胃と腸46巻5号

2011年05月発行

特集 食道表在癌2011 主題 2．食道表在癌の危険因子

食道表在癌の危険因子

著者： 横山顕¹

所属機関： ¹国立病院機構久里浜アルコール症センター臨床研究部

ページ範囲：P.561 - P.570

要旨　飲酒，喫煙，野菜・果物の摂取不足，低BMIが生活習慣とかかわる食道扁平上皮癌の危険因子である．発癌性のあるアセトアルデヒドへの高度曝露が起こるALDH2へテロ欠損者の飲酒のリスクは特に高く，食道・頭頸部の多発重複癌リスクも高める．食道多発癌，多発ヨード不染帯，5mm以上の大不染帯，メラノーシス，MCV増大は，飲酒・喫煙・ALDH2へテロ欠損と関連が強く，同時性・異時性癌のマーカーとなる．ビールコップ1杯で顔が赤くなる現在と過去の体質を問う簡易フラッシング質問紙法はALDH2欠損を90％の精度で判定し，この質問紙法と飲酒・喫煙・食習慣の組み合わせで食道癌リスクを評価する問診票は，検診や生活指導に活用すれば食道癌の予防に役立つ．エタノール代謝が遅れるADH1Bホモ低活性型も，ALDH2欠損型とともに相乗的に飲酒家の食道癌リスクを高め，この遺伝子解析は癌予防の新戦略となる．

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