MULTIPLE PRIMARY ESOPHAGEAL AND CONCURRENT UPPER AERODIGESTIVE TRACT CANCER AND THE ALDEHYDE DEHYDROGENASE-2 GENOTYPE OF JAPANESE ALCOHOLICS

BACKGROUND. Multiple intraesophageal primary cancer and upper aerodige stive tract (UADT) cancer associated with esophageal cancer are common diseases, especially in heavy drinkers. They are often explained by t he concept of field cancerization, which suggests a similar etiology. However, little is known about the nature of the hypothesized etiology . METHODS. Among 901 Japanese male alcoholics systematically screened by upper gastrointestinal endoscopy (with esophageal iodine staining), 33 had squamous cell carcinoma of the esophagus. The multiplicity of their esophageal carcinoma and their concurrent UADT cancer was compar ed with their genotype for aldehyde dehydrogenase-2 (ALDH2), the major determinant of blood acetaldehyde concentration after drinking. RESUL TS. Of 17 patients with inactive ALDH2, 13 (76.5%) had multiple primar y carcinoma of the esophagus, whereas 5 of 16 (31.3%) with active ALDH 2 had multiple carcinomas (P < 0.01). The prevalence of concurrent UAD T cancer was 29.4% in those patients with inactive ALDH2, compared wit h 6.3% in those patients with active ALDH2. CONCLUSIONS. Inactive ALDH 2 is a risk factor for multiple carcinoma of the esophagus in alcoholi cs. Acetaldehyde, a recognized animal carcinogen, appears to play a cr itical role in field cancerization. (C) 1996 American Cancer Society.