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Alcohol abstinence and risk assessment for second esophageal cancer in Japanese men after mucosectomy for early esophageal cancer

View Article: PubMed Central - PubMed

ABSTRACT

Background: Alcohol consumption combined with inactive aldehyde dehydrogenase-2 (ALDH2) and the presence of multiple esophageal Lugol-voiding lesions (LVLs; dysplasia) are strong predictors for multiple development of esophageal squamous cell carcinoma (ESCC) in East Asians. We invented a health risk appraisal (HRA) model for predicting the risk of ESCC based on drinking, smoking, dietary habits, and alcohol flushing, i.e., past or present facial flushing after drinking a glass of beer, a surrogate marker for inactive ALDH2.

Methods: Prospective follow-up examinations (median follow-up time, 50.3 months) were performed in 278 Japanese men after endoscopic mucosectomy for early ESCC (UMIN Clinical Trials Registry ID: UMIN000001676).

Results: Sixty-four subjects developed metachronous ESCC. A receiver operating characteristic curve showed that HRA scores ≥12 best predicted the development of metachronous ESCC. The ESCC detection rate per 100 person-years was 9.8 in the high-HRA-score group (n = 104) and 4.5 in the low-HRA-score group (n = 174), and the risk of development of metachronous ESCC was higher in the high-HRA-score group than in the low-HRA-score group (adjusted hazard ratio: 2.00 [95% CI: 1.12–3.30]). Multiple LVLs was a very strong predictor of the development of metachronous SCC, but high HRA scores predicted it independently. The cumulative incidences of metachronous ESCC decreased after drinking cessation in the high-HRA-score drinker group (adjusted hazard ratio: 0.37 [0.14–0.97]).

Conclusions: Both the HRA model that included alcohol flushing and the multiple LVL grade predicted the development of metachronous ESCC in Japanese men after endoscopic mucosectomy for ESCC. Drinking cessation in the high-HRA-score drinker group reduced the rate of metachronous ESCC.

No MeSH data available.


Related in: MedlinePlus

HRA model for predicting esophageal squamous cell carcinoma (SCC).The risk score is calculated as the sum of scores A to E. Higher scores mean higher risk of esophageal SCC.
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pone.0175182.g001: HRA model for predicting esophageal squamous cell carcinoma (SCC).The risk score is calculated as the sum of scores A to E. Higher scores mean higher risk of esophageal SCC.

Mentions: Aldehyde dehydrogenase-2 (ALDH2) is a major enzyme in the metabolism of acetaldehyde after alcohol consumption, an established human carcinogen for SCC in the UAT [13]. A mutant allele (ALDH2*2; rs671) encodes an inactive subunit, and alcohol consumption by East Asians who are inactive ALDH2*2 carriers markedly increases their risk of SCC in the UAT [8,11,14–20]. We devised a simple alcohol flushing questionnaire for predicting the presence of inactive ALDH2 [21,22], and a health risk appraisal (HRA) model for esophageal SCC that consists of alcohol flushing and drinking, smoking, and dietary habits was developed based on the results of a Japanese male case-control study ([23]; Fig 1). In that study 58% of the esophageal SCC cases had HRA scores in the top 10% of the scores of the controls (an HRA score ≥11). Cross-sectional and follow-up mass-screening studies have shown very high esophageal SCC detection rates in groups with high-HRA-scores, i.e., scores ≥11 [24,25].


Alcohol abstinence and risk assessment for second esophageal cancer in Japanese men after mucosectomy for early esophageal cancer
HRA model for predicting esophageal squamous cell carcinoma (SCC).The risk score is calculated as the sum of scores A to E. Higher scores mean higher risk of esophageal SCC.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5383267&req=5

pone.0175182.g001: HRA model for predicting esophageal squamous cell carcinoma (SCC).The risk score is calculated as the sum of scores A to E. Higher scores mean higher risk of esophageal SCC.
Mentions: Aldehyde dehydrogenase-2 (ALDH2) is a major enzyme in the metabolism of acetaldehyde after alcohol consumption, an established human carcinogen for SCC in the UAT [13]. A mutant allele (ALDH2*2; rs671) encodes an inactive subunit, and alcohol consumption by East Asians who are inactive ALDH2*2 carriers markedly increases their risk of SCC in the UAT [8,11,14–20]. We devised a simple alcohol flushing questionnaire for predicting the presence of inactive ALDH2 [21,22], and a health risk appraisal (HRA) model for esophageal SCC that consists of alcohol flushing and drinking, smoking, and dietary habits was developed based on the results of a Japanese male case-control study ([23]; Fig 1). In that study 58% of the esophageal SCC cases had HRA scores in the top 10% of the scores of the controls (an HRA score ≥11). Cross-sectional and follow-up mass-screening studies have shown very high esophageal SCC detection rates in groups with high-HRA-scores, i.e., scores ≥11 [24,25].

View Article: PubMed Central - PubMed

ABSTRACT

Background: Alcohol consumption combined with inactive aldehyde dehydrogenase-2 (ALDH2) and the presence of multiple esophageal Lugol-voiding lesions (LVLs; dysplasia) are strong predictors for multiple development of esophageal squamous cell carcinoma (ESCC) in East Asians. We invented a health risk appraisal (HRA) model for predicting the risk of ESCC based on drinking, smoking, dietary habits, and alcohol flushing, i.e., past or present facial flushing after drinking a glass of beer, a surrogate marker for inactive ALDH2.

Methods: Prospective follow-up examinations (median follow-up time, 50.3 months) were performed in 278 Japanese men after endoscopic mucosectomy for early ESCC (UMIN Clinical Trials Registry ID: UMIN000001676).

Results: Sixty-four subjects developed metachronous ESCC. A receiver operating characteristic curve showed that HRA scores ≥12 best predicted the development of metachronous ESCC. The ESCC detection rate per 100 person-years was 9.8 in the high-HRA-score group (n = 104) and 4.5 in the low-HRA-score group (n = 174), and the risk of development of metachronous ESCC was higher in the high-HRA-score group than in the low-HRA-score group (adjusted hazard ratio: 2.00 [95% CI: 1.12–3.30]). Multiple LVLs was a very strong predictor of the development of metachronous SCC, but high HRA scores predicted it independently. The cumulative incidences of metachronous ESCC decreased after drinking cessation in the high-HRA-score drinker group (adjusted hazard ratio: 0.37 [0.14–0.97]).

Conclusions: Both the HRA model that included alcohol flushing and the multiple LVL grade predicted the development of metachronous ESCC in Japanese men after endoscopic mucosectomy for ESCC. Drinking cessation in the high-HRA-score drinker group reduced the rate of metachronous ESCC.

No MeSH data available.


Related in: MedlinePlus