Abstract
ObjectiveTo describe the long-term trends of the incidence, mortality and survival of upper digestive tract cancers in a high-risk area of China.MethodsWe extracted esophageal and gastric cancer cases diagnosed from 1991 to 2013 through the Yangzhong Cancer Registry and calculated the crude and age-standardized incidence and mortality rates. Cancer trends were calculated using the Joinpoint Regression Program and were reported using the annual percentage change (APC). The cancer-specific survival rates were evaluated and compared between groups using the Kaplan-Meier method and log-rank test.ResultsThe age-standardized incidence rate of esophageal cancer declined from 107.06 per 100,000 person-years (male: 118.05 per 100,000 person-years; female: 97.42 per 100,000 person-years) in 1991 to 37.04 per 100,000 person-years (male: 46.43 per 100,000 person-years; female: 27.26 per 100,000 person-years) in 2013, with an APC of -2.5% (95% confidence interval (CI): -3.4%, -1.5%) for males and -4.9% (95% CI:-5.8%, -3.9%) for females. The age-standardized incidence rate of gastric cancer was 165.11 per 100,000 person-years (male: 225.39 per 100,000 person-years; female: 113.34 per 100,000 person-years) in 1991 and 53.46 per 100,000 person-years (male: 76.51 per 100,000 person-years; female: 32.43 per 100,000 person-years) in 2013, with the APC of -3.6% (95% CI: -4.5%, -2.7%) for males and -4.8% (95% CI: -5.7%, -3.9%) for females. The median survival time was 3.0 years for patients with esophageal or gastric cancer. Cancer cases detected after 2004 had a better prognosis.ConclusionsThe age-standardized incidence rates of both esophageal and gastric cancer continuously decreased since 1991 through 2013, whereas the mortality rate remained stable before 2004 and significantly declined following the massive endoscopic screening program initiated in 2004. The survival probability of patients with esophageal and gastric cancer has improved obviously in recent decades.
Highlights
The two most common upper digestive tract cancers worldwide, esophageal cancer and gastric cancer, are the sixth and third leading cause of cancer-related death, respectively [1]
The age-standardized incidence rate of esophageal cancer declined from 107.06 per 100,000 person-years in 1991 to 37.04 per 100,000 person-years in 2013, with an annual percentage change (APC) of -2.5% (95% confidence interval (CI): -3.4%, -1.5%) for males and -4.9% for females
The age-standardized incidence rate of gastric cancer was 165.11 per 100,000 personyears in 1991 and 53.46 per 100,000 person-years in 2013, with the APC of -3.6% for males and -4.8% for females
Summary
The two most common upper digestive tract cancers worldwide, esophageal cancer and gastric cancer, are the sixth and third leading cause of cancer-related death, respectively [1]. Since the middle of the 20th century, a steady decline in upper digestive tract cancer incidence has been observed in the majority of more developed countries in Northern America and Europe [2,3,4]. A long-term trend analysis from in China revealed that the all-cancer incidence rates were stable during 2000 through 2011 for males, whereas they increased significantly among females. Esophageal, and liver cancers were identified as leading causes of cancer-related death [5]. Malignancies of both esophageal and gastric cancers have a poor prognosis and lower survival rate as they typically cause no symptoms and are diagnosed with distant metastasis [8, 9]
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