Abstract
BackgroundDespite research efforts, the causative factors that contribute to esophageal squamous cell carcinoma (ESCC) in high-risk areas have not yet been understood. In this study, we, therefore, aimed to describe the risk factors associated with ESCC and its precursor lesions.MethodsWe performed an endoscopic examination of 44,857 individuals aged 40–69 years from five high incidence regions of China in 2017–2018. Participants were classified as 4 groups of normal control, esophagitis, low-grade intraepithelial neoplasia (LGIN) and high-grade intraepithelial neoplasia/esophageal squamous cell carcinoma (HGIN/ESCC) using an unconditional logistic regression determine risk factors.ResultsWe identified 4890 esophagitis, 1874 LGIN and 437 HGIN/ESCC cases. Crude odds ratios (ORs) and adjusted odds ratios were calculated using unconditional logistic regression. Drinking well and surface water, salty diet, and positive family history of cancer were the common risk factors for esophagitis, LGIN and HGIN/ESCC. History of chronic hepatitis/cirrhosis was the greatest risk factor of esophagitis (adjusted OR 2.96, 95%CI 2.52–3.47) and HGIN/ESCC (adjusted OR 1.91, 95%CI 1.03–3.22). Pesticide exposure (adjusted OR 1.20, 95%CI 1.05–1.37) was essential risk factor of LGIN.ConclusionsAmong individuals aged 40–69 years in high incidence regions of upper gastrointestinal cancer, the results provided important epidemiological evidence for the prevention of different precancerous lesions of ESCC.
Highlights
Despite research efforts, the causative factors that contribute to esophageal squamous cell carcinoma (ESCC) in high-risk areas have not yet been understood
Based on the results of the adjusted analysis, we found that some risk factors associated with low-grade intraepithelial neoplasia (LGIN) were the same as high-grade intraepithelial neoplasia (HGIN)/ESCC, consisting of drinking alcohol, drinking well and surface water, salty diet, drinking tea, family history of Environment, lifestyle and habits
We identified that history of chronic hepatitis/cirrhosis was the tremendous risk factor both esophagitis and HGIN/ESCC
Summary
The causative factors that contribute to esophageal squamous cell carcinoma (ESCC) in high-risk areas have not yet been understood. In China, esophageal cancer is the sixth most frequent malignant tumor and the fourth leading cause of cancer-related death [2]. Esophageal adenocarcinoma (EADC) and esophageal squamous cell carcinoma (ESCC) are the two most common histologic subtypes of esophageal cancer [3]. In high-income countries, majority of the esophageal cancer patients have EADCs. In China, more than 90% of the esophageal cancer cases are ESCCs [4]. The most studied region of China is located in the North Central Taihang Mountain. In this area, ESCC is the leading cause of death [5]. Based on a recent report from this region, esophageal cancer prognosis is poor and the 5-year survival rates are about 30% [6]
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