Esophageal Histological Precursor Lesions and Subsequent 8.5-Year Cancer Risk in a Population-Based Prospective Study in China.

INTRODUCTION: Data on the associations between esophageal histological lesions and risk of esophageal squamous cell carcinoma (ESCC) in general populations are limited. We aimed to investigate these associations in a large Chinese general population to inform future Chinese ESCC screening guidelines. METHODS: We performed endoscopic screening of 21,111 participants aged 40-69 years from 3 high-risk areas of China in 2005-2009, and followed the cohort through 2016. Cumulative incidence and mortality rates of ESCC were calculated by baseline histological diagnosis, and hazard ratios of ESCC, overall and by age and sex, were assessed using the Cox proportional hazards models. RESULTS: We identified 143 new ESCC cases (0.68%) and 62 ESCC deaths (0.29%) during a median follow-up of 8.5 years. Increasing grades of squamous dysplasia were associated with the increasing risk of ESCC incidence and mortality. The cumulative ESCC incidence rates for severe dysplasia/carcinoma in situ, moderate dysplasia (MD), and mild dysplasia were 15.5%, 4.5%, and 1.4%, respectively. Older individuals (50-69 years) had 3.1 times higher ESCC incidence than younger individuals (40-49 years), and men had 2.4 times higher ESCC incidence than women. DISCUSSION: This study confirmed that increasing grades of squamous dysplasia are associated with increasing risk of ESCC and that severe dysplasia and carcinoma in situ require clinical treatment. This study suggests that in high-risk areas of China, patients with endoscopically worrisome MD should also receive therapy, the first screening can be postponed to 50 years, and endoscopic surveillance intervals for unremarkable MD and mild dysplasia can be lengthened to 3 and 5 years, respectively.

Population-based study of DNA image cytometry as screening method for esophageal cancer.

AIM: To explore the DNA image cytometry (DNA-ICM) technique as a primary screening method for esophageal squamous precancerous lesions. METHODS: This study was designed as a population-based screening study. A total of 582 local residents aged 40 years-69 years were recruited from Linzhou in Henan and Feicheng in Shandong. However, only 452 subjects had results of liquid-based cytology, DNA-ICM and pathology. The sensitivity and specificity of DNA-ICM were calculated and compared with liquid-based cytology in moderate dysplasia or worse. RESULTS: Sensitivities of DNA-ICM ranging from at least 1 to 4 aneuploid cells were 90.91%, 86.36%, 79.55% and 77.27%, respectively, which were better than that of liquid-based cytology (75%). Specificities of DNA-ICM were 70.83%, 84.07%, 92.65% and 96.81%, but the specificity of liquid-based cytology was 91.91%. The sensitivity and specificity of a combination of liquid-based cytology and DNA-ICM were 84.09% and 85.78%, respectively. CONCLUSION: It is possible to use DNA-ICM technique as a primary screening method for esophageal squamous precancerous lesions.

[The distribution of the pre-cancerous condition and pathological changes of esophageal cancer of the community residents in high-incidence area].

OBJECTIVE: To observe the distribution of the pre-cancerous condition and pathological changes of esophageal cancer of the community residents in high-incidence area, and to provide etiological evidences for secondary prevention. METHODS: An iodine-staining endoscope census was conducted in 9536 residents with high-risk factors at Feicheng, a high esophageal cancer incidence community in Shandong province. Of which, 1507 pathologic biopsies were performed and chi2 test administrated. RESULTS: There was no statistical significance found in biopsy pathologic diagnosis between females and males among 1507 samples. The mild and medium atypical hyperplasia was taken as pre-cancerous condition and severe atypical hyperplasia was taken as pre-cancerous lesion. Taking all the population attending census as denominator, the detection rate of the precancerous state and precancerous lesion were 6.98% (294/4214) and 1.23% (52/4214) for the males, and 3.68% (196/5322) and 0.47% (25/5322) for the females, respectively. A statistical significance was observed when comparing males with females (chi2 were 52.349 and 15.267, respectively, P < 0.05). Analyzed by age group, severe atypical hyperplasia pathological changes were mainly distributed in the age group of 50- and 65-. The constituent ratio between 45 - and 50 - was the highest for CIS. Early carcinoma was mainly distributed in five age groups from 45- to 65-. It showed that high incidence town had a high detection rate of cancer and pathological changes of esophageal cancer in the analysis of urban and rural distribution. CONCLUSION: The distribution of the pre-cancerous state and pathological changes of esophageal cancer of the residents should have provided a scientific basis for the primary and secondary prevention.

[The risk factors related to esophageal squamous cell cancer in Feicheng county, China].

OBJECTIVE: To investigate the risk factors related to the esophageal squamous cell cancer in Feicheng county in Shandong province. METHODS: A case-control study was carried out in Feicheng county. There were two parts consisted in the cases. 253 cases, aged from 40 to 69 years old, were recruited from the screened endoscopic survey program from January 2004 to December 2006. The other part of cases was recruited from the people's Hospital of Feicheng city. 8159 subjects whose had normal endoscope test result were recruited as the control group. Besides cardiograph and ventral ultrasound examination the screening program also included an endoscope test during which mucosal stain with 1.2% iodine solution. The biopsies were taken from the screen and underwent pathologic evaluation by two pathologists; A self-administrative questionnaire survey was conducted in all the subjects to collect information about smoking, alcohol consumption and dietary. The binary Logistic regression was used to estimate odds ratio (OR) and 95% confidence interval (95% CI). The study protocol was approved by the local ethics committee and the study was conducted with the informed consents of all the study subjects. RESULTS: There were 235 esophageal cancers cases (70 identified in screening program, 183 were hospitalized patients) and 8159 controls in the case-control study. Three potential confounders were detected after univariate analysis. After adjusted the three confounders, age, sex and education, we found, smoking, alcohol drinking were the top ranked risk factors for esophageal cancer. When combing smoking and alcohol drinking, the or was 2.73 (95% CI: 1.54 - 4.82) for male, and the proportional attribute relative risk was 51.47%. We also observed that more dietary cellulose and vitamin C intake have protective effects. CONCLUSION: Smoking and alcohol drinking could increase the risk of esophageal cancer, and taking more dietary cellulose and vitamin C might decrease the risk.