Esophageal Histological Precursor Lesions and Subsequent 8.5-Year Cancer Risk in a Population-Based Prospective Study...

Area of Science:

• Gastroenterology
• Oncology
• Epidemiology

Background:

• Limited data exist on the association between esophageal histological lesions and esophageal squamous cell carcinoma (ESCC) risk in general populations.
• Understanding these associations is crucial for developing effective screening guidelines, particularly in high-risk regions like China.

Purpose of the Study:

• To investigate the association between esophageal histological lesions and the risk of ESCC incidence and mortality.
• To inform future ESCC screening guidelines in China based on findings in a large general population.

Main Methods:

• A cohort of 21,111 participants aged 40-69 years from high-risk areas in China underwent endoscopic screening.
• Participants were followed up through 2016, with cumulative incidence and mortality rates of ESCC calculated.
• Cox proportional hazards models were used to assess hazard ratios for ESCC, considering age and sex.

Main Results:

• 143 new ESCC cases (0.68%) and 62 ESCC deaths (0.29%) were identified over a median follow-up of 8.5 years.
• Increasing grades of squamous dysplasia were strongly associated with increased ESCC incidence and mortality.
• Cumulative ESCC incidence rates were 1.4% for mild dysplasia, 4.5% for moderate dysplasia, and 15.5% for severe dysplasia/carcinoma in situ.

Conclusions:

• The study confirms a dose-response relationship between squamous dysplasia grade and ESCC risk.
• Severe dysplasia and carcinoma in situ warrant clinical treatment.
• Recommendations include therapeutic intervention for worrisome moderate dysplasia, postponing initial screening to age 50, and adjusting surveillance intervals for mild and moderate dysplasia.