Abstract
Almost 50% of the world’s esophageal cancer (EC) cases occur in China, and the impact of cancer screening has long been a controversial topic. The study was designed to evaluate the biological correlates of EC screening and subsequent diagnosis in China. Based on the national cohort of esophageal cancer program, a prospective multicenter study in high-risk regions was conducted from 2017 to 2019. 61 participants received twice esophageal endoscopy screening and pathological biopsy successively (with a mean follow-up of 14.03 months). Box–Cox-power transformation and two-way repeated measures ANOVA were used to evaluate hormone cortisol and immunoglobulin (IgA, IgG, IgM) levels in plasma, reflecting their stress, immune function, and biological correlates before screening and after knowing the diagnosis. The median of cortisol, IgA, IgG, and IgM in pre-screening was 15.46 ug/dL, 1.86 g/L, 12.14 g/L, and 0.91 g/L, corresponding value at post-diagnosis was 15.30 ug/dL, 2.00 g/L, 12.79 g/L, and 0.94 g/L, respectively. No significant differences in biological indicators were found between normal and esophagitis and low-grade intraepithelial neoplasia before screening and after diagnosis. After normality transformation, cortisol, IgA, IgG and IgM levels were (0.25 ± 0.04) U/mL, (0.72 ± 0.13) (g/L), (2.44 ± 0.22) (g/L) and (0.98 ± 0.25) (g/L) before screening, (0.25 ± 0.05) U/mL, (0.70 ± 0.13) (g/L), (2.48 ± 0.21) (g/L) and (1.00 ± 0.25) (g/L) after diagnosis, respectively. Repeated Measures ANOVA showed that the main effects were significant on IgA levels between pre-screening and post-diagnosis (P = 0.019). No interaction effects on biological levels between pre-post screening and esophageal pathology, anxiety states (all P > 0.05). Little biological correlates were found both before screening and after diagnosis. Cortisol and IgA dropped less significantly, while IgM and IgA were increased slightly after diagnosis. Further multi-round longitudinal studies are needed to validate these results.
Highlights
Correlates of Esophageal cancer (EC) screening and subsequent diagnosis on cortisol and immunoglobulin levels in China and provide essential evidence and multi-facet evaluation EC screening
About 1 week to 1 month after the screening, screeners are notified to go to the hospital or community health center to get their screening diagnosis reports. They may be diagnosed as normal, esophagitis and LGIN, high-grade intraepithelial neoplasia (HGIN), and EC
The present study provides innovative evidence on biological correlates of cancer screening and diagnosis, which partly fill the gap in how the screening and diagnosis affects hormone levels and immune function
Summary
Study design.Based on the NCEC program, a prospective, multicenter (Linzhou, Cixian) study in highrisk EC regions was conducted from 2017 to 201924. Before screening (pre-screening), information on exposure to risk factors (e.g., smoking and alcohol drinking), blood tests (including cortisol and immunoglobulin), anxiety disorders, and physical examination were gathered uniformly. About 1 week to 1 month after the screening, screeners are notified to go to the hospital or community health center to get their screening diagnosis reports. They may be diagnosed as normal, esophagitis and LGIN, high-grade intraepithelial neoplasia (HGIN), and EC. After knowing esophageal pathology diagnosis (post-diagnosis), the second survey was conducted to get their information about blood tests and anxiety disorders again, track and follow-up their esophageal progression.
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