Anatomical subsite discrepancy in relation to the impact of the consumption of alcohol, tobacco and betel quid on esophageal cancer.
The carcinogenetic impact of risk factors on esophageal cancer (EC) may differ according to the portion of the esophagus where the tumor occurs. It is unclear why more esophageal squamous cell carcinomas (SCC) developed in the middle location. We carried out a multicenter case-control study in Taiwan to assess anatomical subsite risk discrepancy for this neoplasm in regard to the consumption of alcohol, tobacco and betel quid. Four hundred forty seven incident patients with pathology-proven SCC of the esophagus (107 were upper-third [U/3-EC], 199 middle-third [M/3-EC] and 141 lower-third [L/3-EC] cases), as well as 1,022 gender, age and study hospital matched controls were analyzed by unordered polytomous logistic regression. All consumption of the three substances was related to the development of each subsite of EC, with a heterogeneously higher risk for current smokers (adjusted odds ratio (AOR) = 6.2) found in M/3-EC and for current chewers, in U/3-EC (AOR = 4.9). The joint risk of contracting lower two-third EC for drinking and smoking appeared to significantly surpass those estimated by a multiplicative interaction model. Concomitant exposure to these two agents brought the risks of EC at all three subsites up to 10- to 23.9-fold and additional tobacco-free betel quid to a 30.3- to 75.0-fold. In conclusion, tumor subsite discrepancy risk is related to prolonged exposure to tobacco and betel quid with inflorescence. Alcohol interacts with tobacco in a stronger supra-multiplicative way in the middle portion of the esophagus, probably explaining why esophageal SCC occurs more commonly at this anatomical location.
Lee
Chien-Hung
CH
Graduate Institute of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan.
Wu
Deng-Chyang
DC
Lee
Jang-Ming
JM
Wu
I-Chen
IC
Goan
Yih-Gang
YG
Kao
Ein-Long
EL
Huang
Hsiao-Ling
HL
Chan
Te-Fu
TF
Chou
Shah-Hwa
SH
Chou
Yi-Pin
YP
Ho
Chi-Kung
CK
Wu
Ming-Tsang
MT
D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects*; D001114:Areca / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D016022:Case-Control Studies; D003043:Cocarcinogenesis; D004338:Drug Combinations; D004357:Drug Synergism; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D013624:Taiwan / Q000453:epidemiology
D004338:Drug Combinations