Correlation Between Peripheral Blood Level Of Bile Acid And Esophageal Carcinoma:A Retrospective Controlled Study

BackgroundEsophageal cancer is one of the most common malignant diseases of digestive tract,and there is no effective treatment.With the increasing morbidity and mortality of esophageal cancer and its poor prognosis,the prevention and treatment of esophageal cancer has been urgently needed.More and more researches have shown that Bile acids（BA）play an important role in the pathogenesis of digestive tract tumors.BA is a highly soluble,detergent-like amphiphilic molecule with both hydrophilic and hydrophobic surfaces.BA with low hydrophilicity and cytotoxicity protect gastrointestinal and liver cells,while hydrophobic BA may be cytotoxic,causing oxidative stress and DNA damage,which in turn promote cancer.However,the relationship between total bile acids（TBA）in peripheral blood and esophageal cancer has not been elucidated.PurposeTo explore the correlation between peripheral blood TBA level and esophageal cancer,and to further analyze whether peripheral blood TBA is an independent risk factor for esophageal cancer.MethodThis study retrospectively included 2446 patients with esophageal cancer diagnosed by pathology in Xijing Hospital,Xianyang Central Hospital and First Affiliated Hospital of Zhengzhou University from 2013-04-01 to 2020-07-31.Meanwhile,256 normal non-tumor esophageal patients who met the standards of intake and discharge during the same period were included as the control group.General data（including ID number,sex,age,etc.）,medical history（including family history,previous history of surgery,history of chronic disease）,history of drug use,serological indicators（including liver function,renal function,blood routine,tumor markers,etc.）,tumor and pathological stage were collected for all patients.The survival information of some esophageal cancer patients was followed up by telephone.Statistical methods were used to analyze whether there was a difference in serum TBA level between the case group and the control group.Meanwhile,univariate and binary Logistic regression analyses were conducted on all the above factors and the occurrence of esophageal cancer to further clarify whether TBA is a risk factor for the occurrence of esophageal cancer.Results（1）There were differences in gender,residence,occupation and other factors between the esophageal cancer group and non-esophageal cancer group（P<0.05）.（2）The AST,TP,ALB,CRE and UA in esophageal cancer group were lower than those in non-esophageal cancer group（P<0.05）,TBA,WBC and MONO%were higher than those in non-esophageal cancer group（P<0.05）.The level of TBA in peripheral blood of esophageal cancer group was 5.47±5.58μmol/L significantly higher than that of non-esophageal cancer group 4.76±4.50μmol/L,P<0.05.（3）The results of univariate analysis showed that:male,rural,manual workers,ALP>73U/L,peripheral blood TBA>4μmol/L,WBC>5.8×10^{^9}/L,MONO%>0.077,PDW>16.4fl were all risk factors for esophageal cancer.（4）Multivariate regression analysis showed that rural,manual workers,ALP>73U/L,peripheral blood TBA>4μmol/L,WBC>5.8×10^{^9}/L,MONO%>0.077 were independent risk factors for esophageal cancer.AST>13U/L,TP>66.4g/L,UA>260μmol/L,history of cholecystectomy,appendectomy and clopidogrel were negatively correlated with the risk of esophageal cancer.（5）The ROC curve was drawn,and the results suggested that the level of TBA in peripheral blood had a certain significance in the diagnosis of esophageal cancer.（6）There was no significant correlation between peripheral blood TBA level and esophageal carcinoma.（7）There was no significant difference in peripheral blood TBA of esophageal cancer patients with different pathological stages.（8）The K-M survival curve showed that the TBA level of peripheral blood was not significantly correlated with the survival time of esophageal cancer patients.Conclusions（1）The level of TBA in peripheral blood of esophageal cancer patients was significantly higher than that of non-esophageal cancer patients,and the level of TBA in peripheral blood was correlated with esophageal cancer.（2）Peripheral blood TBA is one of the independent risk factors for esophageal cancer.（3）Bile acid may be involved in the occurrence of esophageal cancer,and attention should be paid to screening for esophageal cancer in patients with elevated peripheral blood TBA level.