生活、膳食习惯与食管鳞癌发病部位的关联性

目的阐明生活及膳食习惯对食管3种不同部位鳞状细胞癌(SCC)产生的影响。方法采用以医院为基础的病例-对照研究,共纳入福州市和漳州市各1所医院2010年1月至2016年12月入院的550例病例及按病例组同性别、年龄(±3岁)频数匹配的同期对照550例。使用二类非条件Logisitic回归分析暴露因素与肿瘤的关联性,多类Logistic回归模型研究暴露因素与各部位肿瘤的关联的特异性,使用多重对应分析方法呈现不同部位食管鳞癌的危险因素。结果与对照人群相比,饮茶降低上段与下段肿瘤的风险(颈/上段OR=0. 40,95%CI 0. 22~0. 73;下段OR=0. 50,95%CI 0. 31~0. 81);新鲜蔬菜摄入过少与上段和下段肿瘤的风险增加有关(颈/上段OR=3. 93,95%CI 1. 61~9. 61;下段OR=2. 68,95%CI 1. 30~5. 53);而烫食摄入、硬食摄入、新鲜水果摄入过少则是3个部位肿瘤的共同危险因素(P<0. 05)。以下段肿瘤为参照,饮酒与中段肿瘤的关联强度低于下段(OR=0. 58,95%CI 0. 35~0. 98),与此类似的还有喜烫食(OR=0. 45,95%CI 0. 27~0. 76)、蔬菜摄入过少(OR=0. 44,95%CI 0. 20~0. 99),而新鲜水果摄入过少与中段肿瘤的关联强于下段(OR=1. 66,95%CI 1. 08~2. 55);以中段肿瘤为参照,发现新鲜水果摄入过少与上段肿瘤的关联强度高于中段。多重对应分析结果提示3个部位食管肿瘤的危险因素可能存在特异性。结论不同部位食管鳞癌发病的危险因素存在差异,而烫食摄入、硬食摄入、新鲜水果摄入过少则是3个部位肿瘤的共同危险因素。

Relationship between lifestyle and dietary habits and the occurrence of squamous cell carcinoma in different subsites of the esophagus

OBJECTIVE To elucidate the association between lifestyle and dietary factors and esophageal squamous cell carcinoma( ESCC) in three different sections of the esophagus. METHODS From January 2010 to December 2016,a hospital-based case-control study was conducted,and a total of 550 patients with ESCC and gender and age(±3 age) frequency-matched 550 cancer-free control subjects were recruited in this study. Odds ratios( ORs) and their corresponding 95% confidence intervals( CIs) were calculated by using unconditional binary or multinomial logistic regression. Multiple correspondence analysis( MCA) was applied to illustrate the influence of the risk factors on different sections of the esophagus. RESULTS Tea drinking was associated with lower risk of upper( Ut) and lower thoracic( Lt) ESCC( OR = 0. 40,95% CI 0. 22-0. 73;OR= 0. 50,95% CI 0. 31-0. 81;for Ut and Lt, respectively), and lower intake of vegetables increased the risk of Ut and Lt ESCC( OR = 3. 93,95% CI 1. 61-9. 61;OR =2. 68,95% CI 1. 30-5. 53;for Ut and Lt,respectively). Intake of hot food,hard food and lower intake of fruits were associated with an elevated risk of the ESCC in all subsites( P<0. 05). The strength of association between drinking and ESCC was lower in middle thoracic( Mt) compared with the Lt ESCC( OR = 0. 58,95% CI 0. 35-0. 98). Moreover,this reduction of association strength were also found in eating hot food( OR = 0. 45,95%CI 0. 27-0. 76) and lower intake of vegetables( Ut OR = 0. 44,95% CI 0. 20-0. 99).However,the association between lower intake of fruits and the Mt ESCC risk was stronger compared with Lt ESCC( OR = 1. 66,95% CI 1. 08-2. 55). In additional,the association between lower intake of fruits and the Ut ESCC risk was stronger compared with Mt ESCC.Joint category plot of MCA also identified the heterogeneous associations between risk factors and different sections of the esophagus. CONCLUSION Differences in risk factors of ESCC in different subsites,intake of hot food,hard food,and lower intake of vegetables were common risk factors for three subsites of ESCC.