title: Heavy alcohol intake is a risk factor for esophageal squamous cell carcinoma among middle-aged men: A case-control and simulation study.
abstract: Despite the advances in surgical techniques and treatments, the prognosis of esophageal cancer remains poor, since the disease is usually diagnosed at an advanced stage. Therefore, prevention plays an important role in reducing mortality. Smoking and alcohol intake are modifiable habits and are important risk factors for esophageal cancer. However, the number of large-scale studies that have investigated the association of the amount and duration of smoking and alcohol intake with esophageal cancer risk, while accounting for the effects of gender and cancer subtypes (squamous cell carcinoma and adenocarcinoma), is limited. Therefore, in this hospital-based matched case-control study we investigated this association while accounting for gender and subtype differences. Chinese male patients <60 years of age with esophageal squamous cell carcinoma (ESCC) from the Fourth Hospital of Hebei Medical University in China and healthy individuals were enrolled between January, 2002 and December, 2006. Each ESCC patient was age-matched to a control subject and a total of 535 pairs were enrolled in this study. The combined variables of amount and duration were created to elucidate their effect and association with ESCC. Multiple conditional logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI) in this model, which included a family history of esophageal cancer, a combined smoking variable and a combined alcohol variable. A simulation study was subsequently performed to confirm the reliability of the results. The results of the present study demonstrated that a family history of esophageal cancer and the combined alcohol variable were significantly associated with ESCC risk. Heavy alcohol consumption and intake for ≤20 years increased the risk compared with no intake (OR=1.91, 95% CI: 1.25-2.92). Heavy alcohol consumption and intake for >20 years exhibited an even higher risk (OR=7.25, 95% CI: 3.12-16.83). These results were similar to those of the simulation. Heavy alcohol intake, even for a short duration, is a critical risk factor and may lead to the development of ESCC in Chinese males.
authors.affiliation: Center of Medical Information Science, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan ; Integrated Center for Advanced Medical Technologies, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Kumagai
authors.affiliation: Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata 951-8510, Japan.
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Wakai
authors.affiliation: Department of Medical Informatics, Niigata University Medical and Dental Hospital, Niigata, Niigata 951-8520, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Akazawa
authors.affiliation: Department of Medical Informatics, Niigata University Medical and Dental Hospital, Niigata, Niigata 951-8520, Japan.
authors.forename: Yiwei
authors.initials: Y
authors.lastname: Ling
authors.affiliation: Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China.
authors.forename: Shijie
authors.initials: S
authors.lastname: Wang
authors.affiliation: Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China.
authors.forename: Baoen
authors.initials: B
authors.lastname: Shan
authors.affiliation: Center of Medical Information Science, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan.
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Okuhara
authors.affiliation: Center of Medical Information Science, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hatakeyama
authors.affiliation: Center of Medical Information Science, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Kataoka
keywords: alcohol intake; conditional logistic regression analysis; esophageal squamous cell carcinoma; matched case-control study; middle-aged Chinese men; simulation