Airborne occupational exposures and risk of oesophageal and cardia adenocarcinoma

Background

The reasons for the increasing incidence of and strong male predominance in patients with oesophageal and cardia adenocarcinoma remain unclear. The authors hypothesised that airborne occupational exposures in male dominated industries might contribute.

Methods

In a nationwide Swedish population based case control study, 189 and 262 cases of oesophageal and cardia adenocarcinoma respectively, 167 cases of oesophageal squamous cell carcinoma, and 820 frequency matched controls underwent personal interviews. Based on each study participant''s lifetime occupational history the authors assessed cumulative airborne occupational exposure for 10 agents, analysed individually and combined, by a deterministic additive model including probability, frequency, and intensity. Furthermore, occupations and industries of longest duration were analysed. Relative risks were estimated by odds ratios (OR), with 95% confidence intervals (CI), using conditional logistic regression, adjusted for potential confounders.

Results

Tendencies of positive associations were found between high exposure to pesticides and risk of oesophageal (OR 2.3 (95% CI 0.9 to 5.7)) and cardia adenocarcinoma (OR 2.1 (95% CI 1.0 to 4.6)). Among workers highly exposed to particular agents, a tendency of an increased risk of oesophageal squamous cell carcinoma was found. There was a twofold increased risk of oesophageal squamous cell carcinoma among concrete and construction workers (OR 2.2 (95% CI 1.1 to 4.2)) and a nearly fourfold increased risk of cardia adenocarcinoma among workers within the motor vehicle industry (OR 3.9 (95% CI 1.5 to 10.4)). An increased risk of oesophageal squamous cell carcinoma (OR 3.9 (95% CI 1.2 to 12.5)), and a tendency of an increased risk of cardia adenocarcinoma (OR 2.8 (95% CI 0.9 to 8.5)), were identified among hotel and restaurant workers.

Conclusions

Specific airborne occupational exposures do not seem to be of major importance in the aetiology of oesophageal or cardia adenocarcinoma and are unlikely to contribute to the increasing incidence or the male predominance.     

Occupation and small bowel adenocarcinoma: a European case-control study

OBJECTIVES—Because of the rarity of small bowel adenocarcinoma (SBA), little is known about the aetiology of this disease. This study aimed to identify occupational clustering of cases SBA as a systematic approach to new hypotheses on the aetiology of this disease.
METHODS—A European multicentre case-control study was conducted in 1995-7, inclusive. Incident cases aged 35-69 years with SBA (n=168) were recruited before acceptance by a pathologist. Altogether 107 cases and 3915 controls were accepted, of which 79 cases, 579 colon cancer controls, and 2070 population controls were interviewed.
RESULTS—The strongest industrial risk factors for SBA taking account of 10 years' exposure lag were dry cleaning, manufacture of workwear, mixed farming (women), and manufacture of motor vehicles (men). A significantly increased risk of SBA (odds ratio (OR) and 95% confidence interval (95% CI)) was found among men employed as building caretakers, OR 6.7 (1.7 to 26.0) and women employed as housekeepers, OR 2.2 (1.1 to 4.9); general farm labourers, OR 4.7 (1.8 to 12.2); dockers, OR 2.9 (1.0 to 8.2); dry cleaners or launderers, OR 4.1 (1.2 to 13.6); and textile workers (sewers or embroiders), OR 2.6 (1.0 to 6.8). For the last four groups, together with welders OR 2.7 (1.1 to 6.6) (men) an exposure-response pattern was found when calculating the ORs for jobs held 1-5 years and >5 years, with never having held the job as reference. The ORs (95% CIs) for 1-5 years and >5 years were 4.3 (0.4 to 44.0) and 3.5 (0.9 to 13.7), 3.0 (0.3 to 26.2) and 4.3 (0.9 to 21.2), 4.6 (0.4 to 48.1) and 11.0 (2.0 to 60.4), 1.3 (0.2 to 11.0) and 5.8 (2.0 to 17.2), and 2.8 (0.3 to 23.8) and 4.6 (1.3 to 16.6), respectively, for each of these occupations. Among welders, people performing semiautomatic arc welding (MIG/MAG) were identified as a high risk group (OR 5.0 (1.3 to 19.6)).
CONCLUSIONS—This explorative study suggests an increased occurrence of SBA in certain occupations, which needs further evaluation.


Keywords: small intestine; adenocarcinoma; occupational risk factors     

Diet and lifestyle factors and risk of subtypes of esophageal and gastric cancers: classification tree analysis

PurposeAlthough risk factors for squamous cell carcinoma of the esophagus and adenocarcinomas of the esophagus (EA), gastric cardia (GC), and other (noncardia) gastric (OG) sites have been identified, little is known about interactions among risk factors. We sought to examine interactions of diet, other lifestyle, and medical factors with risks of subtypes of esophageal and gastric cancers.MethodsWe used classification tree analysis to analyze data from a population-based case-control study (1095 cases, 687 controls) conducted in Connecticut, New Jersey, and western Washington State.ResultsFrequency of reported gastroesophageal reflux disease symptoms was the most important risk stratification factor for EA, GC, and OG, with dietary factors (EA, OG), smoking (EA, GC), wine intake (GC, OG), age (OG), and income (OG) appearing to modify the risk of these cancer sites. For esophageal squamous cell carcinoma, smoking was the most important risk stratification factor, with gastroesophageal reflux disease, income, race, noncitrus fruit, and energy intakes further modifying risk.ConclusionVarious combinations of risk factors appear to interact to affect risk of each cancer subtype. Replication of these data mining analyses are required before suggesting causal pathways; however, the classification tree results are useful in partitioning risk and mapping multilevel interactions among risk variables.     

体外预测泌尿系结石理化性质的研究进展

目的 探讨贲门癌手术径路的合理选择。方法 对施行根治性手术的120例贲门癌患者，测量其食管浸润长度，分析手术径路选择的合理性。结果 83例患者食管浸润长度≤2cm，其中Ⅰ型（癌灶中心位于胃食管接合部的接合线以上）25例，经腹入路1例，经胸腹入路2例，经胸入路22例；Ⅱ型（癌灶中心位于接合线及以下）58例，经腹入路50例，经胸腹入路8例。37例患者食管浸润长度〉2cm，其中Ⅰ型9例均经胸腹入路；Ⅱ型28例，经腹入路3例，经胸腹入路25例。所有患者上切缘均无癌残留。结论 当贲门癌食管浸润长度≤2cm时，Ⅰ型选择经胸及经胸腹入路，Ⅱ型以经腹入路手术为主；当食管浸润长度〉2cm时，Ⅰ型和Ⅱ型以经胸腹入路手术为主。依据贲门癌食管浸润长度，合理选择手术径路，可避免切缘癌残留，达到根治目的。     

食管、贲门癌切除术后胸胃排空障碍的诊治体会

目的 探讨食管、贲门癌切除术后胸胃排空障碍的病因、诊断和防治措施.方法 回顾性分析1993年1月至2009年12月19例食管、贲门癌切除术后胸胃排空障碍患者的临床资料.结果 3例确诊为机械性胸胃排空障碍,及时行开腹手术解除梗阻后痊愈出院.16例为功能性胸胃排空障碍,经保守治疗,于发病后7～19d胸胃功能恢复,进食顺利,痊愈出院.结论 食管、贲门癌术后胸胃排空障碍根据临床表现、上消化道造影及胃镜检查即可确诊,其中大多数为功能性胸胃排空障碍,经保守治疗即能痊愈,少数为机械性胸胃排空障碍需及时手术处理.改善术前营养状况、严格手术操作规范、术后有效的胃肠减压及加强饮食管理是预防胸胃排空障碍发生的重要措施.     

贲门癌病人行空肠间置术后早期肠内营养的价值

目的:观察早期肠内营养(EN)对贲门癌病人行空肠间置术的治疗作用。方法:将62例病人分为早期EN组与PN组,对两组病人的术后临床指标和营养指标进行比较。结果:无论是病人主诉和术后并发症的发生率等临床观察指标,还是营养指标,EN组均优于PN组。结论:贲门癌病人行空肠间置术后行早期肠内营养,能促进病人胃肠功能恢复,改善病人营养状况,降低术后并发症的发生率。     

快速康复外科方式在中、下段食管癌和贲门癌手术中的应用

目的研究快速康复外科（FTS）在中、下段食管癌和贲门癌手术中的应用及其意义。方法2007年3月至2009年2月，共手术治疗中、下段食管癌和贲门癌患者226例，其中男168例，女58例；平均年龄593岁。所有患者术后均采用FTS方式治疗。结果手术后共57例患者不能耐受FTS治疗，其中术前有并发疾病患者35例。结论大部分中、下段食管癌、贲门癌患者可以耐受FTS模式，尤其适用于年龄小于65岁，术前无严重并发疾病患者。FTS模式必将成为胸外科的发展趋势之一。     

Reflux-inducing dietary factors and risk of adenocarcinoma of the esophagus and gastric cardia

Gastroesophageal reflux (GER) is the strongest known risk factor for esophageal adenocarcinoma. For long-term sufferers with severe symptoms, the excess risk may exceed 40-fold. GER has also been shown to increase the risk of cancers of the gastric cardia more than fourfold. Several foods, including dietary fat, chocolate, mints, coffee, onions, citrus fruit, and tomatoes, have been associated with temporary symptoms of reflux, most likely through a relaxation of the lower esophageal sphincter (LES). Our aim was to determine whether these foods are associated with risk of adenocarcinoma of the esophagus or gastric cardia. We studied intakes of LES-relaxing foods and other dietary habits potentially associated with reflux in a nationwide population-based case-control study in Sweden, with 185 and 258 cases of esophageal adenocarcinoma and gastric cardia adenocarcinoma, respectively, and 815 controls. We found no association between LES-relaxing foods and symptoms of chronic reflux, although this might be due to avoidance of these foods among sufferers. In addition, we found no association between dietary factors known to cause LES relaxation and the risk of adenocarcinoma of the esophagus or gastric cardia. Our findings indicate that dietary factors associated with LES relaxation and transient GER (but perhaps not severe chronic reflux) are not associated with any important risk of esophageal malignancy.     

XPG基因多态性与贲门癌遗传易感性关系

目的 探讨着色性干皮病基因组G（XPG）rs751402 C/T与rs873601 G/A单核苷酸多态性（SNP）与河北省磁县高发区人群贲门腺癌（GCA）遗传易感性之间的关系。方法 采用聚合酶链反应-连接酶检测反应（PCR-LDR）方法对431例GCA患者和432名健康对照XPG基因rs751402 C/T和rs873601 G/A SNP进行基因分型。结果 XPG基因rs751402 C/T SNP T/T基因型增加了≤61岁年龄组个体GCA的发病风险（OR=1.77,95%CI=1.12～3.30）。XPG基因rs873601 G/A SNP与GCA的发病风险无关。结论 携带XPG基因rs751402 C/T SNP T/T基因型个体GCA的发病风险明显增加,应定期接受上消化道内镜检查,以便实现GCA的早诊早治。     

Occupation and the occurrence of testicular cancer.

To investigate what role a man's occupation may have on his risk of testicular cancer, we conducted a case-control study among noncryptorchid white males who were between 20 and 69 years of age and resided in western Washington State. Cases were men in whom a germ cell tumor of the testis was diagnosed between 1977 and 1984 (n = 323). Their occupational histories were compared to those of controls of the same age, race, and geographic area who were selected through random-digit dialing (n = 658). Administrators/managers (relative risk (RR) = 1.5), salesmen (RR = 1.5), electricians (RR = 2.8), and sailors and fishermen (RR = 3.1) were among the jobs reported more commonly by cases than controls. The risk among farmers/farm managers was also elevated (RR = 1.9), but not that among farm workers (RR = 0.6). No consistent association between any one occupation and testicular cancer has been observed across studies of this topic. The most frequent observation has been an over-representation among cases of certain types of white collar worker; this may reflect the influence of some other aspect of socioeconomic status and not occupational exposures per se.     

机械吻合在食管和贲门癌手术中的临床研究

目的探讨机械吻合在食管和贲门癌手术中的临床疗效。方法将食管癌和贲门癌162例患者随机分为机械吻合(A)组,手工吻合(B)组。A组患者术中应用常州GW-1型圆型吻合器吻合,B组常规手术吻合。比较两组手术时间、吻合口瘘发生率及吻合口狭窄率。结果A组平均手术时间90.5min,无吻合口瘘发生,吻合口狭窄率为1.25%,与对照组比较差异有统计学意义(P<0.05)。结论机械吻合在食管和贲门癌手术中安全可靠、疗效确切,可缩短手术时间,减少术后吻合口瘘及吻合口狭窄率。     

Occupation and pancreatic cancer risk in Louisiana

To study the relation of occupational exposures and pancreatic cancer, we evaluated data from males (198 cases and 209 controls) participating in a hospital-based case-control study conducted in a high-risk area of Louisiana between 1979 and 1983. The questionnaire obtained information on lifetime occupational history, as well as dietary, smoking, and drinking habits and demographic characteristics. After adjustment for smoking and dietary patterns, white collar occupations showed consistent elevations in risk, whereas associations for other occupations were in general unremarkable. Although not significantly elevated, risks for truck drivers (OR = 1.7) and those with long-term employment in machine repair or as mechanics were suggestive (OR = 2.5). No association was found for jobs in oil refining or oil and gas extraction (ORs were 0.5 and 0.4, respectively), although risks were slightly elevated for long-term workers in the chemical processing industry (OR = 1.2). While these associations deserve further study, our findings are consistent with results of other studies which do not suggest that occupational exposures are important determinants of pancreatic cancer.     

内镜联合特利加压素或生长抑素治疗食管胃静脉曲张出血的效果观察

目的　观察内镜联合特利加压素或生长抑素治疗食管胃静脉曲张出血（esophageal gastric varices bleeding, EGVB）的效果。方法　回顾性分析我院2015 年1月—2018 年5月因肝硬化EGVB并给予急诊内镜下硬化治疗或组织粘合剂栓塞治疗的患者128 例,分别给予特利加压素和生长抑素治疗,据此分为特利加压素治疗组（n=80）和生长抑素治疗组（n=48）。在急诊胃镜治疗后24 h行第2次内镜复查,观察2组的24 h止血率、6周病死率、粪便转黄时间、粪便潜血转阴时间以及并发症的发生情况。结果　2组患者在24 h止血率、粪便转黄时间、粪便潜血转阴时间等方面比较,特利加压素组均优于生长抑素组,差异均有统计学意义（P均＜0.05）;而2组患者在6周病死率、并发症的发生等方面相比,差异均无统计学意义（P均＞0.05）。结论　血管活性药物联合内镜治疗是EGVB有效的止血措施,止血24 h复查内镜可以准确判断EGVB控制与否,并可及时给予再次内镜治疗。特利加压素联合内镜治疗可以更快控制急性EGVB,有利于更早进行EGVB二级预防治疗。     

卡维地洛联合托伐普坦片治疗肝硬化合并食管胃底静脉曲张效果观察

目的 探讨卡维地洛联合托伐普坦片治疗肝硬化合并食管胃底静脉曲张患者临床疗效。方法 选取2018年1月—2020年7月本院收治的肝硬化合并食管胃底静脉曲张患者86例,根据随机数表法分为联合组和托伐普坦组各43例,托伐普坦组给予托伐普坦治疗,联合组患者在此基础上给予卡维地洛进行联合治疗,两组均以三个月为一疗程。比较两组患者平均动脉压和心率水平,并比较治疗前后两组患者肝肾功能和肝静脉压力梯度(Hepatic Venous Pressure Gradient,HVPG)水平,观察两组患者治疗过程中不良反应发生情况。结果 治疗前,两组患者平均动脉压和心率水平差异均无统计学意义(P>0.05);治疗后联合组平均动脉压和心率分别为(85.69±15.58)mm Hg、(76.52±8.06)次/分,低于对照组的(97.51±17.52)mm Hg 、(85.73±9.11)次/分,差异有统计学意义(t=3.306、4.965,P值均<0.05)。治疗后联合组患者HVPG为(10.41±1.74)mm Hg,低于托伐普坦组的(12.73±1.98)mm Hg,(t=5.772,P<0.001)。联合组不良反应发生率为30.23%,托伐普坦组为34.88%,两组比较差异无统计学意义(χ2=0.212,P=0.645)。结论 卡维地洛联合托伐普坦片治疗肝硬化合并食管胃底静脉曲张患者临床疗效显著,可显著缓解患者门静脉高压,且无不良反应增加,值得临床进一步推广应用。     

全胃切除空肠P袢代胃术治疗胃底贲门癌的临床效果分析

目的为提高临床治疗效果,探索全胃切除空肠P袢代胃术治疗胃底贲门癌的临床效果。方法选择2008年1月～2009年12月某院就诊的40例胃底贲门癌患者,单盲抽样把其中27例分为实验组,采取空肠P袢代胃吻合术式治疗;余者分为对照组,采取标准Roux-en-Y吻合术式治疗。结果实验组和对照组术中情况对照显示,手术时间和术中出血量差异无统计学意义(P﹥0.05)。实验组患者术后3个月排空时间、每次饮食量分别为(60±22)min、(300±42)ml,显著高于对照组(P﹤0.05),而每天饮食次数为(4.3±1.2)次,显著低于对照组(P﹤0.05)。实验组患者术后并发症发生率为18.5%,显著低于对照组(P﹤0.05)。结论如全胃切除术后消化采用空肠P袢代胃术重建消化道,能有效提高患者术后生活质量,降低并发症发生率,但并未使手术过程复杂化。     

食管胃底静脉曲张内镜硬化剂治疗并发败血症危险因素分析

目的 比较食管胃底静脉曲张活动性出血和无活动性出血患者接受内镜硬化剂治疗后发生脓毒血症的差异,并分析危险因素,为临床治疗提供参考.方法 同顾性分析2005-2009年浙江中医药大学附属第六医院245例接受内镜检查或治疗的肝硬化患者的临床资料,并将患者分为3组:组Ⅰ患者有活动性出血接受内镜硬化剂治疗止血,共87例;组Ⅱ患者接受内镜硬化剂治疗预防出血,共74例;组Ⅲ患者为接受常规内镜检查明确有无静脉曲张或有曲张静脉而不需要硬化剂治疗共84例.在内镜治疗前、后行血病原菌培养.结果 组Ⅰ患者内镜检查治疗前17例(19.5%)血液病原菌培养阳性,硬化剂治疗后5例(5.7%)血病原菌培养阳性.病原菌分别为大肠埃希菌10株,肺炎克雷伯菌5株,棒状杆菌2株.组Ⅱ血液病原菌培养阳性0例,组Ⅲ1例,病原菌为表皮葡萄球菌.所有患者均无临床感染证据.结论 食管胃底静脉曲张无出血患者接受内镜检查治疗不会增加血液感染的危险.对此类患者没有必要预防性应用抗菌药物.相反,对于食管胃底静脉曲张出血接受内镜硬化剂治疗的患者则需要常规接受抗菌药物预防感染.     

胃镜直视下气囊扩张治疗贲门失驰缓症

目的:探讨胃镜直视下气囊扩张治疗贲门失驰缓症的方法和疗效.方法:采用内镜直视下气囊扩张术.结果:10例贲门失驰缓症患者吞咽困难完全消失7例、改善3例,2例患者一个月后复发,再次接受气囊扩张,症状明显改善,无大出血和穿孔等严重并发症.结论:胃镜直视下气囊扩张治疗贲门扩张失驰缓症是安全有效的方法.     

Dietary patterns and risk of squamous-cell carcinoma and adenocarcinoma of the esophagus and adenocarcinoma of the gastric cardia: a population-based case-control study in Sweden

We conducted a large population-based case-control study in Sweden to examine the association of dietary patterns and the development of cancers from the esophagus or gastroesophageal junction. In total 185 patients with esophageal adenocarcinoma, 165 with esophageal squamous-cell carcinoma, 258 with gastric cardia adenocarcinoma, and 815 randomly selected population controls underwent face-to-face interviews. Exploratory factor analysis was used to identify possible dietary patterns. Multivariate logistic regression with adjustments for age, sex, years of education, body mass index, physical activity, symptomatic gastroesophageal reflux, smoking, and total energy intake was used to estimate odds ratios (ORs) and their 95% confidence intervals (CIs). We identified three major dietary patterns in this population, for example, "healthy diet" (high in vegetables, tomato, fruits, fish, and poultry), "Western diet" (high in processed meat, red meat, sweets, high-fat dairy, and high-fat gravy), and "alcohol drinker" (high in intakes of beer, liquor, and French fries). We found that a healthy diet tended to moderately decrease the risk of all three cancers under study, although none of the associations was statistically significant. A high score of Western diet was associated with increased risks of gastric cardia adenocarcinoma (high 3rd tertile vs. low 1st quartile, OR = 1.8, 95% CI = 1.1-2.9, P for trend = 0.04) and esophageal adenocarcinoma (high 3rd tertile vs. low 1st tertile, OR = 1.6, 95% CI = 0.9-3.1, P for trend = 0.13), whereas a dietary pattern characterized by high beer and liquor intake (alcohol drinker) significantly increased the risk of squamous-cell carcinoma of the esophagus (3rd tertile vs. low 1st tertile, OR = 3.5, 95% CI = 1.9-6.3, P for trend < 0.0001). Our study confirms the important role of diet in the carcinogenesis of esophageal and cardia cancer.     

单纯胃囊压迫治疗食道-胃底静脉曲张破裂大出血临床观察

目的：探讨单纯胃囊压迫治疗食道-胃底静脉曲张破裂大出血的临床疗效与副作用。方法：将47例食管-胃底静脉曲张破裂出血病人随机分为观察组（24例）和对照组（23例）。观察纽在常规药物治疗基础上加用单纯胃囊压迫止血,对照组在常规药物治疗基础上用传统三腔二囊管压迫法止血,在治疗前及治疗后48小时观察两组止血效果与不良反应及并发症情况。结果：两组临床疗效基本相近,统计学无明显差异（P＞0．05）。而并发症中食管炎与活动限制、胸内后疼痛观察组明显减少（P＜0.01）。结论：单纯胃囊压迫止血与传统三腔二囊管压迫止血同样有效,而副作用与并发症明显减少。