。结论:2005-2006年间,曾对这两个乡镇进行了大范围食管内镜早期普查干预。因人为干预而造成该时间段食管癌趋势陡然升高,从而对短期时间分析趋势变化造成影响。普查提前检出的癌症患者在进行人群肿瘤登记中,应做好标注统计,杜绝或减少各种偏倚,为综合评价癌症普查效果奠定基础。     

Awareness of breast and cervical cancer risk factors and screening behaviours among nurses in rural region of Turkey

Breast and cervical cancer are the most common causes of cancer mortality among women worldwide, but actually they are largely preventable diseases. There is limited data on breast and cervical cancer knowledge, screening practices and attitudes of nurses in Turkey. A self-administered questionnaire was used to investigate the knowledge and attitude of nurses on risk factors of the breast and cervical cancer as well as screening programmes such as breast self-examination (BSE), clinical breast examination, mammography (MMG) and papanicolaou (pap) smear test. In total, 125 out of 160 nurses participated in the study (overall response rate was 80.6%). The risk factors and symptoms of breast cancer was generally well known, except for early menarche (23.2%) and late menopause (28.8%). For cervical cancer, the correct risk factors mostly indicated by the nurses were early age at first sexual intercourse (56%), smoking (76%), multiple sexual partners (71.2%). As for screening methods, it was believed that BSE was a beneficial method to identify the early breast changes (84.8%) and MMG was able to detect the cancer without a palpable mass (57.6%). Little was known about the fact that women should begin cervical cancer screening approximately 3 years after the onset of sexual intercourse (23.2%) and if repeated pap smear test were normal, it could be done every 2–3 years. Most of the nurses considered that MMG decreases the mortality in breast cancer (65.6%) and also believed that pap smear test decreases the mortality in cervical cancer (75.2%). Despite high level of knowledge of breast cancer risk factors, symptoms and screening methods, inadequate knowledge of cervical cancer screening method were found among nurses.     

The survival of esophageal cancer by subtype in China with comparison to the United States

Adenocarcinoma (AC) and squamous cell carcinoma (SCC) are the main subtypes of esophageal cancer (EC), but nationwide survival of both EC subtypes has never been reported in China. Our study aimed to estimate the survival trends of EC by subtype in China and compare them with those in the United States for the same period. We used data from 64 Chinese cancer registries, which included EC patients diagnosed during 2008 and 2015 and followed up until 31st December 2017. The 5-year age-standardized relative survival by subtype, sex, age group and urban or rural area between 2008 and 2017 were analyzed. We stratified survival estimates by calendar period (2008-2009, 2010-2011, 2012-2014 and 2015-2017). Data from the SEER 18 program were calculated to estimate the survival of EC in the United States. A further comparison between the survivals in areas covered and not covered by population-based endoscopic screening programs in China was conducted. A total of 129 962 records were included in the survival analyses. Results revealed that age-standardized 5-year relative survivals for AC and SCC increased in both China and the United States from 2008 to 2017. In 2015 to 2017, 5-year survival from both subtypes in China was better than the United States (SCC: 36.9% vs 18.5%, AC: 34.8% vs 22.3%). The survival for both subtypes was significantly higher in screening areas than in nonscreening areas in China (SCC: 40.6% vs 32.8%; AC: 43.0% vs 31.3%). A survival gap in EC by subtype exists between China and the United States. Our results may support the beneficial effect of population-based endoscopic screening for survival, and may be poised to inform national policy-making in both countries.     

山东省2013-2016年农村居民食管癌社会性筛查结果分析

目的 山东省自2006年开始承担国家食管癌早诊早治项目,取得了良好的社会效益.本研究旨在分析山东省2013-2016年食管癌早诊早治项目筛查结果,探讨食管癌筛查的改进策略.方法 采用整群随机抽样法选取2013-2016年山东省内9个项目点的目标人群,年龄40～69岁,对符合条件的受检者采用内镜下碘染色观察和指示性活检技术进行筛查;对筛查结果进行分析,计算检出率、早诊率等,并进行统计检验.结果 9个项目点共完成筛查107 431人次,检出重度异型增生及以上病例1 093例,检出率为1.02％,其中早期病例941例,早诊率为86.09％;食管各级病变例数大致呈“金字塔”型分布,筛查可发现大量癌前病变和早期食管癌患者;社会性筛查带动了项目点食管癌诊治水平的提高,但不同地区间的检出率差异较大(P＜0.05),食管癌检出率与当地发病率密切相关;与机会性筛查相比,食管癌社会性筛查具有“检出率低、早诊率高”的特点.结论 食管癌社会性筛查具有良好的社会效益,应继续推广;推动“社会性筛查”和“机会性筛查”融合发展以及“补需方”和“补供方”的有机结合,有利于提高检出率和早诊率,促进筛查工作的可持续发展.     

新疆地区食管癌发病风险的病例对照研究

  目的  探讨新疆地区食管癌发病的相关因素及特征。  方法  选取2010年1月至2016年1月经新疆医科大学第一附属医院诊断为食管癌的患者324例为病例组,同期收治的非癌症患者657例为对照组,采用病例对照研究,分析食管癌发病的相关因素及特征。  结果  2型糖尿病（年限≥2年）为食管癌的相关危险因素,使用胰岛素（≥2年）能够增加食管癌的发病风险。同时吸烟、饮酒、高脂血症、体质量指数≥24、食管憩室为食管癌的危险性因素。  结论  导致食管癌发病的危险因素较多,目前发现2型糖尿病以及使用胰岛素与食管癌的发生存在一定的关联性,应对糖尿病患者易患食管癌的高危亚群做好一、二级预防。      

食管癌在食管黏膜上最初起源点的高发现场前瞻性研究

目的 探讨食管黏膜白脊与食管癌发生的关系,以及食管癌病灶的最初起源点.方法 以1987年河南省林州市食管癌高发现场内镜筛查发现的339例有食管黏膜白脊或白脊背伴有红区和糜烂灶者作为研究组,以同期212例无白脊和活检病灶报告阴性者作为对照组,随访15年.以食管癌的发生为终点事件,比较两组的癌变率.结果 339例有白脊者中,单纯白脊76例,白脊背有红区和糜烂灶者263例.随访15年,76例单纯白脊者中,癌变9例,癌变率为11.8%;263例白脊背有红区或糜烂灶者中,癌变88例,癌变率为33.5%.对照组212例中,17例发生食管鳞状细胞癌,癌发生率为8.0%.结论 食管黏膜白脊与食管癌发生有密切关系,可能是食管癌最初起源点.白脊背出现红色糜烂灶,应视为癌前病变,定期内镜随诊.     

The relationship between a cohort endoscopic screening of 15,000 subjects and the death of patients with esophageal and gastric cancers in high-risk areas

OBJECTIVE Ci-xian County is located in the north of China and is a high-risk area for esophageal cancer （EC）. In 2004, the incidence rate of EC in the county was 127/100,000 and 93/100,000 in the male and female population, respectively, and that of gastric cancer （GC） was 72/100,000 and 36/100,000. Since 2001 a cohort screening, supported by a special national fund, utilizing endoscopic examination with iodine staining for the target population at the age ranging from 40 to 69 years was carried out, so as to reduce the incidence and mortality rates in the high-risk areas of EC. METHODS In October 2001, 4 townships in the Ci-xian County, Hebei, China were selected, with 22,016 cases in the intervention group （IVG） and 33,410 in the control group （CG）. The total population coverage reached 55,000. There were 3257 males and 3339 females in the IVG with the age ranging from 40 to 69 years, and 4299 males and 4430 females in the CG with the same range of the age. Endoscopic screening with iodine staining was used in the IVG, with a screening rate of 53.2%. During the screening by endoscopic examination, 97 cases were found to have esophageal squamous epithelium, carcinoma-in-situ at the cardiac glandular epithelium or intra-mucosal carcinoma. Additionally, 102 cases were identified to have severe atypical hyperplasia in the esophagus and gastric cardia. The natural incidence rate of cancer and the mortality were observed in the CG. The ICD-0 version was used in the tumor incidence and death registration coding. During a period from June to September 2008, based on the information of the tumor registration database of the incidence and mortality in the Ci-xian County, the cohort groups were studied and followed. RESULTS There were 133 patients with untreatable EC and 48 with GC in the IVG, while there were 259 and 37 patients in the CG who died of esophageal and gastric cancer, respectively. The relative risk （RR） of death was 0.76 in the male patients with EC, 95%CI （0.59-0.98）, P = 0.038, and in the female patients the RR was 0.51, 95%CI （0.35-0.75）, P = 0.000. The RR of death in the GC patients was 2.45, （1.40-4.29） in the male, P = 0.01, and 0.99, （0.47-1.99）, in the female cases, P = 0.906. CONCLUSION Six years after a cohort screening of a large population by endoscopic examination with iodine staining in areas at high risk for EC, the death risk in the male and female patients with EC has decreased compared with that in the control group. The difference between the 2 groups was statistically significant. However, no protective method used to decrease the death risk in GC patients has been found during this period of endoscopic screening.     

基因组学和蛋白质组学及代谢组学在食管癌筛查与早期诊断应用研究现状

目的食管癌是常见的消化道恶性肿瘤,发病率较高而生存率较低。本文总结基因组学、蛋白质组学及代谢组学在食管癌早期筛查和诊断中的应用,为今后食管癌早期筛查和诊断提供新的平台和科学理论依据。方法以"基因组学、蛋白质组学、代谢组学、食管癌和早期诊断"为关键词检索CNKI期刊全文数据库,以"genomics、proteomics、metabolomics、esophagus cancer、early diagnosis"为关键词检索PubMed,检索建库至2018-12发表的相关文献。纳入标准:(1)基因组学、蛋白质组学和代谢组学相关研究;(2)食管癌早期筛查与诊断。排除标准:(1)综述类文献;(2)研究资料不全;(3)结果重复且相对陈旧的研究。根据纳入和排除标准选择29篇文献进行分析。结果既往研究证实,食管癌患者与健康者在基因、蛋白质表达及代谢表达方面存在差异,且发现TFF1、CCNA1和TFPI2等DNA甲基化,PA28β、AHSG和LRG等差异表达蛋白及蛋白特征组,多个氨基酸的代谢特征及其他物质的代谢失调均可作为食管癌早期筛查及诊断潜在的生物标志物。此外,利用各类组学技术及血液、尿液等生物样本在寻找生物标志物方面均表现出较好的可行性。结论基因组学、蛋白质组学及代谢组学技术有望为食管癌早期筛查及诊断提供新方法。     

食管癌患者术前营养不足和营养风险发生率及临床营养支持现状调查

目的:调查可手术食管癌患者术前营养不足和营养风险发生率以及临床营养支持治疗的应用状况。方法:采用营养风险筛查2002(NRS2002)对住院手术治疗的202例食管癌患者进行营养风险调查,结合体质指数(body mass in-dex,BMI)判断营养风险和营养不足发生率;同时调查患者住院期间营养支持治疗的应用状况。结果:所有患者中,BMI<18.5kg/m2者54例,营养不足发生率为26.7%(54/202);NRS2002评分≥3分者116例,营养风险发生率为57.4%(116/202);年龄是否>65岁(χ2值分别为6.233、4.730)、术后分期(χ2值分别为7.214、7.191)、梗阻程度(χ2值分别为41.507、51.447)、文化程度(χ2值分别为5.158、10.260)是发生营养不良和营养风险的影响因素,P<0.05。城乡差异和工作性质只与营养不足发生率有关,χ2值分别为6.537、9.197,P值分别为0.011、0.010;而与营养风险发生率无关,χ2值分别为0.300、3.668,P值分别为0.584、0.160;营养不足和营养风险与食管癌发生的部位无关,χ2值分别为2.859、4.551,P值分别为0.239、0.103。经Logistic回归分析后发现,术后分期、梗阻程度和文化程度是营养不足和营养风险发生的影响因素。全部患者中,应用了营养支持治疗者137例(72.3%),其中采用肠内营养支持治疗(enteral nutrition,EN)者48例(35.0%),肠外营养支持治疗(parenteral nutrition,PN)者89例(65.0%),EN/PN为1/1.85;EN在术后28～72h,平均为术后56h;在NRS2002评分≥3分的116例患者中,给予营养支持治疗98例(84.5%),而在NRS2002评分<3分的86例患者中,也有39例(45.3%)给予了营养支持治疗。结论:食管癌手术患者营养不足和营养风险发生率较高,营养支持治疗在临床应用中还存在一定的不合理性。     

胸腹腔镜联合根治术治疗老年食管癌患者的疗效及安全性分析

目的:探讨胸腹腔镜联合根治术治疗老年食管癌患者的临床疗效。方法:选取本院收治的老年食管癌患者64例,按手术方式将其分为开放组（n=29）及胸腹腔镜组（n=35）,分别行开放式食管癌根治术及胸腹腔镜联合食管癌根治术治疗。统计并比较两组患者手术情况,检测并比较术前及术后1周两组患者细胞免疫功能变化,术后定期随访1年,比较两组患者生存情况、复发情况、并发症发生情况及生活质量,并分析两组患者并发症情况相关因素。结果:与开放组比较,胸腹腔镜组患者手术时间、术后拔管时间、住院时间均显著缩短（P＜0.01）,手术切口显著减小（P＜0.01）,术中失血量、术后胸腔引流量均显著降低（P＜0.01）。与术前比较,术后1周两组全血CD4+ T淋巴细胞比例、CD4+/CD8+均显著降低（P＜0.05或P＜0.01）,且胸腹腔镜组显著高于开放组（P＜0.01）;术后1周胸腹腔镜组CD8+ T淋巴细胞比例较术前及开放组均显著降低（P＜0.05）。与开放组比较,胸腹腔镜组患者术后吻合口瘘发生率及总并发症发生率均显著降低（P＜0.05或P＜0.01）。随访期间胸腹腔镜组患者SF-36评分显著升高（P＜0.01）,而复发率显著降低（P＜0.05）;两组1年生存率比较无显著性差异（P＞0.05）。结论:胸腹腔镜联合根治术可有效减轻老年食管癌患者手术创伤,保护机体免疫功能,还可降低患者术后并发症,改善其生活质量,安全性良好。     

淮安地区2010年-2014年食管癌早诊情况及相关危险因素分析

目的：探讨淮安地区食管癌检出率分布特征及影响食管癌发病风险的因素。方法：根据淮安市2010年-2014年食管癌检出资料,分析淮安两县区食管癌检出率以及年龄与食管癌检出率的关系。以此次体检中病理确诊为食管癌的929例患者为病例组,以疾控中心门诊中完全健康的45549名体检人群为对照组,调查两组对象的性别、年龄、饮水来源、抽烟饮酒、肉蛋奶、水果、蒜类、干菜果类、豆类、腌晒食品、油炸食品、米面食品等饮食情况、婚姻状况、精神压抑状态、药物史、胃肠炎、肝炎、家族肿瘤史、是否吞咽困难等。对影响食管癌发病的相关危险因素先行单因素分析,差异有统计学意义的再行多因素非条件 Logistic 回归分析。结果：检出食管癌929例,其中男性531例,女性398例,男女比例1.33：1（P <0.05）。其中食管癌平均检出率1.99%,2012年检出率最高为6.57%,2014年检出率最低为0.07%。食管癌中位检出年龄56岁,41~45岁检出率最低为0.97%,55~70岁之间食管癌检出率呈现上升趋势。两组饮水来源、是否患胃肠炎、是否有家族肿瘤史、近期是否出现吞咽困难及肉蛋奶、水果、蒜类、干菜果类、豆类、腌晒食品、油炸食品的食用频率比较,差异具有统计学意义。两组是否有精神抑郁状态、肝炎比较,差异无统计学意义。非条件Logistic 回归分析发现,患胃肠炎者检出食管癌的风险是不患胃肠炎者的1.46倍,有家族肿瘤史的检出食管癌的风险是无家族肿瘤史的2.31倍,吞咽困难阳性者检出食管癌的风险是吞咽困难阴性者的1.35倍,饮用深井水者检出食管癌的风险是不饮用深井水者的1.89倍,不太经常使用肉蛋奶者检出食管癌的风险是一直都使用肉蛋奶者的1.51倍。结论：饮食因素、生活习惯、社会因素等综合因素长期反复作用可导致食管癌。     

Diet diversity and the risk of squamous cell esophageal cancer

A varied diet may have a favorable role against digestive tract cancers. We analyzed the relationship between diet diversity (i.e. measured by the number of different foods consumed at least once per week) and the risk of esophageal cancer. We considered data from a case-control study conducted between 1992 and 1997 in northern Italy on 304 squamous cell esophageal cancer cases below age 78 years and 743 controls admitted to hospital for acute, nonneoplastic conditions, unrelated to tobacco or alcohol consumption. There was a significant inverse association for total diet diversity: the multivariate odds ratio (OR), adjusted for age, sex, area of residence, education, tobacco smoking, alcohol drinking and non-alcohol energy intake was 0.42 (95% confidence interval, CI: 0.25-0.71) for subjects in the highest versus those in the lowest quartile of diversity. Inverse relations were also found for diversity within vegetables (OR = 0.34, 95% CI: 0.21-0.55) and fruits (OR = 0.51, 95% CI: 0.33-0.80). No significant association was found for meat and cereal diversity. These results add epidemiological support to the dietary guidelines recommending a more varied diet, particularly in fruit and vegetables, for esophageal cancer prevention.