| ObjectivesTo evaluate the distribution,the progress rate and the incidence and mortality of gastric cardia adenocarcinoma(GCA)and precancerous lesions in high-risk areas of China,and to provide evidence for determining the reference ranges of detection rates and the following up intervals of different stages of cardiac precancerous lesions in high-risk areas.Material and MethodsEndoscopy with Lugol's iodine staining was performed on local residents aged 40-69 years in Linzhou,Cixian and Feicheng.Compare' the distribution of GCA and precancerous lesions among different age,gender and areas,and calculate the detection rate range of precancerous lesions.Participants with a clear pathological diagnosis but no treatment accepted endoscopy follow-up.Time interval of endoscopy and progress cases and rate were calculated after comparing the two pathological results,to infer the optimal screening interval.The relative risk and accumulative rate of morbidity and mortality of precancerous lesions during 2005-2016 were calculated according to outcome data of target population.Compare the difference of incidence and mortality of precancerous lesions among age gender and areas.Results1.21606 local people were took part in the endoscopic screening.The compliance rate of screening endoscopy of this study was 47.60%of all,and female's compliance was much higher than that of male(50.32%VS 42.84%,P<0.001).142 cases were excluded since no clear pathologic results and 21464 participants were enrolled in the first part of the study.A total of 2653 cases of GCA and precancerous lesions were diagnosed by endoscopy for the first time(12.36%),the detection rate for atrophic gastritis(AG)was 5.83%(5.52-6.15),low-grade intraepithelial neoplasia(LIN)5.06%(4.77-5.36),high-grade intraepithelial neoplasia(HIN)0.86%(0.74-0.99),early gastric cardia adenocarcinoma(ECA)0.34%(0.26-0.42),GCA 0.28%(0.21-0.36).The detection rates of intraepithelial neoplasia(IN)and GCA in male were significantly higher than that of female(P<0.001).The detection rates of all grades of precancerous lesions increased with age rising(P<0.001).The detection rates of the lesions were different in different high-risk areas apparently.The highest detection rate of lesions was in Linzhou.2.During 2005-2014,a total of 2731 subjects accepted the second endoscopic screening,the follow-up compliance was 12.72%.By comparing the pathological results of two screening,226 patients were found to have progressed in the original sites,including the 89 cases in normal level,51 cases in NAG,56 cases in AG,27 cases in LIN,3 cases in HIN.Through endoscopy,92 cases of new LIN were found:19 cases(21.35%)were normal in the first screening,the interval time of progression were 6 months(15 cases),3 years(3 cases),5 years;29 cases(56.86%)and 44 case(78.57%)were NAG and AG grade in the first screening,and the interval was 0.5-7 years.15 cases of new HIN were found:7 of them(7.86%)were normal in the first screening,the interval time of progression were 6 months(4 cases),7 years(3 cases);4 cases(7.84%)were NAG,the interval time were 0.5,0.5,1,7 years;6(10.71%)and 18 case(66.67%)were AG and LIN grade in the first screening,and the interval time were 0.5(5 cases),7 years,and 0.5(8 cases),1(3 cases),2(3 cases),5,6 years(3 cases).92 cases of new ECA were found:after second years of screening,2 normal cases(1.12%)progressed ECA;1 NAG case(1.96%)progressed after 8 years;5 of them(8.93%)were AG in the first screening,the interval time were 0.5,5,6,7,7 years;6(22.22%)and 1 case(33.33%)were LIN and HIN in the first screening,and the interval time were 2,4,6,7,7,8 years and 3years,respectively.3.2005-2016,a total of 120 new cases were diagnosed as GCA,the 11-year cumulative incidence of GCA was 0.56%,41 cases died,the 11-years cumulative mortality rate was 0.19%,the cumulative incidence and mortality increased with the stage of precancerous lesions rising in high risk areas of China.Survival analysis showed that compared with the normal grade of the cardia,the risk of GCA in LIN was 1.38(1.08-1.75),and the mortality risk was 1.30(0.96-1.77);the risk of GCA in HIN and ECA were 2.95(2.00-4.35),47.63(28.47-79.70),and the risk of death were 1.74(0.97-3.13),2.13(0.53-8.60),respectively.In order to improve the quality of life of patients with GCA,to know the mental health status of the patients.We investigated 32 patients with GCA and 80 healthy controls,the results showed that the patients with cancer had serious psychological problems,the SAS and SDS score of GCA patients were(44.69 ±10.52),(63.71 ±7.04),and the incidence of anxiety and depression were up to 43.80%,93.80%,respectively,the value were significantly higher than those in the control group(33.64±5.75),(38.97±7.70),(p<0.001,p<0.001).For social support,the social support status of GCA patients was generally lower than that of the control group,especially,the total score of social support(31.34±8.47)and utilization of support(5.00± 1.80)were significantly lower than the control group[(37.40±5.43),(6.70 ± 1.84),(P=0.005,P<0.001)].In addition,the symptoms of anxiety was obviously negatively to total score of social support,subjective support and utilization of support,but there was no significant correlation with depression(p>0.05).ConclusionsUp to 12.36%residents that were asymptomatic were suffered from GCA or precancerous lesions in high-risk areas of China.The distribution of GCA and precancerous lesions was closely related to the gender and the age,which suggested that males,the aged were supposed to be paid more attention to.The follow-up intervals for GCA screening were supposed to be reasonable.According to the progress rate,we suggested that the follow-up intervals could be applied to 1-2 years 1 time for AG people,1 year for LIN and half a year for HIN.The cumulative incidence and mortality of the cardiac precancerous lesions showed an upward trend,the cumulative incidence and mortality of male was higher than that of female,and increased with age rising.The relative risk of incidence and death,from high to low,were ECA>HIN>LIN>AG>NAG. |
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