【作者】 王建坡；

【导师】 王立东；

【作者基本信息】 郑州大学 ， 病理学与病理生理学， 2012， 硕士

【摘要】 1.研究背景：食管鳞状细胞癌(esophageal squamous cell carcinoma, ESCC)是世界上最常见的六大恶性肿瘤之一,显著的地域性性分布差异和家族聚集现象提示环境和遗传因素在食管癌的发病机制上均起重要作用。80年代以来,尤其近10年,这些地区居民经济、生活环境和水平以及医疗条件等已发生巨大变化,但是关于不同时间ESCC发病性别比情况,尚缺乏大样本量报道。ESCC男性发病率高于女性,性激素可能是导致ESCC男女发病率不同主要因素之一,其中雌激素可能起保护作用。体内雌激素水平随年龄的增长而不断变化,女性闭经后显著下降。因此,年龄可以作为衡量体内雌激素含量的指标,反映出体内雌激素的水平。本研究旨在通过分析1975-2007年间河南安阳食管癌高发区患者性别比的情况,了解性别与ESCC发病风险的关系。在此基础上,利用放射免疫测定法检测部分患者血清雌激素水平和免疫组化技术观察组织中雌激素受体表达情况,进一步探讨其在食管癌发生中的作用。2.材料与方法2.1研究对象15363例ESCC均来自于1975-2007安阳市肿瘤医院住院资料：1975-1997(男3671例,平均年龄57±10岁；女2615例,平均年龄57±9岁)；1998-2007(男5429例,平均年龄60±10岁；女3648例,平均年龄61±10岁)。血清、食管癌手术切除标本均来自安阳ESCC患者,(男87例,平均年龄54±7岁；女45例,平均年龄55±7岁)。2.2统计学处理本研究采用SPSS17.0软件对资料进行统计学分析,统计结果的显著性检验水准a=0.05。3.结果：3.1家族史阳／阴性患者均在小于50岁组中男女比例最高,且随年龄增加而降低,差异具有统计学意义χ2=16.8,df=3,P<0.05；χ2=26.1,df=3,P<0.05)。3.21975-1997年小于50岁患者男女比例最高,且随年龄增加而降低,差异无统计学意义(χ2=6.0,df=3,P>0.05);1998-2007年小于50岁患者男女比例最高,且随年龄增加而降低,差异亦具有统计学意义(χ2=44.9,df=3,P<0.05)。3.3雌激素广泛存在于食管癌高发区患者血清中,且雌激素受体在高发区食管癌患者正常、癌前病变、癌组织中均有不同程度的表达。4.结论：ESCC小于50岁患者男女比例最高,且随年龄增加而降低,提示体内雌激素水平的差异可能是ESCC男女发病率不同的原因,因为闭经后其对女性的保护作用明显下降。血清雌激素检测和免疫组化结果提示,雌激素的变化可能是食管癌变的重要机制之一。更多还原

【Abstract】 1. BackgroundEsophageal squamous cell carcinoma (ESCC) is the sixth common cause of cancer-related deaths in the world with remarkable variations in incidence by geographic and ethnic divisions which have shown the importance of environmental and genetic factors in the pathogenesis of ESCC. Since1980s, the socio-economic status, living and medical condition of resident in these areas have been improved greatly especially last10years. However, there was little document on the impact of environment changes on sex ratio of ESCC incidence, particularly lack large sample data from HIA along with time changes.There is a striking male predominance in esophageal cancer patients. Sex hormones have been proposed as a possible explanation for the male predominance in esophageal cancer, with possible protective effects for estrogen. Estrogen production abruptly decrease with menopause in females. Since endogenous estrogen production varies with age, age can be used as a proxy for estrogen exposure. Thus, the aim of present study was undertaken in sex ratio of patients with esophageal cancer in HLI of Anyang during the1975-2007to find out the relationship between risk of ESCC and Gender. On this basis, radioimmunoassay (RIA) was used to determine the serum level of estrogen in patients with esophageal cancer from high-incidence area (HIA) and immunohistochemical estrogen receptor expression, to further explore its role in esophageal cancer.2. Materials and methods2.1Materials2.1.115363patients with ESCC in this study were from Anyang Tumor Hospital information during the1975-2007.3671were males and2615were females, with a mean age of57±10years in male and57±9years in female during the1975-1997.5429were males and3648were females, with a mean age of57±10years in male and57±9years in female during the1998-2007. This study included132patients with ESCC, All the patients were from Anyang, Henan, the highest incidence area in northern China, and were confirmed with ESCC by histopathologist. Of the patients with ESCC, there were87males and45females with a mean age of53.7±7.3and54.7±6.6, respectively.2.2MethodsThe appropriate application of social science statistical software package SPSS17.0was used for statistical analysis of data. P value with less than0.05was considered significant.3. Results3.1The sex ratios of the familial cases were highest in the age of <50years, declined with age, and was statistical significance (x2=16.8, df=2,P<0.05; x2=26.1, df=3,P<0.05)。 3.2The sex ratios were highest in the age of<50years during the1975-1997, declined with age, and was not statistical significance (x2=6.0, df=3, P>0.05); The sex ratios were highest in the age of<50years during the1997-2007, declined with age, and was not statistical significance (x2=44.9, df=3,P<0.05)3.3Estrogen exists widely in esophageal cancer patients’serum in high incidence area. And estrogen receptor expression is different levels in the normal, precancerous lesions, cancer of esophageal cancer patients in high incidence.4. ConclusionsThe sex ratios of ESCC were highest in the age of<50years, declined with age, estrogen have been proposed as a possible explanation for the male predominance in esophageal cancer, Estrogen production abruptly decrease with menopause in females. Serum estrogen and immunohistochemical detection results suggest that changes in estrogen may be an important mechanism of esophageal carcinogenesis.更多还原