| Background and ObjectivesTaixing City of Jiangsu Province is one of the esophageal carcinoma high incidence areas in China, the economic development of which is at the middle level among Jiangsu cities. Esophageal cancer in Taixing, the incidence of which is much higher than the national average level, brings patients and their family great mental damage and economic burden, and causes huge loss of human and social resources. Study on esophageal cancer in Taixing has great significance to the people’s health and social development. The actual etiology of esophageal cancer remains unclear, but extensive evidences in the past decades have identified that the consumption of nitrosoamines, the unhealthy lifestyle and dietary habits as prominent risk factors of this disease. Part one:the association between tobacco smoking/alcohol drinking and ESCC. Evidences suggested that tobacco smoking and alcohol drinking were the main risk factors for ESCC. Compared with the strong associations of tobacco smoking and alcohol drinking with esophageal cancer in west countries, the associations were considerably weaker or even absent according to some previous studies in Asia. And the studies in China was very few. Part two:The role of H. pylori infection in esophageal neoplasm was controversial. So we conducted this meta-analysis to summarize the published literature on H. pylori and esophageal neoplasm.Subjects and Methods1. All subjects were restricted to local inhabitants who have lived in Taixing for at least 5 years prior to diagnosis for cases or interview date for controls. The study population was recruited from patients undergoing endoscopy at the four largest hospitals of Taixing. All cases were diagnosed histologically, and most of the histological slides were reviewed by the study pathologist. Control subjects were randomly selected from the Taixing population register and matched to resemble the age and sex distribution among the cases. With written informed consent, all subjects underwent face-to-face interviews by trained interviewers using a standardized questionnaire to obtain information demographic characteristics, and smoking/drinking lifestyles. An unconditional logistic regression model was used to estimate the risk of ESCC and smoking/drinking. Model parameters were estimated by the maximum likelihood method. From these estimates, odds ratios (ORs) with their 95% confidence intervals (CIs) were calculated. All data were analyzed by using SAS version 9.1 software (SAS Institute, Inc., Cary, North Carolina).2. Collect all the studies on Helicobacter pylori infection and esophageal cancer. Investigators extracted information from all eligible publications according to the criteria, then we merge the datas to get the final OR. All statistical analyses used STATA 11.0 (Stata Corp LP, College Station, TX, USA).Results1. Smoking/drinking and ESCC1.1 Demographics A total of 612 ESCC and 770 controls were included in this study. The male to female ratio was 2.29:1 in the ESCC group, was a little higher than that in Taixing’s ESCC group (1.93:1).1.2 Smoking and ESCC(1) No statistical differences were found between smoking and ESCC in the two groups.(2) The ESCC odds ratios associated with begin-age of smoking was 1.71(1.09-2.68), and the p was 0.0138. In general, the risk of ESCC increased monotonically with the dropping of begin-age of smoking.(3) With the increasing of smoking intensity and the cumulative amount of smoking, the risk of ESCC1.3 Drinking and ESCC Drinking was associated with ESCC and the adjusted OR was 2.26(1.68-3.04).(1) There was an inverse association between ESCC and the begin-age of drinking (p <0.0001).(2) The risk of ESCC increased with the time of drinking (p<0.0001).(3) The ESCC odds ratios associated with the increasing of drinking intensity (p< 0.0001).1.4 Interaction analysis There was an interactions between the smoking of ESCC and alcohol consumption on the occurrence of ESCC. The overall OR was 1.81(1.18-2.78).2. Helicobacter pylori infection and esophageal cancer2.1 Demographics 28 studies were included in the qualitative synthesis. The total population of the included studies was 10 285 persons, including 3269 cases and 7016 controls. Of the 28 studies,23 are English and five are Chinese papers. Detailed characteristics of the aggregated data for the 28 studies are summarized in Table 1. In total, nine studies concerned EAC,15 concerned ESCC and four concerned both. There were 13 studies in Asian populations and 15 studies in non-Asian subjects.2.2 Quantitative synthesis The overall OR between HP and EAC was 0.57 (95% CI 0.44-0.73) and 0.64 (95% CI 0.52-0.79) for CagA-positive H. pylori strains with EAC, showing an inverse association between EAC and HP/CagA-positive HP. No significant association was found between H. pylori infection/CagA-positive strains and ESCC, and the overall OR was 1.16 (95% CI 0.83-1.60) and 0.97 (95% CI 0.79-1.19) respectively.Conclusions(1) There was no significant association between smoking and ESCC, but the risk of ESCC was increasing with the smoking intensity.(2) Drinking was one of the risk factors for ESCC.(3) There was an inverse association between HP/CagA-positive HP and EAC.(4) No significant association was found between H. pylori infection/CagA-positive strains and ESCC... |
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