| Background and objective:Esophageal cancer is the sixth leading cause of cancer death and the eighth leading cause of cancer incidence in the world.The 5-year survival rate is about 15% and 25%.The prognosis is related to early diagnosis.In recent years,adenocarcinoma subtype has replaced esophageal squamous cell carcinoma((esophageal squamous cell carcinoma,ESCC)as the main pathological type of esophageal cancer in many western countries,and some studies have shown that the increase in the incidence of adenocarcinoma is due to the increase in the prevalence of Barrett’s esophagus(barrett’s esophagus,BE)in the same period.At present,a large number of studies have confirmed that BE is a precancerous lesion of esophageal adenocarcinoma(Esophageal adenocarcinoma,EAC).The risk of EAC in patients with BE is 30 times higher than that in the general population,so the relationship between BE and EAC can not be ignored.In China,the understanding of BE and EAC is relatively late,so there is still a lack of bulk data.The purpose of this study is to study the incidence and clinicopathological features of BE and EAC,so as to provide reference for the epidemiological investigation of related diseases in China.Methods:1.The data of 779 patients with esophageal cancer and 1648 patients with Barrett esophagus confirmed by gastroscopy in the second affiliated Hospital of Dalian Medical University from January 1,2010 to December 31,2019 were collected.The selected patients had complete case data.Patients with repeated visits were only included in the relevant data when the patient was diagnosed for the first time.2.The patients were divided into groups every 5 years,and the age,sex,incidence,location,gross type,histopathological type and other related information of each period were compared.3.The incidence and clinicopathological features of BE,EAC and esophageal cancer in the past 10 years were analyzed.Results:1.Analysis of the results of Barrett esophagus:(1)General condition of Barrett esophagusA total of 156630 cases of gastroscopy were performed during the 10 years of this study,of which 1648 cases were diagnosed as BE by endoscopy,with a total detection rate of 1.05%(1648/156630).There were 836 males and 812 females,with a male-to-female ratio of 1.03.The proportion of patients diagnosed with BE in the first and last five years was 53.2% and 49.6% respectively,and that of women was 46.8%and 50.4%,respectively.Statistical analysis showed that the difference was not statistically significant(c 2=1.182,P=0.178),indicating that the male and female constituent ratio of BE did not change significantly before and after 5 years.But on the whole,the gender composition is slightly lower than that of men.The age range of 1648 patients diagnosed with BE was 14mur86 years old,with an average age of 55.31 ±13.71 years old,of which 264 cases were less than 40 years old,accounting for 16.0%,accounting for 16.0%,accounting for 16.7%,accounting for16.7%,accounting for 59.5%,accounting for 30.5%,and 605 cases,accounting for36.8%,were over 60 years old.It shows that the middle-aged and elderly patients are the main age group of BE.(2)Gender and the change of annual detection rate of BEA total of 24139 male patients and 22276 female patients were examined in the first 5 years,and 57311 male and 52904 female patients were examined in the last 5years.The detection rates of male BE patients before and after 5 years were 1.18%(284/24139)and 0.96%(552/57311),respectively.There was no significant difference in the detection rate of BE between the first 5 years and the latter 5 years(P>0.05).Thedetection rates of female BE patients before and after 5 years were 1.12%(250 / 22276)and 1.06%(562 / 52904),respectively.There was no significant difference in the detection rate of female BE between the first 5 years and the latter 5 years(P>0.05).It can be seen that in terms of gender detection rate,there is no significant difference in the change before and after 5 years.(3)Endoscopic classifificationAccording to endoscopic morphology,585 cases(35.5%585/1648)were tongue-like type.Island-like type 942 cases,accounting for57.2%(942/1648).circumferential type 121 cases,accounting for 7.3%(121/1648).On the whole,it indicates that island-like type is still the dominant form classification under BE endoscope.Compared with the previous 5 years,there were 136 cases of tongue-like type in the first 5 years,accounting for 25.5%(136/534).There were 360 cases of island-like type,accounting for 67.4%(360/534).Thirty-eight patients(7.1%)(38/534)had circumferential type.There were 449 cases of tongue-like type in the last 5 years,accounting for 40.3%(449/1114).There were 582 cases of island-like type,accounting for 52.2%(582/1114).The number of circumferential type cases was 83,accounting for7.5%(83/1114).The differences in the distribution of morphological typing were statistically significant(c2=36.976,P < 0.001).In recent years,the proportion of BE of tongue-like type increased,while that of island-like type decreased,and the proportion of BE of whole circumferential type did not change much.According to the length of metaplastic columnar epithelium,LSBE was found in 107 cases,accounting for 6.5%(107/1648);SSBE in 1541 cases,accounting for 93.5%(1541/1648).The trend test of the constituent ratio of LSBE in the past 10 years showed that the difference was statistically significant(c2=29.665,P<0.001),indicating that the proportion of LSBE showed an increasing trend in the past 10 years.(4)Comparison of BE detection rateThe detection rates of BE in 2010-1019 were 1.12%,0.86%,1.41%,1.09%,1.20%,1.09%,1.20%,1.19%,0.82% and 0.88%,respectively.The trend Chi-square testshowed that it was statistically significant(trendc2=12.699,P<0.001).Therefore,it can be explained that the detection rate of BE showed a downward trend in the past 10 years.The detection rates of LSBE in 2010-1019 were 0.003%,0.006%,0.02%,0.03%,0.06%,0.08%,0.07%,0.09%,0.09% and 0.1%,respectively.The trend Chi-square test showed that it was statistically significant(trendc2=18.17,P<0.001).The detection rate of LSBE has gradually increased in the past 10 years.2.Analysis of the results of esophageal carcinoma and its pathological types(1)General condition of esophageal cancerA total of 156630 cases of gastroscopy were performed in the past 10 years,including esophageal cancer(n = 779),adenocarcinoma(n = 133),squamous cell carcinoma(n = 625)and other types of cancer(n = 21).Within 10 years,the detection rate of esophageal adenocarcinoma was not statistically significant by trend chi-square test(trend c2=0.350,P=0.554),indicating that the trend of EAC detection rate did not change significantly in the past 10 years.The detection rate of esophageal squamous cell carcinoma and esophageal cancer in the past 10 years was statistically significant by trend chi-square test(trend c 2=27.113,P <0.001;trend c 2=25.297,P<0.001),indicating that the detection rate of esophageal squamous cell carcinoma and esophageal cancer decreased obviously in the past 10 years.(2)EAC and ESCC merge BE.Among all the patients with esophageal cancer,27 patients were complicated with BE(EAC 18cases;ESCC 9cases),4 patients with BE in the first 5 years(ESCC 3cases;EAC 1cases),and 23 patients in the last 5 years(ESCC 6cases;EAC 17cases).It can be seen that the number of esophageal cancer patients with BE increased significantly in recent years,and the number of adenocarcinoma increased more obviously.Therefore,the correlation between BE and EAC has gradually increased in recent years,suggesting that BE may be a precancerous lesion of EAC.(3)Histology and pathology of esophageal carcinomaAccording to the pathological classification of all esophageal cancer,it was foundthat ESCC took the second place in 625 cases(80.2%),133 cases(17.1%).In addition,4 cases of small cell carcinoma,3 cases of adenosquamous carcinoma,2 cases of mucinous adenocarcinoma,7 cases of neuroendocrine carcinoma,2 cases of sarcomatoid carcinoma and 3 cases of spindle cell carcinoma were found(a total of 21 cases,accounting for 2.7%).In the first 5 years,adenocarcinoma was detected in 37cases(12.9%),squamous cell carcinoma in 235 cases(83.6%),and other types of cancer in 9 cases(3.2%).In the last 5 years,adenocarcinoma was detected in 96 cases(19.3%),squamous cell carcinoma in 390 cases(78.3%),and other types of cancer in 12 cases(2.4%).Overall,in recent years,the proportion of adenocarcinoma has increased compared with the previous 5 years,while the proportion of squamous cell carcinoma has decreased.(4)Gross location classification of esophageal carcinomaAccording to the location of all esophageal cancer,there were 23 cases of cervical esophageal cancer(3.0%),85 cases of upper esophageal cancer(11.0%),156 cases of middle esophageal cancer(20.0%)and 515 cases of lower esophageal cancer(66.0%).Generally speaking,the incidence of esophageal cancer is high in the lower part of the esophagus.Esophageal squamous cell carcinoma was mainly found in the middle segment(61.8%)and the lower segment(22.2%),while esophageal adenocarcinoma was mainly found in the lower segment of the esophagus(88%).The difference was statistically significant(c2=39.155,P<0.05),indicating that esophageal adenocarcinoma mainly occurred in the lower esophagus.(5)Staging of esophageal cancer.Among the 779 cases of esophageal cancer,733(98.1%)were advanced esophageal cancer,and 46(5.2%)were early esophageal cancer.The proportion of early esophageal cancer in the first and second 5 years increased from 2.5%(7/281)to7.8%(39/498),and the proportion of advanced esophageal cancer decreased from(97.5%)(274/281)to(92.1%)(459/498).There was a statistical difference in tumor staging between the two periods(c2=9.220,P=0.002),indicating that the detection rateof early esophageal cancer by gastroscope in the last 5 years was higher than before.(6)Age and sex characteristics of esophageal cancer.In the past 10 years,there were 698 male patients with esophageal cancer and 81 female patients,with a male-to-female ratio of 8.6.There were 2 patients less than 40 years old,all male,47 patients aged 49 years(44 males and 3 females),195 patients aged 59 years(188 males and 7 females),and 535 patients aged 60 or older(464 males and 81 females).The total number of patients aged less than 40 years old was male(n =47),male(n = 44),female(n = 3)and 59 years old(male n = 188,female n = 7).There were 535 patients aged 60 or older(464 males and 81 females).After the statistical test of the age and sex characteristics of esophageal cancer,there was a statistical difference(c2=17.115,P<0.001).The incidence age of esophageal cancer was more than 60 years old,and the incidence of esophageal cancer in males was significantly higher than that in females.By analyzing the gender composition ratio of ESCC and EAC,it is found that the majority of ESCC and EAC are males,and the male composition ratio is 91.0% and83.3% respectively.The female composition ratio was 9% and 16.5%,respectively,and the difference was statistically significant after statistical analysis(c 2=6.828,P=0.009).This indicates that men have a high risk of both EAC and ESCC,since ESCC is associated with higher risk in men and higher risk in women.Conclusion:1.The overall detection rate of esophageal cancer showed a downward trend.2.The constituent ratio of esophageal adenocarcinoma to esophageal cancer increased.3.SSBE and island-like BE are still the main types of BE.However,the constituent ratio of LSBE and tongue-like BE increased,and increased synchronously with that of EAC. |
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