MALIGNANT EPITHELIAL TUMORS IN THE UPPER DIGESTIVE-TRACT - A DIETARY AND SOCIOMEDICAL CASE-CONTROL AND SURVIVAL STUDY

Objective: The aim of the present study was to elucidate the influence of social, dietary and environmental factors on the incidence of mali gnant epithelial rumours in the upper digestive tract and on the progn osis of patients with these cancers. Design: A population-based case-c ontrol study was carried out, and the patients in the study were inclu ded in a survival analysis. Setting: The study was carried out at the Department of Otorhinolaryngology at Ulleval University Hospital, Oslo , Norway. Subjects: In the case-control study, 84 patients and 89 cont rols were included. Only the patients were included in the survival an alysis. Results: Smoking showed the highest odds ratio (OR) for morbid ity (OR = 29). The patients had in general a lower social status, and a higher alcohol intake (OR = 6.6). For both beta-carotene and vitamin C, the ORs decreased with increasing intake (OR = 0.2 and 0.3, respec tively). Increased ORs were associated with low values for haemoglobin , iron, TIBC, folic acid, magnesium and especially for albumin (OR = 1 4), and with high values for ferritin, vitamin B12 and thiocyanate (a marker for smoking). Stage of the disease was an important prognostic factor. The relative risk (RR) of dying for disseminated vs localised tumours being 3.2. A poorer prognosis was linked to higher age, to smo king vs no smoking (RR = 2.3), and to lower levels of haemoglobin, alb umin, magnesium and thiocyanate. Conclusions: Strong beer, liquor, con sumption of milk and table fat, low social status and smoking seemed t o have a negative impact on both disease and survival. Fruit and veget ables might, however, reduce the risk. Whereas low serum albumin, iron and magnesium indicated a high OR for cancer, vitamin C and p-caroten e had the opposite implication. No significant implications on surviva l could be detected in blood chemistry beyond the stage of disease.