Purpose To characterize the alterations and significance of Rb in concurrent esophageal and gastric cardia precancerous lesions (dysplasia) from the same patients in Henan,a high-incidence area of esophageal carcinoma.Methods Rb protein expression was detected by the immunohistochemical staining (ABC method) in 30 patients with both esophageal and gastric cardia dysplasia in Henan area.Results Rb positive rates in esophageal epithelial dysplasia (EDYS) and gastric cardia dysplasia (GDYS) were 70% (21/30) and 80% (24/30), respectively, and the difference was not significant,(χ~2=0.800,P>0.05).However, there were 25 patients with Rb coincident changes in EDYS and GDYS from the same patient in 30 cases of esophageal and gastric cardia dysplasia (83%,25/30). The positive coincidence rate for Rb positive expression in EDYS and GDYS from the same patient accounted for 67% (20/30) and the negative coincidence rate was 17% (5/30) (Kappa=0.561,P<0.01).The significant relationship between Rb coincidence expression in EDYS and GDYS was found (P<0.01).Conclusions The high coincident alterations of Rb in EDYS and GDYS from the same patient indicate the possibility of similar molecular basis, which provides an important etiological clue for the similar geographic distribution and risk factors involved in esophageal squmaous cell carcinoma and gastric cardia adenocarcinoma.