Urinary mycotoxins and esophageal cancer risk in China: A case‐cohort study

The association between mycotoxins and esophageal cancer (EC) risk remains poorly understood, highlighting the need for evidence from population-based prospective studies. We conducted a case-cohort study nested within the Taizhou Longitudinal Study to investigate this relationship, analyzing baseline urinary mycotoxins in 866 randomly selected subcohort members and 240 incident EC cases (including seven cases from the subcohort). Using ultra-high performance liquid chromatography-triple quadrupole-tandem mass spectrometry, we measured three mycotoxins: ochratoxin A (OTA), T-2 toxin (T-2), and fumonisin B1 (FB1). While FB1 was detectable in over 88% of urine samples, OTA and T-2 were detected in less than 30% of samples. EC cases showed slightly higher detection rates for all three mycotoxins compared to the subcohort subjects. Weighted Cox proportional hazards regression analyses for case-cohort studies revealed that, after adjusting for potential confounders, the urinary levels of three mycotoxins-OTA (hazard ratio [HR] = 1.07, 95% confidence interval [CI]: 0.73-1.56), T-2 (HR = 1.01, 95% CI: 0.51-2.00), and FB1 (HR = 0.94, 95% CI: 0.53-1.64)-as well as co-exposure to these three mycotoxins (HR = 1.33, 95% CI: 0.34-5.28), showed no significant association with EC risk. These results remained consistent even after excluding the first 2 years of follow-up to minimize the influence of potential reverse causation. Our case-cohort study found no clear associations between urinary mycotoxins-OTA, T-2, or FB1-and EC risk in the studied population.