| 1Background and PurposeEsophageal cancer (EC) is one of the six most common malignant tumorworldwide, its incidence ranked eighth, the fatality rate ranked sixth in commoncancer. The pathological type of EC can be divided into two major histology types,including Esophageal Adenocarcinoma (EAC) and Esophageal Squamous CellCarcinomas (ESCC). Esophagus covering the glandular epithelium develop EAC wasfirst reported by Ortmann in1901. In the western countries, and approximately80%of esophageal malignant tumors are EAC, and its incidence is on the rise. Meanwhilethe in the incidence of ESCC is relatively stable, or falling.The junction areas of the three provinces at south end of the Taihang Moutains inChina is the highest incidence area of esophageal cancer worldwide, so itsgeographical difference is very significantly. ESCC accounts for more than95%ofesophageal cancer, and the propotion of EAC is very low. The clinical pathology andepidemiological literature for EAC are rare in domestic. And, the clinical pathologicaland epidemiological characteristics of EAC in these literatures are quite different withwestern literatures. At the same time, we need to note that small sample size mayaffect the accuracy of the results. Therefore, the clinical pathological andepidemiological characteristics of the EAC and the change in incidence trend during the past forty years need to be clarified.All the EAC patients’ data is obtain from the databases of Henan Key Laboratoryfor Esophageal Cancer Research of the first affiliated hospital of Zhengzhouuniversity, which established in the way of household survey, check in the hospitalpathology results and telephone follow-up. This study mainly on the statisticalanalysis of2116EAC patients’ data collected from1973to2012(a total of40years).Discuss the clinical pathological and epidemiological characteristics of EAC, and onthis basis, contrast the pathological characteristics of EAC patients with ESCCpatients homochronous. By analyzing the data of large sample size, discuss theclinical pathological and epidemiological characteristics of esophageal cancer and itstrend during past40years in china.2Materials and Methods2.1Object of study2116cases of EAC patients and128817cases of ESCC patients wereretrospectively analyzed, all the data is obtain from the database established by HenanKey Laboratory for Esophageal Cancer Research of the first affiliated hospital ofZhengzhou university. The study include1519male and597female, the sex ratio is2.54:1.The average age of male patients is61.2±9.9and for the female patients is60.80±8.8. The patients’ Clinical pathological information including name, gender,age, height, hair area, tumor location, degree of differentiation, lymph node metastasis,clinical stage and family history of cancer, etc. Take immunohistochemical detectionto41cases surgically resected specimens of EAC collected by our laboratory,including26male and15female, The average age of male patients is58.3±7.8andfor the female patients is64.33±9.9.2.2Data collectionThe patients’ clinical data are obtained from face to face epidemiologicalinvestigation conducted by investigators whom had been trained specially enter intohigh-and low-incidence areas of EC. Then the investigator go to the hospital wherethe patients had been treated to find the hospital medical records and check theinformation related. All esophageal cancer patients have definite pathologicaldiagnosis.2.3ImmunohistochemistryDetect the expression of the two neuroendocrine indicators: Syn and CgA inEAC canerous tissue with Avidin Biotinylated enzyme Complex (ABC) of immunohistochemical method. Analysis the relation between neuroendocrineindicators and lymph node metastisis. Dyeing site located in cytoplasm, and thecytoplasm with tan particles is defined as positive reaction.2.4Statistical analysisAll information had been enter into the EXCEL software, the data was analyzedby SPSS17.0. Chi-square test was applied for clinicopathologic feature data analysis.Spearman rank correlation analysis was applied for analysis the percentage change ofEAC and ESCC in different part of esophagus over time, and the changing trend ofEAC/ESCC sex ratio over time. Chi-square test and Fisher’s Exact Test was appliedfor analysis the relation between Syn and CgA positive or not with EACclinicopathologic feature. Inspection level α=0.05.3Results3.1The distribution of clinical and pathological characteristics3.1.1The distribution of general condition for2116cases of EACMale is more than female in patients of EAC (71.8%>28.2%),60-69years oldwas the peak ages (38%), rural population higher than the urban polulation(89.3%>10.7%), the proportion of patients in high incidence area is more than in lowincidence area (60.2%>39.8%), the rate of positive family history was29.6%.3.1.2The distribution of pathological features for2116cases of EACEAC occurred more frequently in middle segment of esophagus(47.3%) andlower segment of esophagus take second place (45.4%); Poor differentiation wasmore frequently observed（54.4%）, followed by middle (37.9%).Lymph nodemetastasis positive rate was49.2%.The majority of patients were in middle stage(88.6%), the early stage (5.9%) is more than the late (5.5%).3.2The change of clinicopathological features for EAC in the past forty yearsBased on diagnosed time, the patients were divided into four period(1973-1982,1983-1992,1993-2002,2003-2012). Comparative analysis for these period showedthat the ratio of patients over60years old (including60-69years old and more than69year old) is on the rise. Fig1. Among the three segment of esophagus, the detectionrate in the middle segment of esophagus is on the rise (19.4%,35.9%,49.8%和48.9%，χ2=32.011，P<0.05). The proportion of the EAC patients in the low incidence area ison the rise significantly(8.3%,18.4%,22.3%和49.2%，χ2=132.399，P<0.05). Lymphnode metastasis positive rate is on the rise (31.7%，53.6%，54.3%和47.9%，χ2=9.145，P<0.05). 3.3comparative analysis on the change of clinicopathological features for EACand ESCC patients in four10-yearsComparative analysis for EAC and ESCC showed that male/female ratio of EACpatients is higher that of ESCC patients. Fig2. The ratio of EAC/ESCC in middle andlower segment esophagus is on the rise in the past four10-years. Fig3. During the past40years, The proportion of EAC in EC patients aged over60is higher than patientsunder the age of60. Particularly, the proportion of EAC in EC patients aged over69ishigher than in any other age group, the proportion of ESCC in EC patients aged50to59is higher than in any other age group.3.4The relation between the expression of the two neuroendocrineindicators(Syn and CgA) and EAC clinicopathological features.The Syn and CgA expression positive or not in EAC cancerous tissue is notrelated with clinicopathological features like age, sex, urban or rural, high or lowincidence area and lympho node metastasis(P>0.05).4Conclusion4.1In the past four10-years, male/female ratio of EAC is always higher than that ofESCC, suggesting that estrogen may be a kind of protection to EAC.4.2The peak age of EAC changed from50-59years old to60-69years old.4.3EAC incidence in low-incidence areas showed an increasing tendency over thepast40years, suggesting that the change of living conditions, that is, the environmentfactor play a role in the pathogenesis of EAC.4.4Incidence of EAC in middle segment esophagus showed an increasing tendency,suggesting that the EAC pathogenesis in our country is different from the westerncountries.4.5The Syn positive expression is not related with lympho node metastasis，this isdifferent with the former literature report that Syn positive expression is related withESCC lympho node metastasis positive, thus can Syn could be the indicator ofjudging prognosis of EAC still need to be investigated. |
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