江苏省经济发达与发展中地区胃癌危险因素对比研究

[目的]探索江苏省经济发达地区与经济发展中地区胃癌危险因素。[方法]分别选择常熟市（GDP64931RMB／人）和泰兴市（GDP13512RMB／人）常住户口且确诊为胃癌的男性病人202例和200例，对照选取与病例同性别、年龄±2岁，与病例居住在同地的非肿瘤居民，按1：1配对进行病例对照研究。[结果]多网素分析发现，吃饭速度快、吃新鲜蔬菜少、胃溃疡和萎缩性胃炎是泰兴市和常熟市胃癌的共同危险因素；而三餐不按时、吃咸鱼咸肉多是常熟市胃癌危险蹦素；十年前家庭人均收入低、人际关系不好、吃油炸食品多、口味咸、性格内向是泰兴市胃癌危险冈素。[结论]在全省对上述普遍存在的高危因素进行广泛地卫生宜教，以减少胃癌危害性。     

A Case Control Study on Risk Factors for Stomach Cancer in Urban Shanghai

Objective To examine the possible risk factors for stomach cancer among men and women in Shanghai, China. Methods In urban Shanghai, in-person interviews were completed for 311 cases newly diagnosed with stomach cancer of ages 30 -74. Data were collected from April 1999 to October 1999 and compared to 1579 population-based controls (controls in three cancer studies used together). Information on demographic variables, smoking, diet consumption and others was collected from all subjects. Unconditional logistic regression was used to adjust the possible factors. Results Stomach cancer risk in men rose with smoking, eating hot and fried foods, chronic gastritis and a family history of gastric cancer among men; the risk among women was associated with the consumption of preserved, pickled and fried foods, heavy drinking, chronic gastritis, a history of ulcer disease and a family history of gastric cancer. A dose-response relationship was found (trends test,P<0.01) among men smokers. In contrast, the consumption of fresh vegetables and fruits, beans (especially soybeans) and soy products, plant oil, and eggs and egg products, was inversely associated with stomach cancer risk. After adjustment of the potential confounding variables, these associations remained significant. Conclusions The present findings provide further evidence that smoking, eating salted foods (especially salted vegetables), oil-fried foods(including fried cereal, eggs, and peanuts), chronic gastritis, a family history of gastric cancer and so on increase the risk of stomach carcinoma in Shanghai. Fresh vegetables and fruits, beans and soybean products (even after adjusted for use of fresh vegetables and fruits), plant oil, and so on may have protective effects.     

Consumption of salted meat and its interactions with alcohol drinking and tobacco smoking on esophageal squamous‐cell carcinoma

Etiology of esophageal cancer has not yet been clearly documented, especially in high‐risk regions. To evaluate the association between salted meat intake and esophageal squamous‐cell carcinoma (ESCC) and to explore its joint effects with alcohol drinking and smoking, a population‐based case–control study was conducted in a high ESCC risk area in China, including 942 incident ESCC cases and 942 age‐ and sex‐matching controls. A validated food frequency questionnaire was used to collect information on dietary factors, alcohol drinking and tobacco smoking. Conditional logistic regressions were applied to estimate the association between salted meat intake and ESCC and its interactions with alcohol drinking and smoking, with adjustment for other confounders, including total energy intake. Salted meat intake was associated with an increased risk of ESCC, showing an exposure–response relationship (p for trend <0.001). Consumption of 50 g salted meat per week was related to an increased risk by 18% (odds ratio = 1.18, 95% confidence interval: 1.13–1.23). Salted meat in combination with either alcohol drinking or smoking had a greater risk than salted meat alone, which was more than additive. The strongest association was seen in the combination of all the three factors, particularly at the highest level of salted meat intake (odds ratio = 29.27, 95% confidence interval: 13.21–64.89). Salted meat intake is strongly associated with ESCC and its interactions with alcohol drinking and/or smoking highlights the significance of reducing salted meat intake among smokers and drinkers with respect to ESCC prevention.     

Protective effect of green tea on the risks of chronic gastritis and stomach cancer

Despite the declining trend, stomach cancer remains the second most common cancer worldwide. We examined the role of green tea consumption on chronic gastritis and stomach cancer risks. A population-based case-control study was conducted in Yangzhong, China, with 133 stomach cancer cases, 166 chronic gastritis cases, and 433 healthy controls. Epidemiologic data were collected by standard questionnaire and odds ratios (OR) and 95% confidence intervals (CI) were estimated using logistic regression models in SAS. Inverse association was observed between green tea drinking and chronic gastritis and stomach cancer risks. After adjusting for age, gender, education, body mass index, pack-years of smoking and alcohol drinking, ORs of green tea drinking were 0.52 (95% CI: 0.29-0.94) and 0.49 (95% CI: 0.31-0.77) for stomach cancer and chronic gastritis, respectively. In addition, dose-response relationships were observed with years of green tea drinking in both diseases. The results provide further support on the protective effect of green tea against stomach cancer. This is the first time that green tea drinking was found to be protective against chronic gastritis, which may be of importance when designing intervention strategies for stomach cancer and its pre-malignant lesions in the high-risk population.     

A comparative case-control analysis of stomach cancer and atrophic gastritis

We conducted a comparative case-control analysis of stomach cancer and atrophic gastritis involving 427 cases with stomach cancer, 1414 cases with atrophic gastritis, and 3014 control subjects based on a questionnaire survey conducted for the subjects who received gastroscopic examination at Aichi Cancer Center Hospital from April 1985 to March 1989. The risk of atrophic gastritis in both males and females was not associated with any environmental factors. The risk of stomach cancer compared with the control subjects was positively associated with an intake of salted fish guts or cod roe [relative risk (RR) = 1.52, 95% confidence interval (CI) = 1.08-2.15] and smoking (RR for 20 or more cigarettes per day = 2.84; 95% CI = 1.79-4.51) and inversely associated with Western-style breakfast (RR = 0.68; 95% CI = 0.48-0.96) in males. Additionally, the risk of stomach cancer was inversely associated with a daily intake of raw vegetables (RR = 0.56; 95% CI = 0.34-0.94) in males when compared with the patients with atrophic gastritis as controls. Several environmental factors, such as intake of green-yellow vegetables, fruit, and meat, and a family history of stomach cancer, were only associated with intestinal types of cancer in females, whereas a clear difference between diffuse and intestinal types was not observed in males. The results of the present study suggest that risk factors for stomach cancer may be different from those for premalignant lesions.     

A Prospective Study of Atrophic Gastritis and Stomach Cancer Risk

The relation of atrophic gastritis, other gastric lesions and lifestyle factors to stomach cancer risk was prospectively studied among 3,914 subjects who underwent gastroscopic examination and responded to a questionnaire survey at the Aichi Cancer Center Hospital. During 4.4 years of follow-up on average, 45 incident cases of stomach cancer were identified at least three months after the initial examination. If the baseline endoscopic findings indicated the presence of atrophic gastritis, the risk of developing stomach cancer was increased 5.73-fold, compared with no indication at the baseline. The risk further increased with advancing degree of atrophy and increasing extension of atrophy on the lesser curvature. These trends in the relative risks were statistically significant ( P = 0.027 and P = 0.041, respectively). The risk of developing stomach cancer was statistically significantly increased among subjects with gastric polyps, but not among those with gastric ulcer. Stomach cancer cases tended to consume more cigarettes, alcohol, rice, pickles and salted fish gut/cod roe and less fruits and vegetables and to have more family histories of stomach cancer than noncases, although these differences were not statistically significant. The results of the present study provide additional evidence on the relation between atrophic gastritis and stomach cancer and suggest a need for intensive follow-up of patients with atrophic gastritis and gastric polyps.     

A prospective study of atrophic gastritis and stomach cancer risk.

The relation of atrophic gastritis, other gastric lesions and lifestyle factors to stomach cancer risk was prospectively studied among 3,914 subjects who underwent gastroscopic examination and responded to a questionnaire survey at the Aichi Cancer Center Hospital. During 4.4 years of follow-up on average, 45 incident cases of stomach cancer were identified at least three months after the initial examination. If the baseline endoscopic findings indicated the presence of atrophic gastritis, the risk of developing stomach cancer was increased 5.73-fold, compared with no indication at the baseline. The risk further increased with advancing degree of atrophy and increasing extension of atrophy on the lesser curvature. These trends in the relative risks were statistically significant (P = 0.027 and P = 0.041, respectively). The risk of developing stomach cancer was statistically significantly increased among subjects with gastric polyps, but not among those with gastric ulcer. Stomach cancer cases tended to consume more cigarettes, alcohol, rice, pickles and salted fish gut/cod roe and less fruits and vegetables and to have more family histories of stomach cancer than noncases, although these differences were not statistically significant. The results of the present study provide additional evidence on the relation between atrophic gastritis and stomach cancer and suggest a need for intensive follow-up of patients with atrophic gastritis and gastric polyps.     

上海市居民饮食与胃癌关系的病例对照研究

目的：探讨上海市居民饮食与胃癌发生的关系。方法：采用全人群病例对照研究，调查1999年4月－10月间诊断的上海市区新发胃癌病例311例（男性198例，女性113例），对照1579例（为“九五”课题中乳腺癌，肺癌及胃癌病例－对照研究之一，对照共用）。采用非条件logistic回归分析，调整可能的混杂因素，包括年龄，文化程度，吸烟（仅男性）慢性胃炎及一级亲属胃癌家族史等，分析饮食口味，热烫饮食，新鲜蔬菜和水果，豆及豆制品，蛋及蛋制品，家禽类，腌制食品，油炸食品，植物油等饮食因素，以估计胃癌发生的比数比和95％可信区间。结果：研究发现新鲜蔬菜（最高摄入量OR＝0．6），水果（OR＝0．6），新鲜豆类OR＝0．4），豆制品（OR＝0．4）和植物油（OR＝0．6）是男性胃癌的保护因素，而油面食（OR＝1．6）增加男性胃癌的危险性，新鲜蔬菜9OR＝0．3），水果（OR＝0．4），新鲜豆类（OR＝0．4，干豆类（OR＝0．5）和蛋及蛋制品（OR＝0．5）对妇性胃癌具有保护作用，而腌制食品（OR＝2．2）和油食品（包括油鱼／肉、油炸面食，油煎蛋和油煎花生米，OR＝2．6是女性胃癌主要的危险因素，重盐饮食和热烫饮食及早餐不规律增加胃癌发生的危险，未发现主食，新鲜肉类（包括鱼，家禽类，红肉类）等与胃癌妇生有联系，结论：高盐饮食，热烫饮食，腌制食品和油炸食品是上海市胃癌的重要危险因素，而新鲜蔬菜，水果，豆及豆制品和植物油等可降低胃癌的危险性。     

Dietary habits and gastro-intestinal cancers: a comparative case-control study of stomach and large intestinal cancers in Nagoya, Japan

A simultaneous case-control study on stomach cancer and colo-rectal cancer involving 93 cases with stomach cancer, 93 cases with colo-rectal cancer and 186 controls was conducted using a common questionnaire at the Aichi Cancer Center Hospital in 1981-83. A fondness for salty tastes, especially salted foods such as pickled hakusai (vegetable) and dried & salted fishes, which are typical traditional Japanese foods showed a significantly positive association with stomach cancer (relative risk(RR) = 2.60, P less than 0.01). On the other hand, the habit of eating a western-style breakfast, particularly for 10 years or more made a significant contribution to the risk of colon cancer (RR = 2.24, P less than 0.05) but conversely decreased the risk of stomach cancer (RR = 0.50, not significant (NS)) and rectal cancer (RR = 0.40, NS). In this study, relatively frequent intakes (4 times/week) of some vegetables, i.e. pumpkin, green pepper, onion and cabbage, showed high relative risks for both stomach and colon cancers, contrary to the findings of previous epidemiological studies. Cigarette smoking increased the risk of stomach cancer (RR = 1.99, NS) but decreased that of colon cancer (RR = 0.61, NS). There was no positive relation between drinking and cancer at any site. Some other factors with opposite effects on the two contrasting cancers and some independent factors were identified in this comparative case-control study.