Status of non-steroidal anti-inflammatory drugs use in areas with a high incidence of upper gastrointestinal cancer in China: a multi-center cross-sectional survey / 中华预防医学杂志

Objective@#To describe the status of non-steroidal anti-inflammatory drugs (NSAIDs) use in areas with a high incidence of upper gastrointestinal cancer in China. @*Methods@#This study was based on the National Key Research and Development Program of "National Precision Medicine Cohort of Esophageal Cancer" and "Study on Identification and Prevention of High-risk Populations of Gastrointestinal Malignancies (Esophageal cancer, Gastric cancer and Colorectal cancer)" . From January 2017 to August 2018, 212 villages or communities with a high incidence of esophageal cancer or gastric cancer were selected from 12 regions in 6 provinces. A total of 35 910 residents aged between 40 and 69 years old who met the inclusion criteria and signed the informed consent were investigated and enrolled in this study. The use of NSAIDs, demographic characteristics, health-related habits, height, weight, and blood pressure were collected by the questionnaire and physical examination. The status of main NSAIDs (aspirin, acetaminophen and ibuprofen) use with the difference varying in genders, age groups and regions were analyzed by using χ2 test and Cochran-Armitage trend analysis method. @*Results@#Of 35 910 subjects, the mean age was (54.6±7.1) years old and males accounted for 43.42% (15 591). The overall prevalence of NSAIDs intake was 4.56% (1 638), but it significantly varied in different provinces (P<0.001). The overall prevalence of NSAIDs intake was 4.87% (1 750) in females, which was significantly higher than that in males 4.24% (1 524) (P<0.001). The prevalence of NSAIDs intake increased with age (P for trend <0.001). As the frequency of NSAIDs intake increased, the incidence of gastrointestinal symptoms, gastrointestinal ulcers and black stools increased (P for trend <0.05 for all). @*Conclusion@#The use of NSAIDs is prevalent in some areas with a high incidence of upper gastrointestinal cancer in China. The increased use of NSAIDs may lead to more adverse effects related to the gastrointestinal tract.

Analysis survival of screening and non-screening patients of esophageal cancer in Linzhou city / 中华预防医学杂志

Objective@#To evaluate effect of screening of esophageal cancer though comparing difference of survival level between screening and non-screening patients in Linzhou city.@*Methods@#The records pathologically diagnosed as serious hyperplasia/carcinoma and esophageal cancer were drawn from database of first round screening in Linzhou city from 2005-2013 and were assigned to the screening group. The records of new esophageal cancer cases which diagnosed within 2 years before, screening from the same village aged from 40 to 69, were drawn from database of cancer registry in Linzhou city and were assigned to the non-screening group. Five or 10 year survival rate with 95%CI of patients with different malignant degree diseases in the screening group and the patients with esophageal cancer in the non-screening group was calculated respectively. The survival curves between the screening and non-screening group were compared by Log rank method.@*Results@#All 26 908 persons were examined in first round screening in Linzhou city from 2005 to 2013. There were 374 persons with serious hyperplasia/carcinoma in situ, 157 persons with esophageal cancer (141 intramucosal carcinomas/submucosal cancers, 16 invasive cancers). The 5 year survival rate of serious hyperplasia/carcinoma, intramucosal carcinoma/submucosal cancer and invasive cancer were 95.0% (95%CI: 91.7%-97.0%) , 72.0% (95%CI: 62.7%-79.3%) and 41.7% (95%CI: 17.4%-64.6%) separately. The 5 year survival rate of esophageal cancer in screening and non-screening group were 68.7% (95%CI:59.9%-75.9%) and 40.8% (95%CI: 36.4%-45.2%). The 10 year survival rate of esophageal cancer in screening and non-screening group were 58.0% (95% CI: 44.6%-69.3%) and 34.3% (95% CI:29.1%-39.5%). The 5 or 10 year survival rate of esophageal cancer in the screening group were higher than that in the non-screening group in whatever sex or age. The survival distribution of the screening group was better than non-screening group (χ2=38.88, P<0.001).@*Conclusion@#More precancerous lesions and early esophageal cancer can be detected and patients' survival level was improved through organized esophageal cancer screening, which provided support to evaluate value of organized screening.

Analysis of psychological status and relevant factors of patients with esophageal and gastric cardia precancerous lesions in Linzhou of Henan / 中华预防医学杂志

Objective@#To explore the psychological status and related factors in patients with precancerous of esophageal and gastric cardia in Linzhou of Henan.@*Methods@#Clinical psycho-rating scale of Social Support Rating Scale (SSRS), Self-Rating Anxiety Scale (SAS, score ≥50 points with symptoms of anxiety) and Self-Rating Depression Scale (SDS, score ≥53 points with the symptoms of depression) were applied to survey life events and psychological status of subjects who aged 40-69 years old and participated in"The Early diagnosis and Early Treatment"program in Linzhou cancer hospital from July 2015 to Jan 2016. Patients with lower intraepithelial neoplasia or high-grade intraepithelial neoplasia were selected as precancerous lesions (n=118), and patients with normal grade were selected as healthy controls (n=210). Compare the differences of the scores between the two groups, and the logistic regression model was used to analyze the related factors of precancerous lesions and psychological status of the study subjects.@*Results@#Precancerous lesions included esophageal (72 cases), gastric cardia (40 cases), esophageal and cardia dual source (6 cases); Precancerous lesions and healthy controls aged (57.17±7.71) and (53.12±7.99) years old, the difference was statistically significant (P<0.001). The anxiety and depression scale showed that the scores of SAS and SDS scores in the precancerous lesions were (37.18±10.01), (40.44±8.37) points, and (34.02±6.63), (38.49±8.73) points in control group, the difference was statistically significant (P=0.002, 0.032). While the social support total score (38.26±5.26), and subjective support score (24.08±3.83) and objective support score (7.50±1.89) in control group were all higher than those of precancerous group (36.80±6.18, 23.01±3.93, 6.93±1.57), and the difference were statistically significant (P=0.024, 0.016, 0.004). In addition, the Logistic analysis showed that subjects with low objective social support, subjective social support and anxiety symptoms were more likely to develop precancerous lesions, and the OR were 0.81, 0.72 and 1.05, respectively (P=0.028, 0.005, 0.009).@*Conclusion@#Social support, anxiety and depression status may be related to the occurrence and development of esophageal and gastric cardia precancerous lesions.

Distribution of esophageal squamous cell cancer and precursor lesions in high-risk areas, Linzhou in Henan province and Feicheng in Shandong province of China, 2005-2009 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To understand the distribution of esophageal squamous cell cancer and precursor lesions in high-risk areas of China, and to provide evidence for determining the reference ranges of detection rates in high-risk areas.</p><p><b>METHODS</b>Endoscopy with Lugol's iodine staining was performed on 15 709 local residents aged 40 to 69 years old in Linzhou of Henan province and Feicheng of Shandong province from 2005-2009. 35 cases without accurate pathology diagnosis and 11 cases with vital disease before screening were excluded. 15 663 subjects were enrolled in this study. Compliance was calculated by the percentage of the people who had endoscopic screening among the target population. Chi-square test and trend chi-square test were used to compare the distribution differences in age, gender and areas of esophageal squamous cell cancer and precancer. 95% CI of the detection rates was then employed to represent the reference ranges of esophageal squamous cell cancer and precursor lesions.</p><p><b>RESULTS</b>The compliance rate of screening endoscopy of this study was 49.36% (15 709/31 826) of all, and female's compliance (54.05%, 8 447/15 628) was much higher than that of male (44.83%, 7 262/16 198) (χ(2) = 88.14, P < 0.001). The detection rates of basal cell hyperplasia, low grade intraepithelial neoplasia, high grade intraepithelial neoplasia and esophageal squamous cell cancer of males were 4.17% (302/7 246), 17.22% (1 248/7 246), 1.67% (121/7 246), 0.83% (60/7 246), and were higher than that of females (3.45% (290/8 417), 14.82% (1 247/8 417), 1.41% (119/8 417), 0.48% (40/8 417), respectively). Except for high-grade intraepithelial neoplasia, the detection rates of male were higher than that of female (P values were 0.018, < 0.001, 0.960, 0.006). The detection rates of all grades of precursor lesions increased with age rising (all P values < 0.001), among which the detection rates of the mentioned four lesions for 40-44 years old were 2.69% (94/3 500), 8.11% (284/3 500), 0.40% (14/3 500), 0.14% (5/3 500), and that of 65-69 years old were 5.46% (46/843), 23.25% (196/843), 3.68% (31/843), 2.14% (18/843). The proportion of esophageal precursor lesion of Linzhou were higher than that of Feicheng observably except for esophageal squamous cell cancer (P values were < 0.001, < 0.001, < 0.001, 0.437). The detection rates of the four lesions of Linzhou and Feicheng were 4.90% (504/10 287), 17.37% (1 787/10 287), 1.79% (184/1 0287), 0.60% (62/10 287) and 1.64% (88/5 376), 13.17% (708/5 376), 1.04% (56/5 376), 0.71% (38/5 376). The 95% CI of detection rates of various lesions were, 3.78% (3.48%-4.08%) for basal cell hyperplasia, 15.93% (15.37%-16.50%) for low-grade intraepithelial neoplasia, 12.31% (11.79%-12.82%) for mild dysplasia and 3.62% (3.33%-3.91%) for moderate hyperplasia, 1.53% (1.34%-1.72%) for high-grade intraepithelial neoplasia and 0.64% (0.51%-0.76%) for esophageal squamous cell cancer, respectively.</p><p><b>CONCLUSION</b>Up to 21.88% residents that were asymptomatic were suffered from esophageal squamous cancer or precursor lesions in high-risk areas in China. The distribution of esophageal squamous cell cancer and precursor lesions was closely related to the gender and the age, which suggested that males were supposed to be paid more attention to.</p>

Cost-effectiveness analysis of esophageal cancer once-in-a-lifetime endoscopic screening in high-risk areas of rural China / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To estimate the cost-effectiveness of esophageal cancer endoscopic screening once-in-a-lifetime and to predict the optimal screening age for people in high-risk areas of rural China.</p><p><b>METHODS</b>A Markov model was constructed to predict and compare the effect of four esophageal cancer endoscopic screening modalities which varied with different screening ages. Long-term epidemiological effectiveness and cost-effectiveness were predicted by simulation of the model.</p><p><b>RESULTS</b>Compared with the control group, strategies starting at 40, 45, 50 and 55 year-old had saved life-years of 629.51, 769.88, 738.98 and 533.21 years per 100 000 people, respectively, of which the strategy starting at 45 year-old saved the maximum life years. All strategies were cost-effective and starting at 40 year-old cost the most per life-year saved. Among all alternatives, strategies starting age at 45 year-old and 50 year-old were incremental cost-effective, and the incremental cost-effective ratios were 34 962.87 and 3 346.43 RMB per life year saved, respectively.</p><p><b>CONCLUSIONS</b>The strategy starting at 40 year-old implemented at present and other strategies were cost-effective in high-risk areas of rural China. However, the 45-year-old group is more aligned with the principle of cost-effectiveness. Considering the cost-effectiveness of different strategies and social economic status, 45 year-old is regarded as the optimal starting age of esophageal cancer once-in-a-lifetime endoscopic screening and is recommended in areas lacking health resources. The strategy of starting age at 40 year-old which could obtain better screening effects would be preferable in wealthy regions.</p>

Long-term survival rate of precancerous lesions and early esophageal cancers after endoscopic mucosal resection / 中华消化内镜杂志

ObjectiveTo evaluate the long-term survival rate of precancerous lesions and early esophageal cancer after endoscopic mucosal resection (EMR).MethodsThe follow-up endoscopy was performed in 154 patients with early esophageal cancer and precancerous lesions who underwent EMR.The examinations were carried out at 1 month,6 months and every 1 year after the procedure,respectively,and argon plasma coagulation (APC) was applied if a recurrent lesion was suspected.The follow-up rate was 100%.ResultsAfter EMR,reecurence occurred in 6 cases (3.9%) in 5 years,of which 4 received esophagectmy,1 underwent APC,and the other one died from matastasis.The 5-year survival rate was 97.4% (150/154),with 1 died from matastasis and 3 from noncancerous diseases.The 5-year survival rate of 125 patients with high grade dysplasia,carcinoma in situ and intramucosal carcinoma was 97.6%( 122/ 125),with 1 died from noncancerous disease and 1 from metastasis.The 5-year survival rate of 29 patients with low grade dysplasia was 96.6% ( 28/29 ) with 1 patient died from noncancerous disease.ConclusionEMR,as a minimally invasive procedure,is suitable for precancerous lesions and early esophageal cancer,especially for high grade dysplasia,carcinoma in situ and intramueosal carcinoma,with little sequela and long-term survival.

Endoscopic study on cancer of gastric cardia in the high incidence areas of China / 中华肿瘤杂志

<p><b>OBJECTIVE</b>Endoscopy was used to study the high incidence area of cancer of gastric cardia.</p><p><b>METHODS</b>417 patients with early cardiac cancer and 451 patients with advanced lesions were analyzed to the high incidence point of cardiac cancer. Verifying endoscopic screening of 205 subjects was performed later in the high incidence area of esophageal cancer.</p><p><b>RESULTS</b>327 of 417 (78.4%) of early cardiac cancer patients and 336 of 451 (74.5%) of advanced lesions were proved to have developed their origin at the root of the mucosal fold in the gastric cardia. Eleven cardiac cancer patients were found by the verifying endoscopic screening, among whom 9 patients (81.8%) developed the primary focus at the root of mucosal fold in the cardia.</p><p><b>CONCLUSION</b>The root of mucosal fold in the gastric cardia is proved to be the high incidence point of cancer of gastric cardia, which is very important clinically.</p>

Prevention and treatment of complications after endoscopic esophageal mucosal resection for early esophageal cancer and precancerous lesion / 中华消化内镜杂志

Objective To evaluate the treatment outcome of endoscopic esophageal mucosal resection (EMR) and alleviate or prevent the complication of EMR. Methods We explore a strategy of endoscopic esophageal mucosal resection to treat early esophageal cancer and severe dysplasia . Endoscopic esophageal mucosal resection was performed with transparent-cap technique, resdiual lesions were treated by Argon Plasma Cocagulation( APC). All patients have been followed up by endoscopic examinations at one month, 4 months, and 12 months after therapy. Results Seventy one cases (88 lesions) were treated by endoscopic esophageal mucosal resection with transparent-cap method. Average doses of saline-epinephrine 18 ml is injected submucosally to each lesion. The resected specimens were on average(21.8 ?1.0)mm ? (18.2?1. 0)mm in size. Five cases have bleeding after mucosectomy, bleeding were managed and controlled by compression , local injection of saline-epinephrin, and APC. Perforation never occurred. Four cases have stenosis after mucosal resection, in three of them the resected area was more than 3/4 esophageal circumference, then it was dilated with water ballon dilater at one month, two months and three months after mucosal resection, all cases were cured. Conclusions Endoscopic esophageal mucosal resection is a safe, simple, minimally invasive and effective procedure with few complication in treating early esophageal cancer and precan-cerous lesion.

Endoscopic screening of esophageal cancer with iodine staining in high risked area / 中华消化内镜杂志

Objective To evaluate the application and effect of endoscopic screening directly with i-odine stain in high risked area of esophageal cancer and compare the detecting rate of cancer and dysplasia before and after iodine stains. Methods In the high risked area of esophageal cancer, endoscopic exam were directly performed in 3 022 people, aged 40 - 69 years with iodine staining and biopsy, then observing and recording the alternation of color and morphology of mucbsa and texture of submucosal blood vessels before and after iodine staining. Results One hundred and thirty one cases of esophageal carcinoma and 659 cases of moderate and severe dysplasia were diagnosed by biopsy; the discovery of esophageal cancer before and after iodine stain were 57 ( 1. 9% ) and 111(3.7%) cases, while of moderate and severe dysplasia were 154(5. 0% ) and 659(21. 8% ) cases respectively with significant statistical differences. Conclusion The mucosal iodine staining under endoscopy markedly increased the detecting rates of early superficial esophageal cancer and dysplasia ( moderate and severe) .