Health-related quality of life among rural residents aged 45-69 years in Hua County, Henan Province, China： Results of ESECC Trial for esophageal cancer screening with endoscopy

Objective： There have been few population-based studies evaluating health related quality of life（HRQOL） in rural populations in China, and this study aimed to assess the current status of and risk factors for HRQOL in a general rural population in high risk region of esophageal cancer in China.Methods： From November 2015 to September 2016, 12,085 permanent residents aged 45–69 years from 257 villages in the Endoscopic Screening for Esophageal Cancer in China（ESECC） trial（Clinical Trials.gov：NCT01688908） randomly selected from Hua County, Henan Province, China were interviewed. The EQ-5 D-3 L,a generic measure of HRQOL, and a questionnaire were used to assess their HRQOL and potential risk factors.Results： Among all the participants, 30.62% of the participants reported problems in at least one EQ-5 D dimension. Pain/discomfort（25.52%） was the most frequently reported problem followed by anxiety/depression（7.97%）, mobility（5.82%）, usual activities（2.61%） and self-care（1%）. These rural residents had a mean EQ-5 D index score of 0.948, and lower EQ-5 D index scores were associated with older age, female gender, lower levels of household annual per capita income, living alone, using shallow wells as main source of drinking water, exposure to family members smoking, testiness, unhealthy dietary habits, overweight or obesity, upper gastrointestinal cancer related symptoms and chronic diseases.Conclusions： Rural residents in China have a relatively low quality of life. Health promotion programs in this population should focus on the elderly, especially elderly women and the elderly living alone. Improving basic living circumstances and primary medical care services should be priorities. Results of this study will also serve as the basis for the cost-utility evaluation in our ESECC screening trial.

Oral microbiome and risk of malignant esophageal lesions in a high-risk area of China:A nested case-control study

Objective:We aimed to prospectively evaluate the association of oral microbiome with malignant esophageal lesions and its predictive potential as a biomarker of risk.Methods:We conducted a case-control study nested within a population-based cohort with up to 8 visits of oral swab collection for each subject over an 11-year period in a high-risk area for esophageal cancer in China.The oral microbiome was evaluated with 16 S ribosomal RNA(rRNA)gene sequencing in 428 pre-diagnostic oral specimens from 84 cases with esophageal lesions of severe squamous dysplasia and above(SDA)and 168 matched healthy controls.DESeq analysis was performed to identify taxa of differential abundance.Differential oral species together with subject characteristics were evaluated for their potential in predicting SDA risk by constructing conditional logistic regression models.Results:A total of 125 taxa including 37 named species showed significantly different abundance between SDA cases and controls(all P<0.05&false discovery rate-adjusted Q<0.10).A multivariate logistic model including 11 SDA lesion-related species and family history of esophageal cancer provided an area under the receiver operating characteristic curve(AUC)of 0.89(95%CI,0.84-0.93).Cross-validation and sensitivity analysis,excluding cases diagnosed within 1 year of collection of the baseline specimen and their matched controls,or restriction to screenendoscopic-detected or clinically diagnosed case-control triads,or using only bacterial data measured at the baseline,yielded AUCs>0.84.Conclusions:The oral microbiome may play an etiological and predictive role in esophageal cancer,and it holds promise as a non-invasive early warning biomarker for risk stratification for esophageal cancer screening programs.

Family history of esophageal cancer modifies the association of serum lipids and malignant esophageal lesions:a nested case-control study from the"Endoscopic Screening for Esophageal Cancer in China"trial

Background:The association of lipids and cancer has varied greatly among different cancer types,lipid components and study populations.This study is aimed to investigate the association of serum lipids and the risk of malignant lesions in esophageal squamous epithelium.Methods:In the"Endoscopic Screening for Esophageal Cancer in China"(ESECC)trial,serum samples were collected and tested for total cholesterol(TC),triglycerides,low-density lipoprotein cholesterol(LDL-C),and high-density lipoprotein cholesterol at the time of subject enrollment.Cases were defined as malignant esophageal lesions identified by baseline endoscopic examination or by follow-up to May 31,2018.Controls were randomly selected using incidence density sampling in the same cohort.Conditional logistic models were applied to identify the association of serum lipids and the risk of malignant esophageal lesions.Effect modification was evaluated by testing interaction terms of the factor under assessment and these serum lipid indicators.Results:No consistent association between serum lipid levels and esophageal malignant lesions were found in a pooled analysis of 211 cases and 2101 controls.For individuals with a family history of esophageal cancer(EC),high TC,and LDL-C were associated with a significantly increased risk of having malignant lesions(odds ratio[OR]Highvs.Low TC=2.22,95%confidence interval[CI]:1.14-4.35;ORHighvs.Low LDL-C=1.93,95%CI:1.01-3.65).However,a negative association was observed in participants without an EC family history(ORHighvs.Low TC=0.69,95%CI:0.48-0.98,Pinteraction=0.002;ORHighvs.Low LDL-C=0.50,95%CI:0.34-0.76,Pinteraction<0.001).Conclusions:In this study,we found that the association of serum lipids and malignant esophageal lesions might be modified by EC family history.The stratified analysis would be crucial for population-based studies investigating the association of serum lipids and cancer.The mechanism by which a family history of EC modifies this association warrants further investigation.