Heredity, diet and lifestyle as determining risk factors for the esophageal cancer on Nanao Island in Southern China

Lifestyle, WCRF/AICR Recommendations, and Esophageal Adenocarcinoma Risk: A Systematic Review of the Literature

One of the most notable changes in the epidemiology of esophageal cancer (EC) is the rising incidence and prevalence of esophageal adenocarcinoma (EAC) in developed countries. The aim of this systematic review was to collect and summarize all the available evidence regarding lifestyle, diet, and EAC risk. We searched the PubMed and Scopus databases in January 2021 for studies providing information about lifestyle, diet, WCRF/AICR recommendations, and EAC risk; published in English; without a time filter. The Newcastle-Ottawa Scale was used to assess risk of bias. The results are stratified by risk factor. A total of 106 publications were included. Half of the case-control studies were judged as high quality, whilst practically all cohort studies were judged as high quality. Body mass index and waist circumference were associated with increased EAC risk. Physical activity did not appear to have a significant direct role in EAC risk. A diet rich in fruit, vegetables, and whole grains appeared to be more protective than a Western diet. Alcohol does not seem to be related to EAC, whereas smokers, particularly heavy smokers, have an increased risk of EAC. Prevention remains the best option to avert EAC. Comprehensible and easy to follow recommendations should be provided to all subjects. Protocol ID number: CRD-42021228762, no funds received.

The Curcumin Analogs 2-Pyridyl Cyclohexanone Induce Apoptosis via Inhibition of the JAK2-STAT3 Pathway in Human Esophageal Squamous Cell Carcinoma Cells

Multiple modifications to the structure of curcumin have been investigated with an aim to improve its potency and biochemical properties. Previously, we have synthesized a series of curcumin analogs. In the present study, the anticancer effect of 2-pyridyl cyclohexanone, one of the curcumin analogs, on esophageal carcinoma Eca109 and EC9706 cell lines and its molecular mechanisms were investigated. 2-Pyridyl cyclohexanone inhibited the proliferation of Eca109 and EC9706 cells by inducing apoptosis as indicated by morphological changes, membrane phospholipid phosphatidylserine ectropion, caspase 3 activation, and cleavage of poly(ADP-ribose) polymerase. Mechanistic studies indicated that 2-pyridyl cyclohexanone disrupted mitochondrial membrane potential, disturbed the balance of the Bcl-2 family proteins, and triggered apoptosis via the mitochondria-mediated intrinsic pathway. In 2-pyridine cyclohexanone-treated cells, the phosphorylation levels of JAK2 and STAT3 were dose-dependently decreased and p38 and p-ERK signals were notably activated in a dose-dependent manner. Moreover, we found that the addition of S3I-201, a STAT3 inhibitor, led to a decreased expression level of Bcl-2 in Eca109 cells. The chromatin immunoprecipitation assay demonstrated that STAT3 bound to the promoter of Bcl-2 in the Eca109 cells. Furthermore, the mutation of four STAT3 binding sites (−1733/−1723, −1627/−1617, −807/−797, and −134/−124) on the promote of Bcl-2 gene alone attenuated the transcriptional activation of STAT3. In addition, down-regulation of STAT3 resulted in less of transcriptional activity of STAT3 on Bcl-2 expression. These data provide a potential molecular mechanism of the apoptotic induction function of 2-pyridyl cyclohexanone, and emphasize its important roles as a therapeutic agent for esophageal squamous carcinoma.

Candidate susceptibility variants for esophageal squamous cell carcinoma

Esophageal cancer is common worldwide, and often fatal. The major histological subtype is esophageal squamous cell carcinoma (ESCC). ESCC shows familial aggregation and high heritability. Mutations in RHBDF2 cause tylosis, a very rare disorder characterized by high life-time risk of ESCC, but no other well-established predisposition genes have been identified. To identify candidate susceptibility variants for ESCC we utilized the Population Information System and the Finnish cancer registry to find study materials by clustering ESCC patients by family name at birth and municipality at birth. We collected archival tissue material and exome sequenced a total of 30 ESCC cases. We prioritized shared, deleterious and rare variants that were significantly enriched in our sample set compared to Finnish and population subset specific controls. Six variants passed filtering, the most frequent being a nonsense mutation in DNAH9 (p.Tyr1573Ter) found in four unrelated patients. DNAH9 has been reported to be frequently lost in ESCC tumors. In this study, one patient's tumor showed loss of the wild type allele of DNAH9 suggesting a tumor suppressive function. A missense variant in GKAP1 was shared by three patients, and missense variants in BAG1, NFX1, FUK, and DDOST by two each. EP300 which has previously been implicated in the genesis of ESCC had a missense variant segregating in three affected individuals in a single family. If validated in independent patient sets, these variants could serve as a tool towards prevention and early diagnosis of ESCC.

Updated incidence rates and risk factors of esophageal cancer in Nan'ao Island, a coastal high-risk area in southern China

Esophageal cancer (EC) is one of the most common cancers in China. The purpose of this study was to investigate the updated incidence rates and risk factors of EC in Nan'ao Island, where the EC incidence rate was chronically the highest in southern China. To calculate the annual incidence rate, data on 338 EC cases from Nan'ao Cancer Registry system diagnosed during 2005-2011 were collected. A case-control study was conducted to explore the EC risk factors. One hundred twenty-five alive EC patients diagnosed during 2005-2011 and 250 controls were enrolled into the case-control study. A pre-test questionnaire on demography, dietary factors, drinking water treatment, and behavioral factors was applied to collect information of all participants. The average EC incidence rates during 2005-2011 were 66.09/105, 94.62/105, 36.83/105 for both genders, males and females, respectively, in Nan'ao Island. The EC incidence rate in males was 2.40- to 4.55-fold higher than that in females in the period from 2006 to 2011 (P < 0.05). Considering the onset age, males tend to be much younger than females and reached peak incidence rate at a younger age (P < 0.05). Drinking water treatment by filter (odds ratio [OR] = 0.28, 95% confidence interval [95% CI] = 0.13-0.58) and fruit consumption (OR = 0.55, 95% CI = 0.32-0.94) reduced the risk for EC. On the contrary, the pickled vegetables consumption (OR = 2.64, 95% CI = 1.46-4.76) and liquor drinking (OR = 2.32, 95% CI = 1.21-4.44) increased the risk for EC. These results may be of importance for future research on EC etiology and prevention strategies.

Quantitative assessment of the association between Fas/FasL gene polymorphism and susceptibility to esophageal carcinoma in a north Chinese population

The case–control study aims to investigate the association of Fas and FasL genetic polymorphisms (Fas‐670A/G (rs1800682), Fas‐1377G/A (rs2234767) and FasL‐844T/C (rs763110)) with esophageal carcinoma susceptibility in a north Chinese population. A total of 204 patients with esophageal carcinoma and 248 healthy controls were enrolled from Henan, China and genotyped by the polymerase chain reaction and restriction fragment length polymorphism method. There were no significant differences in distributions of their genotypes frequencies between patients and controls in Fas‐670A/G, Fas‐1377G/A and FasL‐844T/C polymorphisms (P > 0.05). Stratified analysis showed that no significant association was found between esophageal carcinoma and gene polymorphisms of Fas‐670 A/G, Fas‐1377G/A, and FasL‐844T/C (P > 0.05). Genetic polymorphisms in the death pathway genes Fas and FasL were not associated with risk of developing esophageal carcinoma in a north Chinese population.

A risk of digestive tract neoplasms susceptibility in miR-146a and miR-196a2

Genome-wide association studies have identified many genes associated with digestive tract neoplasms. However, the published findings have been conflicting. The aim of our study was to evaluate the involvement of two polymorphisms (miR-146a rs2910164, miR-196a2 rs11614913) in digestive tract neoplasms risk and explore how miR-146a and miR-196a2 influence this risk. Systemic research of the PubMed, EBSCO, CBM and VIP databases was performed. The software STATA 12.0 was used to calculate odd ratios and 95% confidence intervals. There were 14 studies (6,053 cases and 6,527 controls) available for rs2910164 and 15 studies (5,648 cases and 6,607 controls) involved in rs11614913. Rs2910164G>C was statistically significantly associated with digestive tract neoplasms (OR 1.134, 95% CI 1.076-1.194, P < 0.001). In the subgroup analysis by ethnicity, significant association was observed in Asian individuals (OR 1.145, 95% CI 1.084-1.209, P < 0.001). We found a correlation between rs11614913 and only colorectal cancer (OR 1.325, 95% CI 1.102-1.594, P = 0.003). This study suggested that digestive tract neoplasms might associate with miR-146a variants, but not miR-196a2 variants.

Poultry and fish intake and risk of esophageal cancer: A meta-analysis of observational studies

AIM

Mixed results regarding the association between white meat (including poultry and fish) intake and the risk of esophageal cancer (EC) have been reported. We performed a meta-analysis to provide a quantitative assessment of this association.

METHOD(S)

Relevant studies were identified in MEDLINE until December 31, 2012. Summary relative risks (SRRs) with 95% confidence intervals (CIs) were pooled with a random-effects model.

RESULTS

A total of 20 articles, including 3990 cases with EC, were included in this meta-analysis. Compared to individuals with the lowest level of fish intake, individuals with the highest fish intake were found to have reduced risk of EC (SRRs = 0.69; 95% CIs: 0.57-0.85), while poultry intake was not associated with EC (SRRs = 0.83; 95% CIs: 0.62-1.12). Total fish consumption is associated with reduced esophageal squamous cell carcinoma (ESCC) risk, while poultry consumption was not associated with ESCC risk. Additionally, neither poultry nor fish consumption was associated with esophageal adenocarcinoma risk.

CONCLUSION(S)

Our results suggest that fish consumption may have a potential role in EC prevention, while poultry intake has no effect. However, because the majority of data was from case-control studies, further well-designed prospective studies are warranted.

Esophageal cancer incidence and mortality in China, 2009

OBJECTIVE

Esophageal cancer incident cases and deaths in 2009 were retrieved from national database of population based cancer registry to describe esophageal cancer burden in registration areas.

METHODS

In 2012, 104 population-based cancer registries reported cancer incidence and mortality data of 2009 to Chinese National Central Cancer Registry. Total 72 registries' data met the national criteria to be pooled and analyzed. The crude incidence and mortality rates of esophageal cancer were calculated by age, gender and area. China sensus in 1982 and Segi's world population were applied for age standardized rates.

RESULTS

The crude incidence of esophageal cancer ranked fifth in all cancer sites with rate of 22.14/100,000 (30.44/100,000 for male and 13.64/100,000 for female, 14.21/100,000 in urban and 38.44/100,000 in rural). Age-standardized rates by China population (CASR) and World population (WASR) for incidence were 10.88/100,000 and 14.81/100,000 respectively. The crude mortality of esophageal cancer ranked fourth in all cancer sites with rate of 16.77/100,000 (23.29/100,000 for male and 10.11/100,000 for female, 10.59/100,000 in urban and 29.47/100,000 in rural). The CASR and WASR for mortality were 7.75/100,000 and 10.76/100,000 respectively. For both of incidence and mortality, the rates of esophageal cancer were much higher in males than in females, in rural areas than in urban areas. The overall age-specific incidence and mortality rates showed that both rates were relatively low before 45 years old, and then gradually increased, reaching peak in age group of 80-84.

CONCLUSIONS

The burden of esophageal cancer remained high in China, especially for males in rural areas. Effective prevention and control action, such as health education, nutrition intervention and screening should be enhanced in the future.

Epidemiological study of risk factors for esophageal cancer in Yangquan Area of Shanxi Province based on discordant sib pairs

AIM: To explore the main environmental risk factors for esophageal squamous cell carcinoma (ESCC) based on discordant sib pairs (DSPs) in a moderately high-incidence area, Yangquan City, Shanxi Province, and to provide theoretical evidence for developing effective control and prevention measures in this area.

METHODS: A 1:1 matched case-control study was carried out. One hundred and twenty-seven DSPs were recruited from the cancer registration and follow-up system of the local hospital. All ESCC cases and their matched unaffected sibs were subjected to a survey to obtain demographic information along with personal and family history, and lifestyle factors. The McNemar test was used for data analysis.

RESULTS: Compared with matched unaffected sibs, low family income (OR = 2.00, 95%CI: 1.14-3.52, P = 0.0143), hot food eating and drinking (OR = 2.56, 95%CI: 1.44-4.57, P = 0.0009) and heavy drinking (P = 0.0027) were risk factors for ESCC in the area. These factors play important roles in the development of ESCC, even in cases with a family history of ESCC, and the odds ratios (95%CI) were 2.18 (1.07-4.45), 5.00(1.91-13.06) and infinity, respectively.

CONCLUSION: Besides genetic factors, lack of nutrition, hot food eating and heavy drinking are main risk factors for ESCC in Yangquan City. Prevention and control of ESCC should be intervened at multiple levels, such as genetic factors and lifestyles.