Histological precursors of oesophageal squamous cell carcinoma: results from a 13 year prospective follow up study in a high risk population
- G-Q Wang1,
- C C Abnet2,
- Q Shen4,
- K J Lewin5,
- X-D Sun1,
- M J Roth2,
- Y-L Qiao1,
- S D Mark3,
- Z-W Dong1,
- P R Taylor2,
- S M Dawsey2
- 1Cancer Institute, Chinese Academy of Medical Sciences, Beijing, China
- 2Cancer Prevention Studies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
- 3Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- 4Henan Medical University, Zhengzhou, China
- 5Department of Pathology, UCLA Center for the Health Sciences, Los Angeles, California, USA
- Correspondence to:
Dr S M Dawsey
Cancer Prevention Studies Branch, Center for Cancer Research, National Cancer Institute, 6116 Executive Boulevard, Suite 705, Bethesda, MD 20892-8314, USA;
- Accepted 26 July 2004
- Revised 28 June 2004
Background: Oesophageal squamous cell carcinoma (OSCC) has a very poor prognosis, which is largely due to late diagnosis. Successful early detection strategies will require identification of clinically relevant precursor lesions that can be targets for screening and treatment.
Aims: To identify the clinically relevant histological precursors of OSCC.
Subjects: A cohort of 682 endoscoped patients from a high risk rural population in Linxian, China.
Methods: Subjects were endoscoped and biopsied at baseline and followed for 13.5 years. We estimated the relative risk of developing OSCC for each of the initial histological diagnoses using Cox proportional hazards regression models.
Results: A total of 114 (16.7%) patients developed OSCC during the follow up period. After adjusting for potential confounding factors, relative risks (95% confidence intervals) for incidence of this tumour, by initial histological diagnosis, were: normal 1.0 (reference), oesophagitis 0.8 (0.2–3.2), basal cell hyperplasia 1.9 (0.8–4.5), mild dysplasia 2.9 (1.6–5.2), moderate dysplasia 9.8 (5.3–18.3), severe dysplasia 28.3 (15.3–52.3), and carcinoma in situ 34.4 (16.6–71.4).
Conclusions: In this study, squamous dysplasia and carcinoma in situ were the only histological lesions associated with a significantly increased risk of developing OSCC within 13.5 years after endoscopy. There was no evidence that oesophagitis predisposed to this tumour. Increasing grades of dysplasia were strongly associated with increasing risk, indicating that the histological grading was clinically meaningful. The follow up experience of severe dysplasia and carcinoma in situ was equivalent, suggesting that this distinction is not clinically relevant. Documenting these precursor lesions of OSCC should assist in the development of effective prevention, early detection, and treatment strategies for this disease.
- BCH, basal cell hyperplasia
- CICAMS, Cancer Institute of the Chinese Academy of Medical Sciences
- CIS, squamous carcinoma in situ
- dysplasia NOS, dysplasia not otherwise specified
- OSCC, oesophageal squamous cell carcinoma
- IEN, intraepithelial neoplasia
- NCI, US National Cancer Institute
Correspondence may also be addressed to Dr Y-L Qiao, Cancer Institute, Chinese Academy of Medical Sciences, 17 S Panjiayuan Lane, Chaoyang District, PO Box 2258, Beijing 100021, Peoples’ Republic of China;
Conflict of interest: None declared.