Prospective study of serum retinol, β-carotene, β-cryptoxanthin, and lutein/zeaxanthin and esophageal and gastric cancers in China

Objective: This study examined the relationship between pretrial serum concentrations of retinol, beta-carotene, beta-cryptoxanthin, and lutein/zeaxanthin and the subsequent risk of developing esophageal squamous cell carcinoma and gastric cardia or non-cardia adenocarcinoma in subjects selected from a randomized nutritional intervention trial in Linxian, China, a region with epidemic rates of esophageal and gastric cardia cancer. Methods: We used a stratified case - cohort design to select cohort members for inclusion in this study. In all we measured serum concentrations of the above vitamins in 590 esophageal, 395 gastric cardia, and 87 gastric noncardia case subjects as well as in 1053 control subjects. Relative risks ( RRs) were estimated using Cox proportional hazards models. Results: Median values in our cohort were low for serum retinol (33.6 mug/dl), beta-carotene (4.3 mug/dl), and beta-cryptoxanthin (3.5 mug/dl), but were high for lutein/zeaxanthin (40.0 mug/dl). Gastric cardia cancer incidence fell 10% for each quartile increase in serum retinol (RR = 0.90, 95% CI = 0.83 - 0.99). For esophageal cancer, an inverse association with retinol levels was found only in male non-smokers ( RR = 0.79 per quartile increase, 95% CI = 0.63 - 0.99). For gastric non-cardia cancer, an inverse association was limited to subjects 50 years old or younger ( RR = 0.58 per quartile, 95% CI = 0.31 - 0.96). For beta-cryptoxanthin there was a borderline significant protective association for gastric non-cardia cancer ( RR = 0.88 per quartile, 95% CI = 0.76 - 1.0). In contrast, we found the incidence of gastric non-cardia cancer increased ( RR = 1.2 per quartile, 95% CI = 1.0 - 1.3) with increasing concentration of serum lutein/zeaxanthin. Conclusions: In this population, we found that low retinol and high lutein/zeaxanthin concentrations increased the risks of gastric cardia and gastric non-cardia cancer respectively. We found that there were no strong associations between any of the other analytes and any of the cancer sites.