摘要
目的:探讨食管癌高发区食管癌和贲门癌集中高发对病因和预防的启示作用。方法:通过分析涉县、林州、阳城、磁县1988年1月至2002年12月年男女性食管、贲门、非贲门胃癌发病率的分布,揭示太行山南部食管癌高发区上消化道癌整体高发的特点,然后根据既往移民研究的结果、亚硝胺类动物诱癌的特点以及表观遗传流行病学和生物进化论的原理,对该地域上消化道癌的病因形成假说,并探讨通过改良饮水进行病因学预防的重要性。结果:涉县、林州、阳城、磁县食管、贲门、非贲门胃癌三者发病率的合计均占全身恶性肿瘤的70%～80%。纯山区的涉县以贲门和非贲门的胃腺癌多见,占上消化道癌60%以上;而山区、丘陵、平原各1/3的磁县以食管鳞癌多见,占70%以上;林州和阳城大部分为山区,食管鳞癌和胃腺癌各占约50%。高发区这种上消化道癌的部位构成随地势变化的现象与亚硝胺类动物诱癌实验的结果相似,可能与不同地势下亚硝胺的种类或丰度的差别有关。亚硝胺可通过先天启动、后天积累、二次促癌,以片起源或多点起源的方式导致上消化道癌整体高发。结论:太行山南部食管癌高发区存在环境致癌因素,在该地域寻找能标定个体风险或早期事件的生物学指标是一个今后应致力研究的方向,但通过先期改良饮水等病因预防措施也许有助于更快地把超额的发病率降低到国外人群的水平。
Objective： To detect upper gastrointestinal carcinoma in Northern China, a region at high risk for esophageal cancer; to formulate an explanation for this phenomenon; and to discuss the possible implications for research and prevention of the centralized occurrence of esophageal cancer. Methods： We analyzed the incidence of esophageal cancer, gastric cardia cancer, and non-cardia gastric cancer between 1988 and 2002 in four counties （Cixian, Linzhou, Yangcheng, and Shexian）. According to previous results of immigration studies, epigenetic epidemiology and the Darwinian theory of evolution, we put forward a hypothesis for the etiological factors of esophageal cancer and discussed the importance of primary prevention through improve- ment of drinking water. Results： Esophageal squamous cell carcinoma, gastric cardia cancer and non-cardia gastric cancer constituted about 70%-80% of the total cancer incidence in all of the above four counties. The topography varied geographically. The incidence of gastric adenocarcinoma was higher in the mountainous areas, while the incidence of esophageal squamous cell carcinoma was relatively lower in the mountainous areas. This geographic variation seemed to be related to the regional variation of nitrosamines. Conclusion： This hypothesis satisfactorily explains the findings of immigration studies regarding incidence of esophageal cancer and it has meaningful implications for research and prevention.
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2008年第20期1150-1153,共4页
Chinese Journal of Clinical Oncology
基金
河北省自然科学基金(编号:200500797)
河北省普通高校强势特色学科建设项目~~
关键词
食管癌高发区
表观遗传流行病学
癌变
上消化道癌
High-risk region of esophageal cancer
Epigenetic epidemiology
Carcinogenesis
Upper gastrointestinal carcinoma
