OBJECTIVEThe aim of this study was to observe the association between the occurrence of esophageal cancer lesions and esophageal mucosa fold (white ridges), and further identify where is the initial origin of esophageal cancer lesions in the esophagus mucosa.

METHODSThis was a cohort study which recruited 551 subjects underwent endoscopic examination in a high risk area of esophageal cancer in Linxian, Henan Province in 1987. 339 subjects with esophageal white ridges, and with red area or erosion lesion at the surface of the white ridges, was studied as exposure group. Other 212 subjects whose esophagus had no white ridges and pathological diagnosis was negative, was studied as control group. The endpoint was occurrence of pathologically confirmed esophageal cancer. After a 15-year follow-up, the results were compared between two groups.

RESULTSAmong the 551 subjects, there were 339 cases with esophageal mucosal white ridges in the exposure group. During the period of 15 year follow-up, the incidence of esophageal cancer was 11.8% (9/76) in 76 case with simple mucosal white ridges, 33.5% (88/263) in 263 subjects with white ridges and red area, or erosions on the surface of white ridge. While only 8.0% of subjects (17/212) developed esophageal cancer after the 15-year follow up in the control group. There was a significant difference between the two groups (P < 0.001).

CONCLUSIONEsophageal mucosal white ridge, especially white ridge with red area or erosions is closely associated with subsequent esophageal cancer occurrence in the esophageal cancer high risk area in China. It is suggested that esophageal mucosa with white ridge may be the initial origin of esophageal cancer. Further investigations focused on this spot are required.