Relationship Between Selected Factors And The Occurrence Of Esophageal Precancerous Lesion In China:An Epidemiological Study In Huaian,Jiangsu Province

Research Objectives-the objectives of this study are: To analyze the association between selected factors and the occurrence of esophageal precancerous lesion(EPL)in Huai'an region,a high esophageal cancer risk region located in northern Jiangsu.To determine which factors are more likely to influence the occurrence of esophageal precancerous lesion in Huai'an region.Introduction: Esophageal cancer(EsC)which is ranked sixth among all cancers in mortality and affects more than 450000 people worldwide and the incidence is rapidly increasing.There are two major sub-types of Es C-Esophageal Squamous Cell Carcinoma(ESCC)and Esophageal Adenocarcinoma(EAC).It incidence has not changed appreciable over the last decade.Because of its poor prognosis and difficulty of early diagnosis,the importance of exploring practical means of the prevention of esophageal cancer is thus apparent.Esophageal cancer is usually fatal,with poor 5-year survival(18.3% in Germany and 17.4% in the United States).This poor survival is mainly a result of the late stage at diagnosis when the tumor is no longer amenable to surgical resection.In China,the survival rate is less than 10% when diagnosed at an advanced stage but is as high as 85% if detected at an earlier stage.Esophageal cancer can occur anywhere along the esophagus.It is a cancer that arises in the mucosa of the esophagus and then invades the sub mucosa,the muscular layer and then the surrounding structures.It may penetrate into the trachea or bronchial tree and/or involve the recurrent laryngeal nerve or the aorta.It is one of the malignancies with highest geographic,ethnic,and gender variations.One of the most striking features of Es C is the presence of defined high-incidence geographic regions,including locales in northern China,northeastern Iran,eastern South America,and South Africa.Eastern Africa was recently described as another high-incidence geographic area for Es C,with incidence and mortality rates significantly higher than in western,middle,or northern Africa.Methods and Materials: Residents aged from 35 to75 years old are recruited in the Early Diagnosis and Early Treatment Project of Esophageal Cancer(EDETPEC)in Huai'an,Jiangsu province,China and the subjects are classified by villages.The informed consent form was signed by participants giving consent to take part in the study.Data of 5953 people were collected in total by using questionnaires,and 5851 of them were qualified and can be used to conduct following analysis.At recruitment,the participants underwent a gastroscopy examination and histopathological examination was conducted to determine the situation of the esophagus.Results: Variables are grouped as follows: demographics,lifestyle,diet,nutritional imbalance,history of diseases in other for proper analysis to be done.The multivariate logistic regression analysis done shows that there is an interaction between the variables.Nonetheless,some variables still remained significant which indicates that there is a strong relationship between those variables and the occurrence of EPL.Gender has an OR(95% CI)of 0.642(0.470-0.876)with a P=0.005.Age group has an OR(95% CI)of 2.176(1.789-2.646)with a P<0.001.Family smoking under the lifestyle group shows an OR(95% CI)of 1.579(1.241-2.008)with a P<0.001,whereas,variables under the diet group like source of drinking water,not eating on time and hot diet have ORs(95% CI)of 0.761(0.592-0.979),1.606(1.092-2.363)and 1.286(1.121-1.476)with P=0.033,0.016,<0.001 respectively.Mildew of grains ten years ago has an OR(95% CI)of 4.065(1.351-12.234)with a P=0.013,pickled food has an OR(95% CI)of 1.128(1.007-1.265)with a P=0.038 and salted fish has an OR(95% CI)of 1.472(1.044-2.074)and a P=0.027,all of which are grouped under nutritional imbalance.Conclusion: It can be concluded that the following factors: gender,age group,family smoking,source of drinking water,not eating on time,hot diet,mildew of grain ten years ago,pickled food and salted fish are associated with the occurrence of esophageal precancerous lesions which could later develop to esophageal cancer;either esophageal squamous cell carcinoma or adenocarcnoma.Generally,this study provides a scientific basis for the formulation of primary prevention measures for esophageal cancer in Huai'an area.