Esophageal Cancer Mortality Research Articles

Chemotherapy alone versus definitive concurrent chemoradiotherapy for cT4b esophageal squamous cell carcinoma: a population-based study

BackgroundThe role of radiotherapy for cT4bNanyM0 esophageal squamous cell carcinoma (ESqCC) is relatively unclear, with both chemotherapy (C/T) alone and definitive concurrent chemoradiotherapy (dCCRT) being treatment options in the current guidelines. We aimed to compare the survival of dCCRT versus C/T for these patients via a population-based approach.MethodsEligible cT4b ESqCC patients diagnosed between 2011 and 2017 were identified via the Taiwan Cancer Registry. We used propensity score (PS) weighting to balance the observable potential confounders between groups. The hazard ratio (HR) of death and incidence of esophageal cancer mortality (IECM) were compared between dCCRT and C/T. We also evaluated OS in subgroups of either low or standard radiotherapy doses.ResultsOur primary analysis consisted of 247 patients in whom covariates were well balanced after PS weighing. The HR for death when dCCRT was compared with C/T was 0.36 (95% confidence interval 0.24–0.53, P < 0.001). Similar results were found for IECM. Statistical significance was only observed in the standard RT dose but not in the low dose in subgroup analyses.ConclusionsIn this population-based nonrandomized study of cT4bNanyM0 ESqCC patients from Asia (Taiwan), we found that the use of radiotherapy with chemotherapy was associated with better overall survival than chemotherapy alone. Further studies (especially RCTs) are needed to confirm our findings.

ESOPHAGEAL CANCER MORTALITY IN BRAZIL: A TIME-SERIES ANALYSIS FROM THE GLOBAL BURDEN OF DISEASE STUDY

In the world, around 450,000 new cases of esophageal cancer are diagnosed each year. To evaluate the trend of esophageal cancer mortality rates in Brazil between 1990-2017. A time series study using data on mortality from esophageal cancer in residents ≥30 years in Brazil from 1990 to 2017. Data was estimated by the Global Burden of Disease (GBD) study and analyzed according to sex, age group and federal unit of Brazil. The standardized rates according to age were calculated by the direct method using the standard GBD world population. Annual average percentage change and 95% confidence interval (95% CI) were calculated for mortality by Joinpoint regression. The age-standardized mortality rate in males was 20.6 in 1990 and 17.6/100,000 in 2017, increasing according to age, being 62.4 (1990) and 54.7 (2017) for ≥70 years. In women, the age-standardized mortality rate was 5.9 in 1990 and 4.2/100,000 in 2017. There was a reduction in mortality rates in all age groups and both sexes with great variation among the states. Despite the high mortality rates for esophageal cancer in Brazil, the trend was decreasing, but with regional differences. Mortality was around four times higher in men.

Esophageal cancer: trends in incidence and mortality in China from 2005 to 2015.

BackgroundThe long‐term trend analysis of esophageal cancer is rarely reported in China. Our purpose is to analyze the incidence and mortality trends of esophageal cancer in China from 2005 to 2015.MethodBased on the data in the annual report of the China Cancer Registry, a comprehensive analysis of esophageal cancer cases and deaths from 2005 to 2015 was carried out. The incidence and mortality of esophageal cancer are stratified by gender and region (urban or rural). Long‐term trend analysis was conducted using Joinpoint regression model.ResultIn China, the age‐standardized incidence rates by the world population declined from 13.84/105 in 2005 to 11.64/105 in 2015. Annual percent changes were 3.4% (95% CI: 0.6%, 6.3%) in the period 2005‐2011, −7.4% (95% CI: −10.1%, −4.7%) in the period 2011‐2015, respectively. The age‐standardized mortality rates declined from 10.86/105 in 2005 to 8.57/105 in 2015. And the average annual percent change was −4.1% (95% CI: −6.7%, −1.5%). The incidence and mortality of esophageal cancer in men are higher than those in women, and the incidence and mortality of esophageal cancer in rural areas are much higher than those in urban areas.ConclusionIn China, the incidence of esophageal cancer first increased and then decreased during 2005‐2015, while the mortality rate has been declining.

Low Subcutaneous Adiposity and Mortality in Esophageal Cancer.

Recent data suggest that subcutaneous adiposity represents an independent prognostic marker in cancer. We aimed to determine whether subcutaneous adiposity estimated by the subcutaneous adiposity tissue index (SATI) was associated with mortality in esophageal cancer. We conducted a retrospective analysis of a prospectively enrolled cohort from 2009 to 2015 with esophageal cancer at two major cancer centers. CT scans for initial staging were used to quantify adiposity and skeletal muscle areas. Subjects were categorized as above or below median SATI using sex-specific values. Sarcopenia was defined using previously established skeletal muscle area cutoffs. Cox proportional hazards modeling was performed to determine associations between SATI and all-cause mortality. Of the original 167 patients, 78 met inclusion criteria and had CT images available. Mean age was 67 years, 81.8% had adenocarcinoma, and 58.9% had stage 3 or 4 disease. Median follow-up time was 29.5 months. Overall 5-year survival was 38.9% [95% confidence interval (CI), 26.8-50.7]. Lower body mass index, higher Charlson comorbidity score, and more advanced stage were independently associated with low SATI. Patients with low SATI had increased mortality (unadjusted HR 2.23; 95% CI, 1.20-4.12), even when adjusted for sarcopenia or for percent weight loss. In a multivariable model including age, histology, stage, and receipt of curative surgery, the association between low SATI and mortality was attenuated (adjusted HR 1.64; 95% CI, 0.81-3.34). Low subcutaneous adiposity as estimated by SATI may be associated with increased mortality in esophageal cancer. Interventions to reduce loss of subcutaneous fat may improve survival in esophageal cancer.

Analysis of Esophageal Cancer Death at Different Educational Levels in Inner Mongolia from 2009 to 2015

Objective: This study aimed to clarify the death characteristics of esophageal cancer in Inner Mongolia and the population distribution with various education levels. Methods: The mortality rate of esophageal cancer was calculated using the monitoring point of Death Registry System in Inner Mongolia from 2009 to 2015. The gender, age, region, ethnicity at two education levels of percentage were calculated and the χ2 test was executed. Result: The mortality rate of esophageal cancer was 10.10/105, China Adjustment Mortality was 10.97/105, World Adjustment Mortality was 9.08/105 in Inner Mongolia. The death of esophageal cancer showed statistical significance at two educational levels (P < 0.05). High school and below accounted for 93.9% at the education level, and above high school accounted for 3.5%. In addition, there were significant differences in the percentage of death by gender, age and region at two educational levels (P < 0.05). Conclusion: Education level has a certain relation with the death of esophageal cancer. To improve the health level, health education plans can be formulated according to esophageal cancer prevention relevant policy with different education levels.

Esophageal cancer: Epidemiology, risk factors and screening.

More than 600,000 people are diagnosed with esophageal cancer (EC) every year globally, and the five-year survival rate of EC is less than 20%. Two common histological subtypes of EC, esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC), have great geographical variations in incidence rates. About half of the world’s EC was diagnosed in China and a majority of which belong to ESCC. Globally, the overall incidence rate of EC is decreasing. In some high-risk Asian regions, such as China, the incidence rate of ESCC has generally declined, potentially due to economic growth and improvement of diet habits. In some European high-income countries and the United States, the decline is mainly attributed to the decrease in smoking and drinking. The risk factors of EC are not well understood, and the importance of environmental and genetic factors in the pathogenesis is also unclear. The incidence and mortality of advanced EC can be reduced through early diagnosis and screening. White light endoscopy is still the gold standard in the current screening technology. This article reviews the epidemiology, risk factors, and screening strategies of EC in recent years to help researchers determine the most effective management strategies to reduce the risk of EC.

125P Analysis of esophageal cancer incidence for last 20 years in Uzbekistan

Esophageal cancer (EC) takes, all over the world, 9th place in the structure of new incidents of malignant tumors, amounting to 572034 registered cases and 6th place in the structure of mortality rate, taking 508585 lives annually. According to statistical data, EC develops much more often in men than in women (70% of new cases have developed in men), and people over 70 make up about 40% of the total number of cases, with a peak incidence occurring at the age of 50-60 years. However, these indicators vary by geographic region. So, for example, the highest incidence is found in East Asia, eastern and southern Africa (8.1-23.6‱), while the lowest rate belongs to central America. The aim of the research was to study the dynamics of changes in the incidence trends in the Republic of Uzbekistan over the past 20 years. A meta-analysis of the detection of mortality of esophageal cancer (EC) for all patients with the verified diagnosis was performed. For the period from 2000 - 2019, 18129 patients were identified in the Uzbekistan and the average incidence of EC was 2.8 per 100 thousand of the population. Of these 8283 (45.7%) were treated at the clinic of NCC, in particular, 1174 (14.2%) patients were operated. The analysis revealed that in 2000, in 0,4% and 18,2% of cases, patients had I - II stage disease, in 64,5% of cases – III, and in 18,2% of cases – IV clinical stage, in 2009, 0,5% and 22,8% of cases, patients had I - II stage disease, in 54,4% of cases – III, and in 16,4% of cases - IV clinical stage, and in 2019, 3,3% and 33,7% of cases patients had I – II stage disease, in 44,5% of cases - III, and in 12,5% of cases - IV clinical stage. A relative decrease in the mortality rate over the study period was also revealed: from 2.7% in 2000 to 1.8% in 2019. There has been a decrease in the mortality trend - 2000, 2009 and 2019, 2.2, 1.7 and 1.1, respectively. At the same time, 5-year survival was relatively stable and varied in the range of 12.1% - 27.3%. The largest number of patients was identified in the clinical stage III of the disease and ranged from 42.2 to 67%, respectively.

164 EFFECTIVENESS OF ONE-TIME ENDOSCOPIC SCREENING PROGRAM IN PREVENTION OF ESOPHAGEAL CANCER IN CHINA: A MULTI-CENTER POPULATION-BASED COHORT STUDY

Abstract Esophageal cancer is one of the most common cancers worldwide and half of all new cases occurred in China. Population-based endoscopic screening has been carried out in some high-risk areas in China since 2005, but previous evidence was based predominately on small-sample, single-center studies. We undertook a population-based, multi-center cohort study to estimate the effectiveness of endoscopic screening program in reducing the incidence and mortality of esophageal in high risks areas in China. Methods This study was conducted in six areas in China from 2005 to 2015. All permanent residents aged 40–69 yeas were identified as target subjects. We defined those who were invited and undertook endoscopic screening as the screened group, and those who refused screening as the non-screened group. The target subjects who were not invited to screening was assigned to the control group. The effectiveness of endoscopic screening and screening program were evaluated by comparing the reductions in the incidence and mortality from esophageal cancer in those screened or those invited to screening with reductions in the control group, respectively. Results Our cohort analysis included 637 500 people: 299 483 in the control group and 338 017 in the invited to screening group, 113 340 (33.53%) of whom were screened eventually. Compared with subjects in the control group, esophageal cancer incidence and mortality were reduced by 26% (relative risk(RR) 0.74, 95% confidence interval(CI), 0.69–0.79) and 60% (0.40, 0.36–0.45) respectively in those screened, and they were reduced by 15% (0.85, 0.82–0.89) and 33% (0.67, 0.63–0.71) respectively in those invited to screening. Conclusion Among individuals aged 40–69 years in high risk areas of esophageal cancer, one-time endoscopic screening program was associated with a significant decrease in esophageal cancer incidence and mortality.

Global trends in the incidence and mortality of esophageal cancer from 1990 to 2017.

BackgroundThe incidence and mortality of esophageal cancer are high, with 5.90 new cases and 5.48 deaths per 100 000 people worldwide in 2017. The prognosis of esophageal cancer is poor, with an overall 5‐year survival rate of less than 20%. Esophageal cancer in different geographical locations has different etiologies, and the incidence and mortality of esophageal cancer continue to rise in some regions.MethodsWe collected incidence and mortality data by age and gender for 195 countries and territories from 1990 to 2017 in the Global Burden of Disease (GBD) database. And we used these data to calculate the estimated annual percentage change (EAPC) to quantify trends in morbidity and mortality. Then we analyzed the gender‐ and age‐specific incidence and mortality in esophageal cancer to targeted high‐risk populations. Finally, we analyzed the correlation between the age‐standardized mortality rate (ASMR) and both the EAPC and social‐demographic index (SDI), and we calculated the Pearson correlation coefficient.ResultsWe found that Malawi, East Asia, and high‐middle SDI regions had the highest age‐standardized incidence rate (ASIR) and ASMR, and the ASIR and ASMR in western Sub‐Saharan Africa showed an upward trend. Our study also showed that the incidence and mortality in esophageal cancer were highest in men and in the 70+ years age group, and they presented a decreasing trend in most regions, but the 15‐49 years age groups in Australasia, Caribbean, and Oceania and the 70+ years age group in High‐Income North America, Oceania and high‐SDI regions presented an increasing trend. There were significant negative associations between ASMR at baseline and EAPC and between ASMR and SDI in 2017.ConclusionBy analyzing the global distribution of incidence and mortality in esophageal cancer, trends over time, and gender and age specificity, we can understand the heterogeneity of its global trends. This heterogeneity can help us to identify high‐risk groupsand to provide clues for the exploration of the etiology and early prevention of the disease.

Trends in incidence and mortality of esophageal cancer in Inner Mongolia, 2010-2015.

BackgroundEsophageal cancer is among the leading cancer types in Inner Mongolia. This study aimed to investigate the incidence and mortality rates of esophageal cancer in 2015 and the trends in these rates in the 2010–2015 period in this region.MethodsNational Colorectal Cancer Roundtable (NCCR) screening methods and criteria were used to extract data from 10 cancer registries stratified by area (urban/rural), sex, and age group. The Chinese standard population in 2000 and Segi's world population were used to calculate age‐standardized rates. The annual percentage change (APC) in these rates was calculated using the Joinpoint Regression Program.ResultsIn 2015, Inner Mongolia had 4324 new cases (4027 male vs. 297 female patients) and 3559 deaths (3300 male vs. 259 female patients) from esophageal cancer. The crude incidence, age‐standardized incidence by Chinese population, age‐standardized incidence by world population, and cumulative incidence were 13.45/100 000, 9.92/100 000, 10.18/100 000, and 1.30%, respectively. The corresponding figures for mortality were 11.32/100 000, 8.35/100 000, 8.53/100 000, and 1.04%. The incidence and mortality increased with age between 40 and 80 years. The rates in rural dwellers, especially men, showed negative APC (−13.25% vs. −11.08%; P < 0.05).ConclusionsThe incidence and mortality rates of esophageal cancer in Inner Mongolia increased between 2010 and 2015. The rates were higher in men in rural areas, middle‐aged and elderly individuals. Prevention and control programs focused on these groups, in addition to early diagnosis and treatment of esophageal cancer, are needed to reduce these rates.Key points Significant findings of the study: In Inner Mongolia, incidence and mortality rates of esophageal cancer were higher in urban areas than in rural areas and in men than in women between 2010 and 2015, and in middle‐aged and elderly than in younger people. What this study adds: Prevention and control programs, in addition to early diagnosis and treatment of esophageal cancer, should be tailored to specifically target men in rural areas and middle‐aged and elderly individuals in order to reduce the incidence and mortality rates of this pathology.

Sa1240 PREDICTORS FOR LYMPH NODE METASTASIS OF T1B ESOPHAGEAL CANCER AND SURVIVAL FOLLOWING ENDOSCOPIC THERAPY WITH/WITHOUT ADJUVANT THERAPY AND SURGERY: AN ANALYSIS OF SURVEILLANCE, EPIDEMIOLOGY, AND END RESULTS (SEER) DATABASE

Endoscopic therapy (ET) has become a treatment of choice for high grade dysplasia and intramucosal (T1a) esophageal cancer (EC). For T1b EC (tumor invading submucosa), esophagectomy remains the mainstay treatment because previous studies, using single-centered data, reported higher risk of lymph node metastasis (LNM). The use of ET in low risk T1b EC and ET followed by adjuvant chemotherapy ± radiation (CRT) for patients who decline or are unfit for surgery have been reported. However, outcomes data have been limited to a few small studies from tertiary centers. 1) to determine the prevalence and risk factors of LNM of T1b EC using a large national cancer database and 2) evaluate the survival outcomes of T1bN0M0 EC after ET alone, ET+CRT compared to radical surgery. We used the SEER 18 database to identify patients with T1b histologically confirmed EC diagnosed between 1998-2016. Prevalence of LNM at initial diagnosis and its risk factors were analyzed. Cancer-specific survival (CSS) and overall survival (OS) were calculated using Kaplan-Meier’s (KM) estimate. The multivariate analysis was performed with the Cox-regression method after controlling for other relevant covariates. A total of 1374 patients with T1b EC were identified (mean age: 65; 82% men; 89% white; 77% adenocarcinoma[AC]; 22% squamous cell cancer[SCC]) (Table 1).Overall, 283 patients(20.6%) had LNM at the time of diagnosis with prevalence of 20% in AC and 22.8% in SCC(p=0.279). In multivariate analysis, age≦65, diagnosis in 2010-2016(vs older years), tumor size ≧ 2 cm, and poorly differentiation were associated with LNM. Survival of patients with T1b with LNM was significantly lower than those with LNM(-) [3-yr OS: 63.7% and 47.8%, p<0.001; 3-yr CSS: 72.1% and 54.1%, p<0.001]. Subgroup of patients with T1bN0M0 EC who received ET only(n=96), ET+CRT(n=22) and surgery(n=788) were further analyzed. The median follow-up time was 39 months(IQR 14-89). 3-yr OS and CSS were: 65%/81% in ET, 30%/88% in ET+CRT and 73%/79% in surgery. KM curves are shown in Figure 1. In a multivariate proportional hazards model; adjusted for age, gender, race, histologic type, year of diagnosis, site of cancer, SEER region, ET alone and surgery resulted in statistically equivalent in overall mortality[Hazard ratio(HR) 0.93, 95%CI 0.68-1.43, p=0.93] and esophageal cancer mortality[HR 1.47, 95%CI 0.86-2.51, p=0.16]. ET+CRT, as compared to ET alone, was associated with increased overall mortality[HR 2.17, 95%CI 1.03-4.57, p=0.04], with no significant difference in esophageal cancer survival. In this population-based study, the prevalence of LNM in T1b EC is 20%. In patients with T1bN0M0, overall and cancer specific survival of those treated with ET appears to be similar to those treated with surgery. Addition of CRT following ET negatively impacts survival outcomes.Figure 1Kaplan–Meier graphs showing the survival in patients with T1bN0M0 esophageal cancer treated with endoscopic treatment +/- chemoradiation or surgeryView Large Image Figure ViewerDownload Hi-res image Download (PPT)

Spatial distribution of esophageal cancer mortality in China: a machine learning approach.

BackgroundEsophageal cancer (EC) is one of the most common cancers, causing many people to die every year worldwide. Accurate estimations of the spatial distribution of EC are essential for effective cancer prevention.MethodsEC mortality surveillance data covering 964 surveyed counties in China in 2014 and three classes of auxiliary data, including physical condition, living habits and living environment data, were collected. Genetic programming (GP), a hierarchical Bayesian model and sandwich estimation were used to estimate the spatial distribution of female EC mortality. Finally, we evaluated the accuracy of the three mapping methods.ResultsThe results show that compared with the root square mean error (RMSE) of the hierarchical Bayesian model at 6.546 and the sandwich estimation at 7.611, the RMSE of GP is the lowest at 5.894. According to the distribution estimated by GP, the mortality of female EC was low in some regions of Northeast China, Northwest China and southern China; in some regions downstream of the Yellow River Basin, north of the Yangtze River in the Yangtze River Basin and in Southwest China, the mortality rate was relatively high.ConclusionsThis paper provides an accurate map of female EC mortality in China. A series of targeted preventive measures can be proposed based on the spatial disparities displayed on the map.

Fresh fruit consumption may decrease the long-term risk of esophageal cancer mortality: A 30-year follow-up study in the Linxian Dysplasia Nutrition Intervention trial (NIT).

BackgroundThe objective of this study was to explore the association between fresh fruit consumption and long‐term risk of upper gastrointestinal cancer (UGI) in the Linxian Dysplasia Nutrition Intervention Trial (NIT) cohort.MethodsA cohort of 3318 subjects with esophageal squamous dysplasia participated in the Linxian Dysplasia NIT in May 1985 and were followed up until 30 September 2015. Demographic characteristics, lifestyle, and history of diseases were collected at the baseline. The primary endpoint was death from esophageal squamous cell carcinoma (ESCC), gastric cardia carcinoma (GCC), and gastric noncardia carcinoma (GNCC). Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were estimated using the Cox proportional hazard model.ResultsIn the 30‐year follow‐up, a total of 541 ESCC, 284 GCC, and 77 GNCC deaths occurred. Relative to those who never or rarely consumed fresh fruit, the risk of ESCC mortality in participants who consumed fresh fruit more than 12 times/year were significantly decreased by 37.3% (HR = 0.63, 95% CI: 0.49–0.81). In the subgroup analyses, significantly protective effects on ESCC mortality were observed especially in females (HR = 0.59, 95% CI: 0.40–0.89), non‐smokers (HR = 0.67, 95% CI: 0.48–0.94), and nondrinkers (HR = 0.69, 95% CI: 0.51–0.93).ConclusionsConsuming fresh fruit more than 12 times/year may reduce the long‐term risk of ESCC mortality in this dysplasia population, particularly in females, non‐smokers, and nondrinkers. Future studies are needed to confirm these findings.

Esophageal cancer: How far is close enough?

e19049 Background: According to Surveillance, Epidemiology, and End Results (SEER) data, 5-year survival of esophageal cancer (EC) improved from 4.1% to almost 20% from 1975 to 2016, however, this is still poor compared to other cancers. Chitti et al describe temporal changes in EC mortality by geographic region across the United States (U.S.) and concluded that disparities exist. Other studies described survival disparities for rural communities specific to small cell lung carcinoma, cervical cancer, and breast cancer. Hung et al determined that 1 in 5 rural Americans lived &gt; 60 miles from a medical oncologist. Studies performed outside of the U.S. described no difference in survival with travel distance. No studies on this topic have focused on gastrointestinal malignancy. Our study aimed to associated travel distance with travel time to a medical oncology treatment center as time can vary greatly with similar distances. We focused specifically on esophageal cancer considering its high mortality rate and significant effect on quality of life. Methods: We performed a descriptive analysis of a retrospective cohort (January 2008 – August 2019) of all individuals diagnosed with esophageal cancer using data from the institutional Oncology Tumor Registry, a regional cancer registry, and the electronic health records (EHR) of patients throughout a rural integrated health system in Pennsylvania. We geocoded home addresses using Google Maps Geocoding application programming interface (API) and the average driving distance and time to the nearest medical oncology treatment center was calculated using the Google Maps Distance Matrix API. Travel time compared to cancer stage was also assessed. Addresses listed over 100 miles were evaluated for documentation accuracy via the EHR. Results: A total of 1157 adult patients diagnosed with esophageal cancer was evaluated; of these, 433 had a documented outpatient chemotherapy infusion site visit. The mean travel distance to a medical oncology treatment center was 19.8 miles with a median of 16 miles; this correlated with a mean travel time of 28.2 minutes. Seventy-five percent of the population lived within 26 miles of an outpatient oncology center. The maximum distance traveled was 139 miles, which was confirmed via EHR chart review. Conclusions: This study shows that a rural population may not necessarily experience disparity in travel distance and time to a medical oncology treatment center. This was an exploratory study and further analysis will be needed to see if there was any statistically significant difference in survival based on distances when stratified by stage, age, treatment modality, etc.

Association between the National Cancer Screening Programme (NSCP) for gastric cancer and oesophageal cancer mortality

BackgroundThe aim was to evaluate whether this gastric cancer-screening programme was effective in reducing oesophageal cancer mortality.MethodsA population-based retrospective cohort study was conducted using the Korean National Cancer Screening Programme (NCSP) database. The study cohort comprised 16,969 oesophageal cancer patients who had been diagnosed in 2007–2014. We analysed the association between the history of NSCP for gastric cancer and oesophageal cancer mortality.ResultsCompared with never-screened subjects, ever-screened subjects had an overall HR for oesophageal cancer mortality of 0.647 (95% CI, 0.617–0.679). According to the time interval since screening, the HRs of death were 0.731 (95% CI, 0.667–0.801) for 6–11 months, 0.635 (95% CI, 0.594–0.679) for 12–23 months, 0.564 (95% CI, 0.522–0.610) for 24–35 months and 0.742 (95% CI, 0.679–0.810) for ≥36 months. According to the last screening modality, the HRs of death were 0.497 (95% CI, 0.464–0.531) for upper endoscopy, and 0.792 (95% CI, 0.749–0.838) for UGIS. Upper endoscopy reduced the mortality consistently in all age groups over 50 years, whereas UGIS could not.ConclusionThe NCSP for gastric cancer was effective in reducing the mortality of oesophageal cancer, and upper endoscopy was superior to UGIS.

Esophageal cancer: analytical&#x0D; indicators of cancer service efficacy

Relevance: Esophageal cancer ranks eighth in the structure of malignant tumors in the Republic of Kazakhstan.&#x0D; According to the Kazakh Institute of Oncology and Radiology, in 2018, 1225 were primarily registered with esophageal&#x0D; cancer, and 825 patients died from this disease.&#x0D; The purpose of this study was to analyze the esophageal cancer incidence and mortality among the population&#x0D; of the Republic of Kazakhstan in 2009-2018 and determine&#x0D; the cancer service efficacy.&#x0D; Results: The analysis of intensive indicators of esophageal cancer incidence showed a decrease in the number of&#x0D; primary cases from 8.2‰ in 2009 to 6.7‰ in 2018, and&#x0D; the mortality – from 6.9‰ to 3.8‰. The share of early&#x0D; detection (Stage I-II) has increased by 38.2% since 2009 to&#x0D; reach 52.1% in 2018. The share of stage IV esophageal cancer&#x0D; has decreased from 7.2% in 2009 to 5.8% in 2018. One-year&#x0D; mortality has decreased by 14.7% since 2009 to reach 41.2%&#x0D; in 2018, which speaks of the improvements in the timely diagnosis of esophageal cancer. The number of patients who&#x0D; received radical comprehensive treatment has increased by&#x0D; 8.6% to reach 32.2% in 2018. The number of patients who&#x0D; received surgical treatment in 2009-2018 remained almost&#x0D; at the same level and amounted to 18.9 and 18.0%, respectively. However, during the years of screening for esophageal&#x0D; cancer, the proportion of surgical treatment has increased&#x0D; from 26.6% to 30.4%. The ratio of incidence to mortality has&#x0D; decreased from 91.4% to 68.8% in the study period indicating an improvement in the level of cancer service in the Republic of Kazakhstan.&#x0D; Conclusion: The analysis of intensive indicators of&#x0D; esophageal cancer incidence showed a decrease in primary&#x0D; incidence. The screening conducted in 2013-2016 has shown&#x0D; an improvement in early detection of esophageal cancer&#x0D; (stages I-II) and a decrease in the share of the advanced&#x0D; stage. The findings of this study shall serve as the basis for&#x0D; planning anti-cancer activities

Esophageal cancer: analytical indicators&#x0D; of cancer service efficacy

Relevance: Esophageal cancer ranks eighth in the structure of malignant tumors in the Republic of Kazakhstan. According to the Kazakh Institute of Oncology and Radiology, in 2018, 1225 were primarily registered with esophageal cancer, and&#x0D; 825 patients died from this disease.&#x0D; The purpose of this study was to analyze the esophageal cancer incidence and mortality among the population of the&#x0D; Republic of Kazakhstan in 2009-2018 and determine the cancer service efficacy.&#x0D; Results: The analysis of intensive indicators of esophageal cancer incidence showed a decrease in the number of primary cases from 8.2‰ in 2009 to 6.7‰ in 2018, and the mortality – from 6.9‰ to 3.8‰. The share of early detection&#x0D; (Stage I-II) increased by 38.2% since 2009 to reach 52.1% in 2018. The share of stage IV esophageal cancer decreased from&#x0D; 7.2% in 2009 to 5.8% in 2018. One-year mortality decreased by 14.7% since 2009 to reach 41.2% in 2018, which speaks of the&#x0D; improvements in the timely diagnosis of esophageal cancer. The number of patients who received radical comprehensive&#x0D; treatment increased by 8.6% to reach 32.2% in 2018. The number of patients who received surgical treatment in 2009-2018&#x0D; remained almost at the same level and amounted to 18.9 and 18.0%, respectively. However, during the years of screening&#x0D; for esophageal cancer, the proportion of surgical treatment increased from 26.6% to 30.4%. The ratio of incidence to mortality decreased from 91.4% to 68.8% in the study period indicating an improvement in the level of cancer service in the&#x0D; Republic of Kazakhstan.&#x0D; Conclusion: The analysis of intensive indicators of esophageal cancer incidence showed a decrease in primary incidence. The screening conducted in 2013-2016 has shown an improvement in early detection of esophageal cancer (stages&#x0D; I-II) and a decrease in the share of the advanced stage. The findings of this study shall serve as the basis for planning anti-cancer measures

Characterization of Esophageal Cancer and ItsAssociation with Influencing Factors in GuangzhouCity, China.

Epidemiological features of esophageal cancer (EC), as well as their associations with potential influencing factors in a city, have seldom been seldom explored on a fine scale. The EC death cases in Guangzhou city during 2012−2017 were collected to describe the epidemiological characteristics such as EC mortality rate (ECMR) and health-seeking behaviors of deaths. Potential influencing factors, including socioeconomic conditions (population density, gross domestic product density), medical resources, and ageing degree were also gathered for exploring their relationships with the epidemiological characteristics of EC. A total of 2,409 EC deaths were reported during 2012−2017 in Guangzhou with an age-standardized ECMR of 3.18/105. The prevalence of EC in Guangzhou was spatially featured and was divided into three regions with obvious differentiated ECMR (ECMR of 6.41/105 in region A, ECMR of 5.51/105 in region B, ECMR of 2.56/105 in region C). The street/town-level ECMR was spatially clustered in Guangzhou city, especially two clusters of streets/towns with high ECMR were highlighted in region A and B respectively. Meanwhile, demographic features including gender gap, death age, temporal interval between diagnosis and death, health-seeking behaviors were remarkably different among the three regions. Moreover, health-seeking behaviors (e.g., the proportion of hospital deaths) of the EC deaths were obviously influenced by medical institution occupancy rate and socioeconomic conditions at street/town level. In addition, the street/town-level ECMR was significantly associated with ageing degree across Guangzhou city (r = 0.466, p < 0.01), especially in region A (r = 0.565, p < 0.01). In contrast, the ECMR in region B was closely related to population density (r = −0.524, p < 0.01) and gross domestic product density (r = −0.511, p < 0.01) when the ageing degree was controlled, while these associations were weak in region C. The epidemiological characteristics of EC in Guangzhou city were spatially featured and potentially associated with socioeconomic conditions, medical resources and ageing degree on a fine scale across Guangzhou city. This study could provide scientific basis for local authorities to implement more targeted EC interventions.

20-Year Comparative Survival and Mortality of Cancer of the Esophagus by Age, Sex, Race, Stage, Grade, Cohort Entry Time-Period, Disease Duration &amp; Selected ICD-O-3 Oncologic Phenotypes: A Systematic Review of 83,658 Cases for Diagnosis Years 1973-2014: (SEER*Stat 8.3.4)

Objective.— To update trends in incidence, prevalence, short- and long-term survival and mortality of esophageal cancer using the statistical database of SEER*Stat 8.3.4 for diagnosis years 1973-2014 employing multiple case selection variables. Methods.— A retrospective, population-based study using nationally representative data from the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) program to evaluate 83,658 cases of esophageal cancer for diagnosis years 1973-2014 comparing multiple variables of age, sex, race, stage, grade, cohort entry time-period, disease duration, and, two histologic oncotypes. Relative survival statistics were analyzed in two cohorts: 1973-1994 and 1995-2014. Survival statistics were derived from: SEER*Stat Database: Incidence – SEER 9 Regs Research Data, November 2016 Submission (1973-2014) &amp;lt;Katrina/Rita Population Adjustment&amp;gt; Released April 2017 (Ref. 9). Case frequency and incidence data, derived from the SEER program, were used to design the table format and number of pages for this report. Results.— In a total of 83,658 cases of esophageal cancer in the United States for diagnosis years 1973-2014, multiple variables of age, sex, race, stage, grade, cohort entry time-period, disease duration, and, two histologic oncotypes were compared. Mean age in males was 66.5 years, females 70.1 years, both male and female 67.2 years. Greater than 85% of incidence cases occurred between ages 55-85+ years with the zenith in males at 65-69 years (59.4%) and 70-74 years (60.5%) in females. The overall annual US death rate from 1975-2014 has slightly increased from 3.69 to 3.99 per 100,000 per year, and excess mortality remains exceedingly high. Of the 83,658 invasive cases, 82.6% were clinically staged and 79.4% were histologically graded. Conclusions.— Relative frequency, incidence and time-trends, and the clinical, demographic and secular variables of age, sex, race, stage, grade, cohort-entry time-periods, and predominant clinical oncotypes were comparatively analyzed to provide a comprehensive medical-actuarial assessment of esophageal cancer survival and mortality in the 1973-2014 time-frame.

Ornithine decarboxylase inhibition downregulates multiple pathways involved in the formation of precancerous lesions of esophageal squamous cell cancer.

The high incidence and mortality of esophageal squamous cell cancer (ESCC) is a major health problem worldwide. Precancerous lesions of ESCC may either progress to cancer or revert to normal epithelium with appropriate interventions; the bidirectional instability of the precancerous lesions of ESCC provides opportunities for intervention. Reports suggest that the upregulation of ornithine decarboxylase (ODC) is closely related to carcinogenesis. In this study, we investigated whether ODC may act as a target for chemoprevention in ESCC. Immunohistochemistry (IHC) assays indicate that ODC expression is higher in esophageal precancerous lesions compared with normal tissue controls. Its overexpression promotes cell proliferation and transformation of normal esophageal epithelial cells, and its activity is increased after N-nitrosomethylbenzylamine (NMBA) induction in Shantou human embryonic esophageal cell line (SHEE) and human immortalized cells (Het1A) cells. In addition, p38 α, extracellular regulated kinase (ERK1/2) in the mitogen-activated protein kinase pathway and protein kinase B (AKT)/mammalian target of rapamycin (mTOR)/ribosomal protein S6 kinase (p70S6K) pathways are activated in response to NMBA treatment. Difluoromethylornithine (DFMO) is an ODC inhibitor, which inhibits NMBA-induced activation of p38 α, ERK1/2 and AKT/mTOR/p70S6K pathways; this has been verified by Western blotting. DFMO was also found to suppress the development of esophageal precancerous lesions in an NMBA-induced rat model; IHC demonstrated p38 α, ERK1/2, and AKT/mTOR/p70S6K pathways to be downregulated in these rats. These findings indicate the mechanisms by which ODC inhibition suppresses the development of esophageal precancerous lesions by downregulating p38 α, ERK1/2, and AKT/mTOR/p70S6k signaling pathways, ODC may be a potential target for chemoprevention in ESCC.