Clinicopathologic analysis in 13823 cancers of esophagus and cardia as well as a comparative analysis of c-fos and Egr-1 expression on 47 esophageal carcinoma cases in Chaoshan littoral region of China

M Su MD^a, YM Wu MD^a, XY Li MD^a, DP Tian MD PhD^a, SM Lu MD^c, HX Yang MD^a, H Zhao PhD^a, DR Li MD^b, ZC Zheng MD^d, XH Xiu PhD^a

^aDept.of Pathology, Shantou University Medical College, Shantou, China, ^bThe tumor Hospital of Shantou University Medical College, The tumor Hospital of Shantou, , ^cThe first affiliated hospital of Shantou University Medical College, The first affiliated hospital of Shantou, , ^dThe second affiliated hospital of Shantou University Medical College, The second affiliated hospital of Shantou

Aim: Chaoshan’s predominant inhabitants are offsprings of migrants who came from the Central Plains of China hundreds or thousand years ago which in noted for high risk regions of esophageal cancer. Chaoshan residents also with high risk of esophageal carcinoma (EC) and cardiac carcinoma (CC) are a relatively isolated population who have kept the old Chinese language(Chaoshan dialect) and customs. However, there have been no previous detailed reports of the clinical and pathologic data of CC and EC. Methods: The clinico-pathologic data of 9650 patients with EC and 4173 patients with CC in the Chaoshan population were analyzed. Moreover, the expression of Egr-1, c-fos mRNA and their protein products on 47 fresh EC specimens including cancer lesion, para-cancerous mucosa and incional margin were also studied. Results: The male to female ratio was 3:1 in EC and 4.75:1 in CC. The average age of the occurrence of EC was 54.6years, and of CC was 58.1 years. For both EC and CC age at diagnosis was a little younger in Chaoshan region than in most other areas. The most commonly affected site of esophageal carcinoma was the middle third of esophagus(72.0%); the second was the lower third (15.3%). The main gross type of esophageal carcinoma was ulcerative type (41.50%); the medullary type was second (39.6%). Squamous cell carcinoma accounted for the overwhelming majority of esophageal cancer (96.4%); adenocarcinoma accounted for the overwhelming majority of cardiac carcinoma (94.5%). Egr-1 mRNA and protein positive signals were located at the basal layer of some normal epithelia. In a few cancer tissues, a high expression of Egr-1 mRNA and protein was also found in dysplasia lesion of para-cancerous regions. Whereas c-fos mRNA and protein positive signals were a very low level on normal epithelia, high expression on para-cancerous lesion and cancer tissues was present. Conclusion: 1.Both EC and CC are common in males. 2.The average age of occurrence is younger in Chaoshan than in most other regions of China. 3. Squamous cell carcinoma accounted for the overwhelming majority of esophageal cancer; adenocarcinoma accounted for the overwhelming majority of cardiac carcinoma.4. The result suggest that c-fos and Egr-1 are important markers for early diagnoses in clinic and mechanism research in tumorigenesis.

Paper presented at the International Symposium on Predictive Oncology and Intervention Strategies; Nice, France; February 7 - 10, 2004; in oral session 897 (Precursor lesions).