| Objective:In many western countries an increase in the incidence of esophagus adenocarcinoma(EAC) and gastric cardia cancer(GCC) has been reported over the past 30 years. Whereas cases of distal gastric adenocarcinoma have steadily declined, the incidence of esophageal adenocarcinoma(EAC) and gastric cardiachas adenocarcinomas(GCC) increased 2.5-3.0 fold since the 1970 s in western country. But it is unclear about China.This study aims to determine the incidence of esophagus adenocarcinoma(EAC) and gastric cardia cancer(GCC) in a cohort of consecutive patients underwent endoscopy for upper gastrointestinal diseases at a major endoscopy center in Chongqing, China. Methods:Pathological reports of all patients underwent endoscopy between 1978 and 2012 at the Southwest Hospital in Chongqing, China were reviewed. Endoscopic detection rate and the constituent proportion of esophageal adenocarcinoma(EAC),esophageal squamous cell carcinoma(ESCC), gastric cardia adenocarcinoma(GCC) and gastric non-cardiac adenocarcinoma(GNCC) as well as gender-specific rates were compiled at seven five-year intervals( 1978-1982, 1983-1987, 1988-1992, 1993-1997, 1998-2002, 2003-2007, 2008-2012) and serial comparison was made. All analyses were conducted using SPSS18.0 software. The endoscopic detection rate and the constitute proportion of EAC and GCC was calculated using linear regression test. Differences were considered statistically significant at p < 0.05. Results:1. Endoscopic detection rates of EAC and GCC in total patientsA total of 440,248 patients underwent endoscopy in our hospital from 1978-2012. ESCC were detected in 10,323 cases(2.3%), EAC in 350 cases(0.08%), GCC in 3,076 cases(0.70%), and GNCC in 5,642 cases(1.3%). The detection rate of EAC in the seven five-year span were 0.18%、0、0.07%、0.08%、0.08%、0.11%、0.07% respectively(R=0.143,p=0.143). The endoscopic detection rates of GCC were 0.53%、0.70%、0.82%、0.81%、0.81%、0.79%、0.63%(R=0.981,p=0.001).2. Endoscopic detection rates of EAC and GCC in maleDuring the 35 years, a total of 2,516 cases of GCC and 281 cases of EAC were diagnosed in men.The detection rate of EAC started from 0.24%, through 0、0.10%、0.11%、0.11% to 0.16%、0.12%(R=0.032,p=0.945). GCC detection rate rose from 0.64% to 0.90%、1.12%、1.04%、1.14%、1.30%、1.09%(R=0.796, p=0.032).3. Endoscopy detection rates of EAC and GCC in female560 cases of GCC and 77 cases of EAC were diagnosed in female over the 35 years. The detection rates of EAC over the seven five-year spans were 0、0、0.02%、0.02%、0.04% 、 0.06%、 0.03% respectively(R=0.826, p=0.022). The detection rate of GCC increased from 0.22% to 0.27%、0.35%、0.42%、0.38%、 0.28%、0.22%(R=0.917, p=0.049).4. Trends in the constituent proportion of EAC and GCC in total patientsThe changes in the constituent proportion of EAC(EAC /(EAC + ESCC). The constituent proportion of EAC started from 21.4% through 0、 1.9%、2.2%、3.4% to 3.9% 、 3.2%(R=0.880, p=0.021,without the first maximum value). The constituent proportion of GCC(GCC/(GCC + GNCC)increased from 16.8% to 25.3%、 33.7%、30.7% to 38.3%、36.6%、 35.3% and was statistically significant(R=0.842, p=0.018).5. Trends in the constituent proportion of GCC and EAC in maleThe proportions of EAC in male in the seven five-year span were 23.1%、0、2.0%、2.5%、3.4%、3.7%、3.2%, the increase is significant(R=0.865, p=0.026, without the first maximum value). Similarly, the proportion of GCC in male rose from 18.0% to 26.3%、 37.0%、33.6%、41.7%、41.1%、 37.9%(R=0.839,p=0.018).6. Trends in the constituent proportion of GCC and EAC in femaleThe ratio of EAC increases from 0、0 to 1.6%、1.1%、3.3%、4.7%、 3.4%(R=0.902,p=0.005). The proportion of GCC rise from 7.1% to 13.5%、 23.1%、22.5%、29.0%、24.3%、 to 25.4%(R=0.833,p=0.020). Conclusion:From 1978-2012, the incidence of EAC and GCC and their constituent proportion increased in a major endoscopy center in Chongqin, China, especially in male. A more dramatic increase in the incidence of EAC and GCC might happen in China in the near future with the increasing prevalence of gastroesophageal reflux disease. |
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