Incidence Of Gastric Cardia Adenocarcinoma Research Articles

Surveillance of premalignant gastric cardia lesions: A population-based prospective cohort study in China.

In our study, we aimed to assess the long-term risk of gastric cardia adenocarcinoma (GCA) for patients with different histological cardia lesions to inform future guidelines for GCA screening in China. We conducted a population-based prospective study among 9740 subjects who underwent upper endoscopy screening during 2005 to 2009 and followed until December 2017. Cumulative incidence and mortality rates of GCA were calculated by the baseline histological diagnoses, and the hazard ratios (HRs), overall and by age and sex, were analyzed by Cox proportional hazards models. During a median follow-up of 10 years, we identified 123 new GCA cases (1.26%) and 31 GCA deaths (0.32%). The age-standardized incidence and mortality rates of GCA were 128.71/100 000 and 35.69/100 000 person-years, and cumulative incidence rate in patients with cardia high-grade dysplasia (CHGD), cardia low-grade dysplasia (CLGD) and atrophic carditis (AC)/cardia intestinal metaplasia (CIM) was 25%, 3.05% and 1.58%, respectively. The progression rate and cancer risk of GCA increased monotonically with each step in Correa's cascade. Individuals aged 50 to 69 years had 4.4 times higher GCA incidence than those aged 40 to 49 years. Patients with CLGD had a significantly higher 3-year GCA incidence than the normal group, while patients with AC/CIM had a comparable GCA risk during 3-year follow-up but a higher risk at 5-year intervals. Our results suggested a postponed starting age of 50 years for GCA screening, immediate treatment for patients with CHGD, a 3-year surveillance interval for patients with CLGD, and a lengthened surveillance interval of 5 years for patients with AC/CIM.

Changing Disparity of Gastric Cancer Incidence by Histological Types in US Race-Specific Populations.

Background:The incidence pattern of gastric cancer by histological types across major race/ethnic groups is unknown.Methods:Age-standardized rates from 1992-2016 by race/ethnicity were calculated using data from Surveillance, Epidemiology, and End Results Program (SEER). Annual percent changes (APCs) in rates and corresponding 95% confidence intervals (CIs) were calculated and pairwise comparison of rates between race/ethnic groups was performed using the Joinpoint Regression Program. Calendar periods of incidence rates of gastric cardia and non-cardia cancer by histological types across race/ethnicity groups were shown by figures.Results:The White population has the highest incidence of gastric cardia adenocarcinoma and the incidence is keeping constant from 1992 through 2016 except the decreasing in the Asian population (AAPC = −1.4, 95%CI (−2.1, −0.8)). Although the incidence of non-cardia adenocarcinoma is decreasing in each group, the descending trend in the Asian population is the quickest (AAPC = −3.8, 95%CI (−4.0, −3.5)). Gastric carcinoids were observed to have statistically significant increasing trends in all race/ethnicity groups, especially in Hispanic women from 0.4 per 100,000 to 1.6 per 100,000 persons. The incidence of gastrointestinal stromal tumors (GISTs) is rising, with Non-Hispanic blacks having the highest incidence.Conclusion:This study demonstrated disparities in the incidence of gastric cancer by histological types among different race/ethnic groups. Further investigations are warranted to understand the changing incidence patterns by race/ethnicity.

Incidence Trends of Esophageal and Gastric Cancer Subtypes by Race, Ethnicity, and Age in the United States, 1997–2014

There is limited information on contemporary incidence rates and trends, by race, ethnicity, and age, for major subtypes of esophageal and gastric cancer in the United States. We examined the most recent nationwide incidence data for esophageal squamous cell carcinoma, esophageal adenocarcinoma (EAC), gastric cardia adenocarcinoma (GCA), and gastric non-cardia adenocarcinoma (GNCA) by race, ethnicity, and age in the United States. Average contemporary incidence rates (2010-2014) and annual percent changes in rates (from1997 through 2014) by race, ethnicity, and age were calculated for each cancer subtype using nationwide data compiled by the North American Association of Central Cancer Registries. From 1997 through 2014, overall esophageal squamous cell carcinoma incidence rates continuously decreased in both sexes and all racial and ethnic groups, although rates remained stable among younger non-Hispanic white women. Overall, EAC incidence rates decreased or stabilized during the most recent time period (2006-2007 through 2014) in men and women, after increasing from 1997 through 2006 and 2007. However, EAC incidence rates continued to increase from 1997 through 2014 in several subpopulations, including non-Hispanic white men younger than 50 years, non-Hispanic white women younger than 70 years, and Asian/Pacific Islander men (all ages combined). Overall GCA incidence rates increased among non-Hispanic whites, but decreased among Hispanics (men only) and Asian/Pacific Islanders. Although overall GNCA rates decreased in both sexes and all racial and ethnic groups, rates increased in younger age groups among men (all races and ethnicities combined) and non-Hispanic white, non-Hispanic black, and Hispanic women. Using high-quality nationwide population-based data, we found increasing incidence trends for EAC, GCA, and GNCA in several subpopulations in the United States.

A pooled analysis of dietary sugar/carbohydrate intake and esophageal and gastric cardia adenocarcinoma incidence and survival in the USA.

During the past 40 years, esophageal/gastric cardia adenocarcinoma (EA/GCA) incidence increased in Westernized countries, but survival remained low. A parallel increase in sugar intake, which may facilitate carcinogenesis by promoting hyperglycaemia, led us to examine sugar/carbohydrate intake in association with EA/GCA incidence and survival. We pooled 500 EA cases, 529 GCA cases and 2027 controls from two US population-based case-control studies with cases followed for vital status. Dietary intake, assessed by study-specific food frequency questionnaires, was harmonized and pooled to estimate 12 measures of sugar/carbohydrate intake. Multivariable-adjusted odds ratios (ORs) and hazard ratios [95% confidence intervals (CIs)] were calculated using multinomial logistic regression and Cox proportional hazards regression, respectively. EA incidence was increased by 51-58% in association with sucrose (ORQ5vs.Q1 = 1.51, 95% CI = 1.01-2.27), sweetened desserts/beverages (ORQ5vs.Q1 = 1.55, 95% CI = 1.06-2.27) and the dietary glycaemic index (ORQ5vs.Q1 = 1.58, 95% CI = 1.13-2.21). Body mass index (BMI) and gastro-esophageal reflux disease (GERD) modified these associations (Pmultiplicative-interaction ≤ 0.05). For associations with sucrose and sweetened desserts/beverages, respectively, the OR was elevated for BMI < 25 (ORQ4-5vs.Q1-3 = 1.79, 95% CI = 1.26-2.56 and ORQ4-5vs.Q1-3 = 1.45, 95% CI = 1.03-2.06), but not BMI ≥ 25 (ORQ4-5vs.Q1-3 = 1.05, 95% CI = 0.76-1.44 and ORQ4-5vs.Q1-3 = 0.85, 95% CI = 0.62-1.16). The EA-glycaemic index association was elevated for BMI ≥ 25 (ORQ4-5vs.Q1-3 = 1.38, 95% CI = 1.03-1.85), but not BMI < 25 (ORQ4-5vs.Q1-3 = 0.88, 95% CI = 0.62-1.24). The sucrose-EA association OR for GERD < weekly was 1.58 (95% CI = 1.16-2.14), but for GERD ≥ weekly was 1.01 (95% CI = 0.70-1.47). Sugar/carbohydrate measures were not associated with GCA incidence or EA/GCA survival. If confirmed, limiting intake of sucrose (e.g. table sugar), sweetened desserts/beverages, and foods that contribute to a high glycaemic index, may be plausible EA risk reduction strategies.

Incidence of Adenocarcinoma of the Gastric Cardia Is Similar to That of Adenocarcinoma in the Esophagus After Successful Radiofrequency Ablation in Barrettʼs Esophagus

Introduction: Radiofrequency ablation (RFA) is an effective treatment for Barrett's Esophagus (BE) that results in high rates of complete eradication of intestinal metaplasia (CEIM). Despite RFA, progression to adenocarcinoma may occur, in either the tubular esophagus or the gastric cardia. We sought to describe the rate and timing of gastric cardia adenocarcinoma after RFA for BE. Methods: The U.S. RFA Registry is a national, prospective study of patients with Barrett's Esophagus (BE) treated with RFA at 148 institutions (113 community-based, 35 academic-affiliated). We included patients without prevalent adenocarcinoma. We estimated the incidence rate of gastric cardia adenocarcinoma overall and stratified by CEIM status with profile-likelihood confidence limits (CL). We performed inverse probability of sampling weighting to estimate incidence rates of cardia adenocarcinoma among patients with cardia sampling under a scenario of universal sampling. We estimated unadjusted and adjusted rate ratios for cardia adenocarcinoma among the full population and among the standardized, sampled population. Results: Of 5,521 patients in the registry, 5,085 without prevalent adenocarcinoma were included for analysis. Baseline characteristics are described in table 1. There were 21 incident cases of cardia adenocarcinoma, of which 13 occurred before or at the time of esophageal CEIM and 8 occurred during surveillance. In the full population, the overall incidence of cardia adenocarcinoma was 1.49 per 1,000 person-years (95% CL: 0.94 - 2.22), prior to CEIM was 2.23 (95% CL: 1.23 - 3.68), and after CEIM was 0.97 (95% CL: 0.45 - 1.81). In the sampled, standardized population the overall incidence of cardia adenocarcinoma was 3.03 per 1,000 person-years (95% CL: 2.02 - 4.34), prior to CEIM was 5.89 (95% CL: 3.54 - 9.11), and after CEIM was 1.58 (95% CL: 0.76 - 2.85). Incidence of cardia adenocarcinoma was much less than incidence of esophageal adenocarcinoma before CEIM (13.4 per 1,000 person-years) but similar to after CEIM (2.60 per 1,000 person-years). Conclusion: Cardia adenocarcinoma incidence is similar to esophageal adenocarcinoma incidence after successful RFA. Both cardia and esophageal adenocarcinoma are strongly associated with baseline histologic grade and less common after CEIM. Nearly half of U.S. RFA registry patients never had pathologic examination of the cardia, suggesting that neoplasia may be missed without routine sampling of the cardia.Table 1: Baseline clinical and endoscopic characteristics of 5,085 patients in the U.S. RFA registry dataset, 2,327 patients with cardia sampling, and the inverse probability of sampling weighted pseudo-populationTable 2: Unadjusted and adjusted rate ratios for the incidence of gastric cardia adenocarcinoma among U.S. RFA registry patients and the standardized population with cardia samplingFigure 1

Microarray expression profile analysis of long non-coding RNAs of advanced stage human gastric cardia adenocarcinoma

Gastric cardia adenocarcinoma (GCA) is a unique malignant tumor for its characteristics different from gastric and esophageal cancer epidemiologically and pathologically. The incidence of GCA has steadily increased for the last three decades and many patients are diagnosed with advanced stage because of the lack of typical and obvious symptoms at an early stage. To gain insight into the molecular mechanisms of GCA of advanced stage, we investigated the microarray expression profile of long non-coding RNAs of 12 advanced stage GCA patients. Long non-coding RNAs (lncRNAs) lack protein-coding potential and are over 200 bp in length. LncRNAs are known to be involved in the multifactor and multistep processes of tumor development and metastasis. In this study, we performed lncRNA transcriptome profiling of GCA biopsy tissue from 12 GCA patients who were confirmed by pathology to have developed lymph node metastasis and 12 paired non-cancerous gastric cardia tissues to determine if a gene expression profile unique to the lymph node metastasis group could be detected. Comparison of differentially expressed transcripts between the groups identified eight pathways that corresponded to down-regulated transcripts and 18 pathways that corresponded to up-regulated transcripts (p value cut-off 0.05). Gene ontology analysis showed that the up-regulated transcripts were most highly enriched in SRP-dependent cotranslational protein targeting to membrane, cytosolic ribosome, and structural constituent of ribosome, and the down-regulated transcripts were highly enriched in carboxylic acid transport, focal adhesion, and cation binding. This study shows that lncRNAs dysregulation exerts important roles in human GCA lymph node metastasis, indicating that lncRNAs are novel candidate biomarkers for the clinical diagnosis of advanced stage GCA and that could be targets for further therapy.

Gastric Cardia Cancer: How Much Is It from Fat?

The overall age-adjusted incidence of gastric cancer hasdecreased in the United States from 11.7 to 7.1 persons per100,000 from 1975 to 2008 according to the surveillanceepidemiology and end results (SEER-9) database [1]. Simi-lar trends have been observed worldwide. Although theincidence of gastric non-cardia adenocarcinoma (GNCA)has decreased worldwide the incidence of gastric cardiaadenocarcinoma (GCA) has steadily increased over the lastthree to four decades along with a rise in esophageal ade-nocarcinoma (EAC) incidence [2, 3].It is possible that the incidence of GCA has increaseddue to better understanding and appropriate classificationof distal esophageal and GCA rather than a true increase incancer incidence rate [4]. Current studies, however, are notcompletely devoid of the error of misclassification andhence concluding that the increase reflects a prior falseunderestimation is not completely justified. There is roomfor error even in studies that have selected patients basedon standardized classifications. Various studies have usedthe International Statistical Classification of Diseases andRelated Health Problems (ICD-9) and International Clas-sification of Diseases for Oncology (ICD-O) codes [5–7].Misclassification in the ICD-9 coding system could lead toincorrect estimation of cancer incidence (Table 1). First,EAC and cardio-esophageal junction cancers were classi-fied under one group (ICD-9-151.0). Second, GCAcould be misclassified under ‘‘unspecified gastric cancers’’(ICD-9-151.9) or ‘‘overlap sites of stomach’’ (ICD-9-151.8) [8]. In the ICD-O 2/3 system GCA tumors areclassified under C16.0 but they could be incorrectly labeledas ‘‘overlapping lesions of esophageal cancer’’ (C15.8) [9](Table 1). Nyre´n et al. in 1999 studied the possibility ofmisclassification in the Swedish cancer registry from 1989and 1994 and reported that the incidence of GCA could be45 % higher or 15 % lower than that reported [10].The Siewert classification sorts tumors as esophagealtumor (type I), true cardia tumor (type II) and subcardialtumor (types III). This is based on the location of thecancer with respect to the cardia, which is defined as oralend of the typical longitudinal gastric mucosa folds. Thismight be a better way of differentiating junctional cancers[11] (Table 2; Fig. 1).Obesity as a Risk Factor for Cardia CancerAmong the risks factors for EAC and GCA, obesity standsout as an important modifiable factor (Table 3). Theprevalence of obesity has increased from 13 to 32 %between the 1960s and 2004. Currently, 68 % of US adultsaged 20 and over are overweight or obese and 34 % areobese [12]. With the rise in the epidemic of obesity in theWestern world there has been an increase in the incidenceof GCA. One study calculated that the attributable riskpercentage of GCA due to obesity has increased steadily inthe United States to 21 and 10 % in men and women,respectively [13].Several case control studies and meta-analysis haveshown a positive association between higher BMI, ECAand GCA. The association appears to be much stronger forEAC. A UK-based case-control study in 2005 showed apositive association between BMI[25 kg/m

Trend analysis for clinical characteristics and prognosis of adenocarcinoma of cardia

The incidence of adenocarcinoma of the cardia has recently increased. This study compared the clinicopathology and prognosis of patients with gastric cardia adenocarcinoma in different periods between 1984 and 2003. A total of 589 patients with pathologically confirmed gastric cardia adenocarcinoma hospitalized in Sun Yat-sen University Cancer Center between 1984 and 2003 were divided into 5-year groups. Retrospective analysis of clinical and prognostic characteristics between the different 5-year groups was conducted. The number of hospitalized patients increased by 134.5%, with an annual increase of 4.6%. Median age was 60 years, with an increase of 5 years. Patients aged between 55 years and 64 years decreased, while patients aged > or = 65 years increased. The male-to-female ratio was 2.88:1, with no significant change. The rates of patients with the stage-I and -II disease changed insignificantly, while patients with stage-III disease increased, and patients with stage-I disease decreased. The 5-year survival rate of all the patients was 28.5%, which increased from 20.9% between 1984 and 1993 to 35.5% between 1994 to 2003. During the past 20 years, associated with the upward-trending incidence of gastric cardia adenocarcinoma, the admission rate at our hospital of patients with the tumor increased. The median age of the patients also increased. The ratio of men to women had no significant change. The proportion of patients with late-stage disease decreased and prognosis has improved.

Changing incidence of gastric and oesophageal cancer subtypes in central Switzerland between 1982 and 2007

Several Western countries have reported a decrease in the incidence of noncardia gastric adenocarcinoma and a strong increase in the incidence of oesophageal and cardia adenocarcinoma. We examined incidence rates of gastric and oesophageal cancer by subsite and histology in Central Switzerland over the last 26 years. Data on biopsy-diagnosed gastric and oesophageal carcinoma incidence during 1982-2007 were obtained from the Cancer Registry of the Institute of Pathology, Lucerne, the Medical Centre for Central Switzerland. Age-adjusted (standardized to the European standard population), and sex-specific incidence rates were calculated. In total, 2,322 cancers were diagnosed: 1,240 noncardia gastric adenocarcinomas, 459 cardia gastric adenocarcinomas, 248 oesophageal adenocarcinomas, and 375 squamous cell carcinomas. From 1982 to 2007, the incidence rates of noncardia adenocarcinoma decreased substantially from 17.9 (per 100,000) to 6.0 in men and 10.3 to 5.5 in women. In men, the incidence of gastric cardia adenocarcinoma decreased from 7.5 to 4.3, the incidence of oesophageal adenocarcinoma increased from 3.3 to 4.8, and the incidence of oesophageal squamous cell carcinoma decreased from 6.6 to 4.1; the incidence rates of these cancers were low in women (1.1-2.4). In conclusion, the incidence of gastric noncardia carcinoma has decreased substantially over the past 26 years. In contrast to other Western countries, the incidence of gastric cardia adenocarcinoma did not increase in Central Switzerland. Whereas the rate of oesophageal adenocarcinoma increased, the rate of squamous cell carcinoma decreased. These results suggest substantial changes in environmental and life-style risk factors over the past 26 years.

#8 Esophageal and gastric cancer in the united states

PURPOSE: Historically, esophageal and gastric cancers have been considered as two cancers. Esophageal cancers were predominantly squamous cell carcinomas, stomach cancers were adenocarcinomas, tumors arose throughout each of the two organs, and rates for each were higher among blacks than whites. Recent observations suggest that there may be at least three, if not four, distinct epidemiologic and potentially etiologic entities: squamous cell carcinoma of the esophagus (SCE), adenocarcinoma of the esophagus (ACE) (arising in the distal region), proximal stomach or gastric cardia adenocarcinoma (GCA), and noncardia gastric adenocarcinoma (NGA). METHODS: We analyzed SEER incidence data for 1974–78 to 1994–98 by anatomic site and histologic type to describe these potentially different tumors, review known or suspected risk factors, and describe the trends in prevalence of these factors. RESULTS: SCE rates decreased after 1988 for all race-gender groups. In contrast, the incidence of ACE increased more than 400% among white males, and ACE rates surpassed those of SCE after 1988. ACE rates increased more than 300% among white females, rose 100% among black males, and also showed an upward trend among black women. NGA trends were generally downward. However, similar to ACE, GCA rates increased from 1974–78 to 1984–88, although to a lesser extent, and appear to have stabilized since then. With the decrease in NGA rates and the increase then stabilization in GCA rates, rates of GCA and NGA among white men were similar in 1994–98. CONCLUSIONS: Declines in the prevalence of smoking and drinking and increases in consumption of fresh fruits and vegetables may contribute to the downward trends in SCE. Increases in gastroesophageal reflux disease and obesity, and declines in Helicobactor pylori ( H. pylori ) infection may contribute to the upward trends in ACE. Reductions in NGA may be related to improved diet and reductions in smoking and H. pylori prevalence. Factors contributing to the rising incidence of GCA of the cardia during the 1970s and 1980s, but not the 1990s, are less clear.

Esophageal and gastric cardia epithelial cell proliferation in northern Chinese subjects living in a high-incidence area

Linxian and the nearby county Huixian, in the Henan province in Northern China, have a very high incidence of esophageal squamous cell carcinoma (SCC). Previous studies from these counties have suggested that increased proliferation of esophageal epithelial cells, morphologically manifested as basal cell hyperplasia (BCH) and dysplasia (DYS), is an early indicator of abnormality in persons predisposed to SCC. A high incidence of gastric cardia adenocarcinoma (AC) was also found in these areas. To determine proliferation patterns of esophageal and gastric cardia epithelia with normal and different severities of precancerous lesions, we measured proliferating cell nuclear antigen (PCNA), Ki-67, and bromodeoxyuridine (BrdU) incorporation and compared the results. Esophageal biopsies (175) and gastric cardia biopsies (41) were collected from symptom-free subjects in Huixian. Of these, 23 esophageal biopsies were incubated with BrdU. The avidin-biotin-peroxidase complex (ABC) method was used to detect PCNA, Ki-67, and BrdU. The number of immunostain-positive cells was counted manually. Intense immunostaining for PCNA, Ki-67, and BrdU was observed in the cell nuclei of tissues with normal and different severities of precancerous lesions. With esophageal biopsies, both PCNA and Ki-67 increased significantly as the epithelia progressed from normal to BCH and to DYS. The number of PCNA- and Ki-67-positive cells was three times higher than that of BrdU incorporation in the same category of BCH. With cardia biopsies, the number of Ki-67 positive cells was lower in normal tissue and increased significantly from chronic superficial gastritis to chronic atrophic gastritis to DYS. Staining patterns for PCNA and Ki-67 were correlated with the histopathology of the esophagus. The correlation was not as clear with gastric cardia. BrdU studies appear to be more complicated. The PCNA and Ki-67 methods may be useful for screening high-risk esophageal and gastric cardia cancer subjects, and for monitoring chemoprevention effects.

Epidemiological characteristics of adenocarcinoma of the gastric cardia and distal stomach in the United States, 1973-1982.

Data from the Surveillance, Epidemiology, and End Results (SEER) programme of the National Cancer Institute were utilized to estimate the incidence of adenocarcinoma of the gastric cardia and distal stomach in the US in order to determine whether the epidemiological features of these diseases differ. Based upon 12,562 histologically confirmed cases identified, the annual incidence of gastric cardia adenocarcinoma was 1.1 per 100,000 people and for the distal stomach 3.8 per 100,000. The male-to-female ratio for adenocarcinoma arising in the cardia was 7.0, versus 2.2 for that arising in the distal stomach. The sex ratio shifted across age groups for the gastric cardia and was highest for the 50-59 year age group, but remained relatively stable across age groups for cancers of the distal stomach. Over the decade studied, the sex ratio decreased from 8.0 to 4.6 for gastric cardia tumours, but remained constant for adenocarcinoma of the distal stomach. Blacks were 2.5 times more likely to develop adenocarcinoma of the distal stomach than whites, but had a 50% lower risk of gastric cardia tumours than whites. These results support an emerging concept that adenocarcinoma of the gastric cardia, gastro-oesophageal junction and distal oesophagus may comprise a group of disease which is aetiologically distinct from distal gastric tumours.