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©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
Esophageal squamous cell cancer in a highly endemic region
Akwi W Asombang, Violet Kayamba, Mpala M Lisulo, Kathryn Trinkaus, Victor Mudenda, Edford Sinkala, Stayner Mwanamakondo, Themba Banda, Rose Soko, Paul Kelly
Akwi W Asombang, Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, MO 65203, United States
Violet Kayamba, Edford Sinkala, Paul Kelly, Department of Internal Medicine, University of Zambia School of Medicine, University Teaching Hospital, Lusaka 50001, Zambia
Violet Kayamba, Mpala M Lisulo, Edford Sinkala, Stayner Mwanamakondo, Themba Banda, Rose Soko, Paul Kelly, Tropical Gastroenterology and Nutrition Group, University of Zambia School of Medicine, University Teaching Hospital, Lusaka 50001, Zambia
Kathryn Trinkaus, Washington University School of Medicine, Biostatistics Shared Resource, Siteman Cancer Center, Saint Louis, MO 63110, United States
Victor Mudenda, Department of Pathology, University of Zambia School of Medicine, Lusaka 50110, Zambia
Paul Kelly, Blizard Institute, Barts and The London School of Medicine, Queen Mary University of London, E1 4NS London, United Kingdom
Author contributions: Asombang AW, Kayamba V, Kelly P designed research; Asombang AW, Kayamba V, Lisulo MM, Mudenda V, Sinkala E, Mwanamakondo S, Banda T, Soko R and Kelly P conducted research; Lisulo M and Mudenda V provided essential reagents or provided essential materials; Mudenda V reviewed the histology; Asombang AW, Trinkaus K and Kelly P analyzed data or performed statistical analysis; Asombang AW, Kayamba V, Trinkaus K and Kelly P wrote paper; Asombang AW and Kelly P had primary responsibility for final content.
Supported by NIH grant, No. R24TW007988; the American Relief and Recovery Act; and the Siteman Comprehensive Cancer Center NCI Cancer Center Support Grant, P30 CA091842. Akwi W. Asombang was a Fogarty International Clinical Research Fellow at the time of this study.
Conflict-of-interest statement: No authors declare a conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Akwi W Asombang, MD, MPH, FAAP, FACP, FACG, Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, CE405, DC 043.00, Five Hospital Drive, Columbia, MO 65203, United States.
asombanga@health.missouri.edu
Telephone: +1-573-8821013 Fax: +1-573-8844595
Received: October 29, 2015
Peer-review started: November 9, 2015
First decision: December 11, 2015
Revised: December 21, 2015
Accepted: December 30, 2015
Article in press: December 30, 2015
Published online: March 7, 2016
Processing time: 117 Days and 4.2 Hours
AIM: To identify risk factors associated with esophageal cancer in Zambia and association between dietary intake and urinary 8-iso prostaglandin F2α (8-isoPGF2α).
METHODS: We conducted a prospective, case control study at the University Teaching Hospital. Subjects included both individuals admitted to the hospital and those presenting for an outpatient upper endoscopy. Esophageal cancer cases were compared to age and sex-matched controls. Cases were defined as patients with biopsy proven esophageal cancer; controls were defined as subjects without endoscopic evidence of esophageal cancer. Clinical and dietary data were collected using a standard questionnaire, developed a priori. Blood was collected for human immunodeficiency virus (HIV) serology. Urine was collected, and 8-isoPGF2α was measured primarily by enzyme-linked immunosorbent assay and expressed as a ratio to creatinine.
RESULTS: Forty five controls (mean age 54.2 ± 15.3, 31 male) and 27 cases (mean age 54.6 ± 16.4, 17 males) were studied. Body mass index was lower in cases (median 16.8) than controls (median 23.2), P = 0.01. Histopathologically, 25/27 (93%) were squamous cell carcinoma and 2/27 (7%) adenocarcinoma. More cases smoked cigarettes (OR = 11.24, 95%CI: 1.37-92.4, P = 0.02) but alcohol consumption and HIV seropositivity did not differ significantly (P = 0.14 for both). Fruit, vegetables and fish consumption did not differ significantly between groups (P = 0.11, 0.12, and 0.10, respectively). Mean isoprostane level was significantly higher in cases (0.03 ng/mg creatinine) than controls (0.01 ng/mg creatinine) (OR = 2.35, 95%CI: 1.19-4.65, P = 0.014).
CONCLUSION: Smoking and isoprostane levels were significantly associated with esophageal cancer in Zambians, but diet, HIV status, and alcohol consumption were not.
Core tip: The most common type of esophageal cancer in developing countries, including Sub-Saharan Africa, is squamous cell carcinoma, in contrast to the United States and United Kingdom, in which adenocarcinoma predominates. Yet, there are few studies evaluating risk factors, antioxidant status and the role of oxidative stress of esophageal cancer in Africa. This study explores the association of a non-invasive marker for oxidative stress in esophageal cancer.
