Changing trend of incidence and mortality of esophageal cancer during 2010-2016 in Henan Province, China / 中华肿瘤杂志

Objective: To estimate the incidence and mortality of esophageal cancer in 2016 and their changing trend during 2010-2016 according to the cancer registration data in Henan province. Methods: The data quality including completeness, validity, and reliability of local registries which submitted the cancer registration data of 2016 were assessed according to the criteria of Guideline on Cancer Registration in China and IARC/IACR. Esophageal cancer cases (ICD10: C15) were extracted from the database, and the incidence and mortality stratified by gender, age, and areas (urban/rural) were calculated, the incidence and mortality of provincial cancer were estimated combined with provincial population data. China's 2000 census population and Segi's population were used to calculate the age-standardized rate. Joinpoint model was used to estimate the changing trend of age standardized incidence and mortality along with the calendar year. Results: Approximately 40.10 thousand new esophageal cancer cases were diagnosed in Henan in 2016, accounting for 13.46% of all new cancer cases, and it ranked the third among cancer of all sites. The crude incidence of esophageal cancer was 37.21/100 000 with an age-standardized incidence rate by China standard population (ASIRC) of 26.74/100 000 and an age-standardized incidence rate by world standard population (ASIRW) of 27.12/100 000. The incidence of esophageal cancer in males was higher than that in females, with the ASIRC of 34.53/100 000 and 19.19/100 000, respectively. It was higher in rural areas than that in urban areas, with the ASIRC of 28.13/100 000 and 20.90/100 000, respectively. About 29.30 thousand deaths of esophageal cancer in Henan in 2016, accounting for 15.61% of all cancer deaths in Henan, which ranked the third among cancer of all sites. The crude mortality rate was 27.14/100 000 with an age-standardized mortality rate by China standard population (ASMRC) of 18.74/100 000 and an age-standardized mortality rate by world standard population (ASMRW) of 18.78/100 000. The mortality in males was higher than that in females, with the ASMRC of 24.78/100 000 and 13.12/100 000, respectively. It was also higher in rural areas than that in urban areas, with the ASMRC of 19.48/100 000 and 15.73/100 000, respectively. The ASIRC and ASMRC were declining with annual percent change (APC) of 3.12% (APC=-3.12%; 95%CI: -5.30%, -0.90%; P=0.015) and 2.47% (APC=-2.47%; 95%CI: -4.70%, -0.20%; P=0.039) during 2010-2016. However, the significant declining trend was only observed in rural areas in Henan, and the changing trend was same between males and females. Conclusions: The incidence and mortality of esophageal cancer are declining since 2010, however, the disease burden remains large in Henan. Therefore, comprehensive prevention and control efforts should be strengthened according to its epidemic characteristics and risk factors.

Caracterización de pacientes operados por cáncer del esófago en Cuba / Characterization of Patients Operated on for Esophageal Cancer in Cuba

Introducción: El cáncer en Cuba constituye un grave problema de salud debido a sus altas tasas de incidencia y mortalidad. Representa la primera causa de años de vida potencialmente perdidos y en el esófago es poco frecuente, su comportamiento es más agresivo y la supervivencia es baja. Objetivo: Caracterizar los pacientes operados por cáncer de esófago en Cuba en el periodo de 1988 al 2020. Métodos: Se realizó una investigación observacional clínico epidemiológica multicéntrica, no randomizada, en el periodo de 1988 al 2020. El universo y la muestra quedaron constituido por 595 enfermos de 9 centros hospitalarios. Algunas variables estudiadas incluyeron sexo, edad, variedad histológica, intervención quirúrgica realizada y presencia de comorbilidades asociadas. Resultados: Predominó el sexo masculino (66,1 por ciento), la edad promedio fue 62,8 años. La hipoproteinemia estuvo presente en el 46,1 por ciento. El 43,2 por ciento fueron fumadores y el 35,8 por ciento ingería bebidas alcohólicas. El epidermoide fue la variedad histológica más frecuente (64,6 por ciento). Las técnicas quirúrgicas más utilizadas fueron la de Ivor Lewis (68,4 por ciento) y la transhiatal (63,6 por ciento). Predominó la anastomosis en un plano, término-lateral, de localización torácica para el epidermoide (68,4 por ciento) y la cervical para el adenocarcinoma (71,4 por ciento), realizada de forma manual en cara posterior. Conclusiones: El cáncer de esófago predominó en hombres mayores de 55 años fumadores y con hipoproteinemia. Las técnicas quirúrgicas más utilizadas fueron la de Ivor Lewis y la transhiatal(AU)

Introduction: Cancer in Cuba is a serious health concern due to its high incidence and mortality rates. It represents the first cause of years of life potentially lost and. Esophageal cancer is rare, but its behavior is more aggressive and its survival rate is low. Objective: To characterize patients operated on for esophageal cancer in Cuba in the period from 1988 to 2020. Methods: A nonrandomized, multicenter, clinical-epidemiological and observational research was carried out in the period from 1988 to 2020. The universe and the sample consisted of 595 patients from nine hospital institutions. Some of the variables studied included sex, age, histological variety, surgical intervention performed, and presence of associated comorbidities. Results: There was a predominance of the male sex (66.1 percent). The average age was 62.8 years. Hypoproteinemia was present in 46.1 percent. 43.2 percent of patients were smokers and 35.8 percent drank alcoholic beverages. Epidermoid was the most frequent histological variety (64.6 percent). The most widely used surgical techniques were Ivor Lewis (68.4 percent) and transhiatal (63.6 percent) esophagectomies. There was a predominance of one-plane, termino-lateral anastomosis of thoracic location for epidermoid cases (68.4 percent) and the cervical one for adenocarcinoma cases (71.4 percent), performed manually on the posterior face. Conclusion: Esophageal cancer prevailed in men over 55 years of age, smokers and with hypoproteinemia. The most used surgical techniques were Ivor Lewis and transhiatal esophagectomies(AU)

Caracterización y oportunidad del tratamiento quirúrgico en pacientes con cáncer de esófago / Characterization and Chances for Surgical Treatment in Patients with Esophageal Cancer

Introducción: El cáncer de esófago es una de las neoplasias más agresivas del tracto digestivo, presenta alta morbilidad y mortalidad a nivel mundial. Objetivo: Determinar las características clínico epidemiológicas de los pacientes con cáncer de esófago y su oportunidad del tratamiento. Métodos: Se realizó una investigación básica de tipo descriptiva y retrospectiva en los pacientes con cáncer de esófago hospitalizados en el Instituto Nacional de Oncología y Radiobiología durante el período enero 2016 - enero 2017. Se obtuvieron los datos necesarios de las historias clínicas individuales de los casos que cumplieron los criterios de inclusión. Se aplicaron frecuencias absolutas y porcentajes para permitir los análisis estadísticos de variables seleccionadas. Resultados: El diagnóstico en las edades entre 60 y 69 años fue más frecuente, con el 44,8 por ciento de los casos; el 73,7 por ciento eran hombres y el 52,3 por ciento de la raza negra. En el 71,0 por ciento se encontró antecedentes de esofagitis de reflujo; 78,9 por ciento eran fumadores y 52,6 por ciento bebedores abusivos. La disfagia fue el síntoma más común y el carcinoma epidermoide se presentó con mayor frecuencia alcanzándose el 82,1 por ciento de la muestra estudiada. La mayoría de los casos se diagnosticó en estadio III. Conclusiones: Esta neoplasia constituye un problema de salud en Cuba, se incrementa su incidencia en los últimos años. Se recomienda aplicar el programa de detección y diagnóstico precoz de la enfermedad(AU)

Introduction: Esophageal cancer is one of the most aggressive neoplasms of the digestive tract; it accounts for high morbidity and mortality worldwide. Objective: To determine the clinical-epidemiological characteristics of patients with esophageal cancer and their chances for treatment. Methods: A descriptive and retrospective basic research was carried out, during the period from January 2016 to January 2017, in patients with esophageal cancer hospitalized at the National Institute of Oncology and Radiobiology. The necessary data were obtained from the individual medical records of the cases. that met the inclusion criteria. Absolute frequencies and percentages were applied for the statistical analyses of the selected variables. Results: The diagnosis at ages between 60 and 69 years was more frequent, accounting for 44.8 percent of the cases. 73.7 percent were men and 52.3 percent were of black race. A history of reflux esophagitis was found in 71.0 percent. 78.9 percent were smokers and 52.6 percent were abusive drinkers. Dysphagia was the most common symptom, while squamous cell carcinoma presented more frequently, reaching 82.1 percent of the sample studied. Most of the cases were diagnosed in stage III. Conclusions: This neoplasm is a health concern in Cuba; its incidence has increased in recent years. It is recommended to apply the program of early diagnosis and detection of the disease(AU)

Is there correlation between human papillomavirus (hpv) and esophageal epidermoid carcinoma? / Há correlação entre o papilomavírus humano (hpv) e o carcinoma epidermoide de esôfago?

ABSTRACT Background: Currently, persistent human papillomavirus (HPV) infection has been related in some geographic regions as a risk factor for esophageal squamous cell carcinoma. It results in the immunoexpression of the p16 protein, which has been used as marker of the oncogenic lineage by this etiological agent. Aim: To correlate epidemiological aspects of esophageal squamous cell carcinoma with the prevalence of HPV infection. Methods: Fifty-eight cases were analyzed and submitted to histopathological and immunohistochemical analysis by p16. Results: Of the 58 cases evaluated, 40 were men and 18 women, with a mean age of 63.2 years. p16 immunoexpression was positive in 46.55%. Conclusion: The prevalence of HPV infection is high in esophageal squamous cell carcinoma presenting in almost half of the cases (46.55%), without gender differentiation.

RESUMO Racional: Atualmente a infecção persistente pelo papilomavírus humano (HPV) tem sido relacionada em algumas regiões geográficas como fator de risco para o carcinoma epidermoide do esôfago. Ela resulta na imunoexpressão da proteína p16, que tem sido utilizada como marcadora da linhagem oncogênica por este agente etiológico. Objetivo: Correlacionar aspectos epidemiológicos do carcinoma epidermoide do esôfago com a prevalência de infecção pelo HPV. Métodos: Foram analisados 58 casos buscando-se perfil epidemiológico dos pacientes, com suas peças submetidas à análise histopatológica e imunoistoquímica pelo p16. Resultado: Dos 58 casos avaliados, 40 eram homens e 18 mulheres, com idade média de 63,2 anos. A imunoexpressão pelo p16 foi de 46,55%. Conclusão: A prevalência de infecção pelo HPV é alta no carcinoma epidermoide de esôfago apresentando-se em quase a metade dos casos (46,55%), sem diferenciação de idade quanto aos gêneros.

Epidemiological and clinical features of functional dyspepsia in a region with a high incidence of esophageal cancer in China / 中华医学杂志(英文版)

BACKGROUND@#Functional dyspepsia (FD) has rarely been investigated in areas with a high prevalence of esophageal squamous cell carcinoma (ESCC). This study aims to reveal the epidemiological and clinical features of FD and organic dyspepsia (OD) in such a population.@*METHODS@#A middle-aged and elderly population-based study was conducted in a region with a high incidence of ESCC. All participants completed the Gastroesophageal Reflux Disease Questionnaire and Functional Gastrointestinal Disease Rome III Diagnostic Questionnaire, and they underwent gastroscopy. After exclusion of gastroesophageal reflux disease, uninvestigated dyspepsia (UID) was divided into OD and FD for further analyses.@*RESULTS@#A total of 2916 participants were enrolled from July 2013 to March 2014 in China. We detected 166 UID cases with questionnaires, in which 17 patients with OD and 149 with FD were diagnosed via gastroscopy. OD cases presented as reflux esophagitis (RE), ESCC, and duodenal ulcer. Heartburn (52.94%) and reflux (29.41%) were common in OD, but no symptomatic differences were found between FD and OD. Male sex, low education level, and liquid food were the risk factors for OD, while frequent fresh vegetable consumption was a protective factor. FD included 56 (37.58%) cases of postprandial distress syndrome (PDS), 52 (34.89%) of epigastric pain syndrome (EPS), nine (6.04%) of PDS + EPS, and 32 (21.48%) of FD + functional esophageal disorders. The Helicobacter pylori infection rate in FD patients was not higher than that in the control group (34.23% vs. 42.26%, P = 0.240). Frequent spicy food consumption was associated with PDS (odds ratio [OR]: 2.088, 95% confidence interval [CI]: 1.028-4.243), while consumption of deep well water was protective for PDS (OR: 0.431, 95% CI: 0.251-0.741).@*CONCLUSIONS@#The prevalence of FD was 5.11% in the studied population. Gastroscopy should be prescribed for dyspepsia patients in case that ESCC and RE would be missed in UID cases diagnosed solely by the Rome III questionnaire.@*TRIAL REGISTRATION@#ClinicalTrials.gov, NCT01688908; https://clinicaltrials.gov/ct2/show/record/NCT01688908.

Caracterización clínica, epidemiológica y anatómica del cáncer de esófago / Clinical, Epidemiological and Anatomical Characterization of Esophagus Cancer

Introducción: El cáncer de esófago es una enfermedad muy frecuente con tasas de supervivencia desalentadoras, debido a su naturaleza extremadamente agresiva. Objetivo: Caracterizar clínica, epidemiológica y anatómicamente a los pacientes con cáncer de esófago. Método: Se realizó un estudio descriptivo de casos clínicos que acudieron al servicio de Gastroenterología del Hospital Dr. Juan Bruno Zayas Alfonso, en el período comprendido entre junio -noviembre del año 2018. El universo de estudio estuvo conformado por el total de los pacientes de ambos sexos cuya cifra ascendió a 35. Resultados: El grupo de edad que predominó en ambos sexos fue el de 70 años y más, con 37,1 por ciento entre los hombres y 17,1 por ciento en las mujeres. Los hombres fueron los más afectados (68,6 por ciento). La localización anatómica que prevaleció fue a nivel del tercio inferior en un 37,1 por ciento entre los hombres y un 17,1 por ciento entre las féminas. El 57,1 por ciento resultó encontrarse bajo peso, en su mayoría presentaron el esófago de Barret como antecedente patológico personal, acompañado de odinofagia en el 88,6 por ciento de los pacientes. Conclusiones: El estudio permitió caracterizar a los pacientes con cáncer de esófago según variables clínicas, epidemiológicas y anatómicas. Aparece con mayor frecuencia en las últimas décadas de la vida y en etapas avanzadas de la enfermedad, se localiza con mayor frecuencia en el tercio inferior y asociados a antecedentes patológicos personales(AU)

Introduction: Esophageal cancer is a very frequent disease. Due to its extremely aggressive nature, it presents poor survival rates. Objective: To characterize clinically, epidemiologically and anatomically patients with esophageal cancer. Method: A descriptive study was carried out with clinical cases that attended the gastroenterology service at Dr. Juan Bruno Zayas Alfonso Hospital, in the period between June and November 2018. The study population was made up of the total number of patients of both sexes, whose number amounted to 35. Results: The age group that predominated in both sexes was 70 years and over, accounting for 37.1 percent among men and for 17.1 percent among women. Men were the most affected (68.6 percent). The anatomical location that prevailed was the level of the lower third, accounting for 37.1 percent among men and for 17.1 percent among women. 57.1 percent turned out to be underweight; most of them presented Barrett esophagus as a personal pathological history, accompanied by odynophagia in 88.6 percent of the patients. Conclusions: The study allowed characterizing patients with esophageal cancer according to clinical, epidemiological and anatomical variables. It appears more frequently in the last decades of life and in advanced stages of the disease. It is most frequently located in the lower third and associated with a personal pathological history(AU)

Complicaciones postoperatorias en esofagectomía por cáncer: evaluación de 215 casos según definiciones del grupo de consenso internacional / Postoperative complications in esophagectomy for cancer: evaluation of 215 cases according to definitions of the international consensus group

Resumen Introducción: La esofagectomía presenta una alta morbilidad postoperatoria. Sin embargo, las definiciones de las complicaciones son variables. Un grupo multinacional (esophagectomy complications consensus group; ECCG) propuso definiciones estandarizadas. Objetivo: Evaluar las complicaciones postoperatorias en esofagectomía según las definiciones propuestas por el ECCG. Materiales y Método: Realizamos un estudio de cohorte retrospectivo, a partir de una base de datos prospectiva. Se incluyeron pacientes sometidos a una esofagectomía por cáncer entre 1996 y 2018 en un centro. Se aplicaron las definiciones de las complicaciones postoperatorias según el ECCG. Resultados: Se incluyeron 215 pacientes (Hombres 64%; edad 67 [31-82] años). Un 64% presentaban alguna comorbilidad. Existió un predominio de carcinoma escamoso con un 68%. La ubicación tumoral más frecuente fue el tercio inferior del esófago (48%). Se utilizó un abordaje abierto en 74% y mínimamente invasivo en 26%. La morbilidad postoperatoria total fue de 67%. Las complicaciones más frecuentes fueron las respiratorias alcanzando un 27%. En total, un 25% de los pacientes presentó una filtración de la anastomosis esofagogástrica, de las cuales un 24% fueron tipo II (no requirieron una reintervención quirúrgica). Se produjo una paresia de cuerda vocal en 7%, todas tipo I (no requirieron terapia específica). Se presentó una fístula quilosa en 2%, en 1% se trataron con nutrición parenteral (tipo II) y en 1% se realizó una reintervención (tipo III). Conclusión: La esofagectomía se asocia a una alta morbilidad. Las principales complicaciones son las respiratorias y las gastrointestinales. La utilización de las definiciones de consenso permite una estandarización y graduación de las complicaciones.

Introduction: Esophagectomy presents a high postoperative morbidity. However, the definitions used are variable. A multinational group (esophagectomy complications consensus group; ECCG) proposed standardized definitions. Aim: To evaluate postoperative complications in esophagectomy according to the definitions proposed by the ECCG. Materials and Method: We conducted a retrospective cohort study, based on a prospective database. Patients undergoing esophagectomy for cancer between 1996 and 2018 at one center were included. The definitions of postoperative complications according to the ECCG were applied. Results: We included 215 patients (64% men, age 67 [31-82] years). Sixty-four percent had some comorbidity. There was a predominance of squamous carcinoma with 68%. The most frequent tumor location was the lower third of the esophagus (48%). An open approach was used in 74% and minimally invasive in 26%. Total postoperative morbidity was 67%. The most frequent complications were respiratory complications, which reached 27%. The leakage of the esophagogastric anastomosis reached 25%, 24% were type II (did not require surgical reoperation). There was a vocal cord paresis in 7%, all were classified as type I (did not require specific therapy). A chylous fistula was presented in 2%, in 1% they were treated with parenteral nutrition (type II) and in 1% a reoperation was performed (type III). Conclusion: Esophagectomy is associated with a high morbidity. The main complications are respiratory and gastrointestinal. The use of consensus definitions allows standardization and grading of complications.

Esôfago de Barrett: o estado da arte / Barrett's Esophagus: the state of the art

Objetivo: Demonstrar fatores envolvidos nos distúrbios do sono em profissionais que fazem plantões. Métodos: Trata-se de estudo transversal, cuja amostra foi composta de 244 voluntários, plantonistas da área da saúde, sendo 191 do sexo feminino, que responderam a um questionário socioeconômico, associado à aplicação da Escala de Sonolência de Epworth e ao Índice de Qualidade do Sono de Pittsburgh. Os dados foram analisados pelos coeficientes de Spearman e de Kendall Tau, com distribuição de probabilidade gama. Resultados: Houve significância (p<0,05) com o Índice de Qualidade do Sono de Pittsburgh e a atividade física (+0,216), ergonomia (+0,148), filhos (-0,146), valor da remuneração (+0,112) e disfunção durante o dia (+0,352). Também houve significância com a Escala de Sonolência de Epworth e atividade física (+0,138), renda familiar (-0,118), trabalho semanal (-0,151), latência do sono (-0,106), duração do sono (-0,107), eficiência do sono (-0,139) e disfunção durante o dia (+0,170). Por fim, a eficiência do sono teve significiância com profissão (-0,209), tabagismo (+0,402), Escala de Sonolência de Epworth (-0,139) e dissonias com a obesidade (índice de massa corporal >30; razão de chance de 1,40; intervalo de confiança de 95% de 1,02-1,94). Conclusão: As medidas autorrelatadas são prontamente obtidas com questionários validados, como a Escala de Sonolência de Epworth e o Índice de Qualidade do Sono de Pittsburgh, encontrando-se correlações com renda familiar, ter ou não filhos, índice de massa corporal, atividade física, ergonomia, condições de trabalho, tabagismo e componentes biopsicossociais. Em virtude do caráter transversal deste estudo é indispensável mais estudos com maior follow-up

Objective: To demonstrate factors involved in sleep disorders in professionals who take shifts. Methods: This is a cross-sectional study whose sample consists of 244 volunteers, on-duty health workers, 191 females, who answered a socioeconomic questionnaire, associated with application of the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index. Data were analyzed with Spearman's and Kendall Tau coefficients, and gamma probability distribution. Results: There was significance (p<0,05) with the Pittsburgh Sleep Quality Index and physical activity (+0,216), ergonomics (+0,148), children (-0,146), the wage (+0,112), dysfunction during the day (+0,352). Also there was significance with the Epworth Sleepiness Scale and physical activity (+0,138), family income (-0,118), weekly workload (-0,151), sleep latency (-0,106), sleep duration (-0,107), sleep efficiency (-0,139), and dysfunction during the day (+0,170). Finally, sleep efficiency was significant with occupation (-0,209), smoking habits (+0,402), Epworth Sleepiness Scale (-0,139), dyssomnia with obesity (body index mass >30; OR of 1,40; CI 95% 1,02-1,94). Conclusion: Self-reported measures are readily obtained with validated questionnaires such as Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index, with correlations with family income, having children or not, body mass index, physical activity, ergonomics, working conditions, smoking habits, and biopsychosocial components. Due to the cross-sectional nature of this study, further research with longer follow-up is indispensable

Caracterización clínico-patológica del cáncer esofágico avanzado en el Hospital Universitario Comandante Faustino Pérez. Matanzas / Clinic-pathologic characterization of the advanced esophagus cancer in the University Hospital Comandante Faustino Perez, Matanzas

RESUMEN Introducción: el cáncer de esófago en estadio avanzado, es uno de los más agresivos. En Cuba ocupa el décimo lugar entre las causas de muerte. Objetivo: caracterizar clínico y patológicamente a los pacientes con cáncer esofágico diagnosticados en el hospital estudiado. Materiales y métodos: se realizó un estudio prospectivo-descriptivo donde se efectuó una caracterización clínico-patológica a 59 pacientes con el diagnóstico endoscópico e histológico de cáncer de esófago, en el Hospital Faustino Pérez Hernández de Matanzas, de enero del 2016 a diciembre del 2017. Se estudiaron variables como: grupo etáreo, sexo, antecedentes patológicos personales y familiares, factores de riesgo, síntomas y signos predominantes en el diagnóstico, tiempo de aparición de los síntomas, tipo endoscópico, localización, tipo histológico, grado de diferenciación histológica, estadio de la enfermedad, tipo de tratamiento y tiempo de vida posterior al diagnóstico. Resultados: predominó el sexo masculino (88.1%) en pacientes mayores de 60 años (52.6%). La disfagia, la astenia y la anorexia fueron los síntomas más frecuentes; el etilismo crónico y el hábito de fumar fueron los factores de riesgo predominantes. La localización anatómica más frecuente fue el tercio medio (54.2%), el tipo endoscópico vegetante (88.1%) y el tipo histológico carcinoma epidermoide bien diferenciado (55.9%). Hubo relación entre el tiempo de inicio de los síntomas entre 3 y 6 meses antes del diagnóstico y el estadio IV de la enfermedad que predominó en 29 pacientes (49.2%). La mayoría de los pacientes recibieron tratamiento oncológico combinado con cirugía paliativa (47.5%) o ningún tratamiento (45.8%) pues el 50.8% de los pacientes fallecieron al mes del diagnóstico demostrando que el diagnóstico del cáncer esofágico se realiza casi siempre en estadios avanzados de la enfermedad cuando son posible pocas opciones terapéuticas. Conclusiones: el cáncer de esófago aún sigue diagnosticándose de forma tardía en estadios avanzados, con elevada prevalencia del carcinoma epidermoide sobre el adedocarcinoma que indica pocas acciones de salud preventivas sobre los factores de riesgo en la población estudiada, existiendo relación entre el estadio avanzado de la enfermedad y el poco tiempo de vida de estos pacientes posterior al diagnóstico.

ABSTRACT Introduction: the advanced-stage esophagus cancer is one of the most aggressive cancers. In Cuba, it is in the tenth place among the death reasons. Objective: to clinically and pathologically characterize the patients with esophageal cancer diagnosed in the mentioned hospital. Materials and methods: a prospective-descriptive study was carried out based on the clinical-histological characterization of 59 patients with the endoscopic and histological diagnosis of esophageal cancer in the Hospital "Faustino Pérez Hernández", of Matanzas, in the period from January 2016 to December 2017. The studied variables were: age group, sex, personal and familiar pathological antecedents, risk factors, symptoms and signs that were predominant in the diagnosis, time passed since the symptoms appeared, endoscopic kind, location, histological kind, level of histological differentiation, disease stage, kind of treatment, and life time after the diagnosis. Results: male sex predominated (88.1 %) in patients older than 60 years (52.6 %). Dysphagia, asthenia and anorexia were the most frequent signs. Alcoholism and smoking were the predominant risk factors. The most frequent anatomic location was the middle third (54.3 %); the endoscopic vegetating kind (88.1 %) and the histological kind well-differentiated epidermoid carcinoma (55.9 %) prevailed. The authors found a relation between the beginnings of the symptoms 3 to 6 months before the diagnosis and the disease IV stage predominating in 29 patients (49.2 %). Most of patients underwent oncologic treatment combined with palliative surgery (47.5 %) or no treatment (45.8 %), because 50.8 % of the patients died a month after the diagnosis, showing that the diagnosis of esophageal cancer is almost always achieved at advanced stages of the disease, when few therapeutic options are possible. Conclusions: esophageal cancer is still being diagnosed late, in advanced stages, with a higher prevalence of the epidermoid carcinoma over the adenocarcinoma. It indicates few health preventive actions on the risk factors among the studied population. There is a relation between the disease advanced stage and the few time patients live after the diagnosis.

Epidemiological profile of esophageal cancer mortality in Rio Grande do Sul and its health regions

Introduction: Malignant esophageal neoplasia is a rare tumor, but it has high morbidity and mortality. Early diagnosis and intensive treatment associated with surgical approach remains the best treatment for the disease. Its epidemiology is extremely diverse in the world, even in the same country. Methods: This was a retrospective analysis made from 2000-2015, analyzing the mortality rates of malignant esophageal neoplasia in the state of Rio Grande do Sul (RS) in its 30 Health Regions and in Brazil. The mortality data were collected in the Mortality Information System (SIM) and the population data in the Brazilian Institute of Geography and Statistics (IBGE). Results: The esophageal cancer mortality rate was 8.61 (95% CI, 8.49-8.73) per 100,000 inhabitants in RS, while the national rate was 3.66 (95% CI, 3, 49-3.82), with a significant difference (p <0.0001). The regional distribution was variable, and the West Border region presented the highest rate, 12.91 (95% CI, 12.05-13.77). However, even regions with lower mortality presented twice as much deaths than the national rate. Mortality increased with aging, with the oldest age groups (≥80 years) presenting 69.62 (95% CI, 64.9-74) deaths per 100,000 inhabitants. Conclusion: Esophageal neoplasia is still a very serious condition in the state of RS, being associated with an almost 3-fold higher mortality rate compared to the national rate. Even within the state different epidemiological patterns are found. (AU)

Perfil dos Pacientes com Câncer de Esôfago Diagnosticados entre 2001 e 2010 no Brasil / Profile of Patients with Esophageal Cancer Diagnosed Between 2001 and 2010 in Brazil / Perfil de los Pacientes con Cáncer de Esófago Diagnosticados entre 2001 y 2010 en Brasil

Introdução: O câncer de esôfago é a terceira neoplasia mais comum do trato digestivo e apresenta prognóstico ruim quando diagnosticado em estádios avançados da doença. Objetivo: Descrever as características sociodemográficas, clínicas e de tratamento dos pacientes diagnosticados com câncer de esôfago no Brasil, no período de 2001 a 2010. Método: Estudo transversal de base secundária em pacientes com câncer de esôfago, cadastrados entre 2001 e 2010, nos Registros Hospitalares de Câncer. Foram analisadas as variáveis sociodemográficas, clínicas e de tratamento. Foi realizada análise descritiva utilizando média e desvio-padrão para as variáveis contínuas, e frequência absoluta e relativa para as categóricas. Resultados: Foram incluídos 24.204 pacientes, com média de idade de 60,8 anos (±11,5). A maioria da população era do sexo masculino (78,3%), de baixa escolaridade (75,2%), etilista (62,9%), tabagista (76,0%) e com estádio avançado ao diagnóstico (41,3% em estádio clínico III e 26,9%, IV), sendo o grupo topográfico de maior prevalência o esôfago superior e médio (76,4%). Não foram submetidos a nenhum tratamento oncológico 12,7% dos pacientes. Os tratamentos mais frequentes foram a combinação entre radioterapia e quimioterapia (25,6%) e o tratamento isolado com radioterapia (21,9%). Ao final do primeiro tratamento oncológico, 10,7% estavam sem evidência de doença, 8,4% com remissão parcial, 26,6% com doença estável e, os demais, com doença em progressão ou óbito (54,4%). Conclusão: No Brasil, os casos diagnosticados por câncer de esôfago são, em sua maioria, diagnosticados em estádios avançados da doença, o que representou maior agressividade terapêutica e pior resposta ao tratamento.

Introduction: Esophageal cancer is the third most common neoplasm of the digestive tract and presents poor prognosis when diagnosed in advanced stages of the disease. Objective: To describe the socio-demographic, clinical and treatment characteristics of patients diagnosed with esophageal cancer in Brazil, from 2001 to 2010. Method: A cross-sectional study of patients with esophageal cancer registered between 2001 and 2010 in Hospital-based registries. Socio-demographic, clinical and treatment variables were analyzed. Descriptive analysis was performed using mean and standard deviation for continuous variables, and absolute and relative frequency for categorical variables. Results: A total of 24,204 patients were included, with a mean age of 60.8 years (± 11.5). The majority of the population was male (78.3%), with a low level of schooling (75.2%), alcoholics (62.9%), smokers (76.0%), and had an advanced stage of diagnosis (41.3% in clinical stage III and 26.9% in stage IV), the topographic group being the most prevalent was in the esophagus upper and middle (76.4%). 12.7% of the patients were not submitted to any cancer treatment. The most frequent treatments were the combination of radiotherapy and chemotherapy (25.6%), and treatment alone with radiotherapy (21.9%). At the end of the first cancer treatment, 10.7% had no evidence of disease, 8.4% had partial remission, 26.6% had a stable disease, and the remaining patients had progression or death (54.4%). Conclusion: In Brazil, the cases diagnosed for esophageal cancer are mostly diagnosed in advanced stages of the disease, which represents greater therapeutic aggressiveness and worse response to treatment.

Introducción: El cáncer de esófago es la tercera neoplasia más común del tracto digestivo y presenta un pronóstico malo cuando se diagnostica en estadios avanzados de la enfermedad. Objetivo: Describir las características sociodemográficas, clínicas y de tratamiento de los pacientes diagnosticados con cáncer de esófago en Brasil, en el período de 2001 a 2010. Método:Estudio transversal de base secundaria en pacientes con cáncer de esófago, registrados entre 2001 y 2010, en los Registros Hospitalarios de Cáncer. Se analizaron las variables sociodemográficas, clínicas y de tratamiento. Se realizó un análisis descriptivo utilizando media y desviación estándar, para las variables continuas, y frecuencia absoluta y relativa para las categóricas. Resultados: Se incluyeron 24.204 pacientes, con una media de edad de 60,8 años (±11,5). La mayoría de la población era del sexo masculino (78,3%), de baja escolaridade (75,2%), etilista (62,9%), tabaquista (76,0%) y con estadio avanzado al diagnóstico (41,3% en estadio clínico III y 26,9% en estadio IV), siendo el grupo topográfico de mayor prevalencia el esófago superior y medio (76,4%). No fueron sometidos a ningún tratamiento oncológico, el 12,7% de los pacientes. Los tratamientos más frecuentes fueron la combinación entre radioterapia y quimioterapia (25,6%), y el tratamiento aislado con radioterapia (21,9%). Al final del primer tratamiento oncológico, el 10,7% estaba sin evidencia de enfermedad, el 8,4% con remisión parcial, el 26,6% con enfermedad estable y los demás, con enfermedad en progresión o muerte (54,4%). Conclusión: En Brasil, los casos diagnosticados por cáncer de esófago son en su mayoría, diagnosticados en estadios avanzados de la enfermedad, lo que representó mayor agresividad terapéutica y peor respuesta al tratamiento.

Baixa prevalência de esôfago de Barrett em área de risco para câncer esofágico no Sul do Brasil / Low prevalence of barrett's esophagus in a risk area for esophageal cancer in south of brazil

ABSTRACT BACKGROUND: Barrett's esophagus a complication of gastroesophageal reflux disease (GERD) is a precursor of esophageal adenocarcinoma. The incidence of esophageal adenocarcinoma has been increasing in most Western countries. Rio Grande do Sul (RS), the Southernmost state of Brazil has the highest rates of esophageal cancer with low prevalence of esophageal adenocarcinoma. OBJECTIVE: To investigate the prevalence of Barrett's esophagus among patients underwent to upper gastrointestinal endoscopy in the last 5 years. METHODS: The records of patients underwent upper gastrointestinal endoscopy between 2011 and 2015 were analyzed. Demographic data, GERD symptoms, endoscopic findings, extension and histological diagnosis of columnar epithelia of the esophagus were recorded. Significance among the variables was accessed by chi-square test and Fisher's exact test with 95% CI. RESULTS: A total of 5996 patients underwent to upper gastrointestinal endoscopy in the period were included. A total of 1769 (30%) patients with GERD symptoms or esophagitis and 107 (1.8%) with columnar lined esophagus were identified. Except for eight patients, the others with columnar lined esophagus had GERD symptoms or esophagitis. Barrett's esophagus defined by the presence of intestinal metaplasia occurred in 47 patients; 20 (43%) with segments over 3 cm and 27 (57%) with segments shorter than 3 cm. The global prevalence of Barrett's esophagus was 0.7% and in GERD patients 2.7%. The odds ratio for the occurrence of columnar lined esophagus in patients with GERD was 30 (95%CI=15.37-63.34). The odds ratio for the presence of intestinal metaplasia in long segments was 8 (95%CI=2.83-23.21). CONCLUSION: GERD patients had a risk 30-folds greater to present columnar lined esophagus than patients without GERD symptoms. Long segments of columnar lined esophagus, had a risk eight-folds higher to have Barrett's esophagus than short segments. Barrett's esophagus overall prevalence was 0.7%. In GERD patients, the prevalence was 2.7%. Long Barrett's esophagus represented globally 0.3% and 1.1% in GERD patients.

RESUMO CONTEXTO: Esôfago de Barrett, complicação da doença do refluxo gastroesofágico (DRGE), é lesão precursora do adenocarcinoma esofágico. O adenocarcinoma esofágico apresenta incidência crescente principalmente no ocidente. O estado do Rio Grande do Sul apresenta as taxas mais altas de câncer esofágico no Brasil, porém com baixa prevalência de adenocarcinoma. OBJETIVO: Investigar a prevalência de esôfago de Barrett em pacientes submetidos a endoscopia digestiva alta nos últimos 5 anos. MÉTODOS: Revisão de prontuários dos pacientes submetidos a endoscopia digestiva alta entre 2011 e 2015. Registrados dados demográficos, sintomas de DRGE, achados endoscópicos, extensão e diagnóstico histológico de epitelização colunar do esôfago. A significância entre as variáveis foi acessada pelos testes do qui-quadrado e exato de Fisher com IC95%. RESULTADOS: Foram incluídos 5996 pacientes. Identificamos 1769 (30%) com sintomas de DRGE ou esofagite e 107 (1,8%) com epitelização colunar. À exceção de oito pacientes com epitelização colunar, os demais apresentavam sintomas de DRGE ou esofagite. Esôfago de Barrett definido pela presença de metaplasia intestinal ocorreu em 47 pacientes; 20 (43%) com segmentos acima de 3 cm e em 27 (57%) com segmentos menores. A prevalência global de esôfago de Barrett foi 0,7% e em pacientes com DRGE foi 2,7%. A razão de chances para a ocorrência de epitelização colunar em pacientes com DRGE foi 30 (IC95%=15,37-63,34) e para a ocorrência de metaplasia intestinal em segmentos longos foi 8 (IC95%=2,83-23,21). CONCLUSÃO: Pacientes com DRGE apresentaram risco 30 vezes maior que pacientes sem DRGE para a ocorrência de epitelização colunar. O risco de ocorrência de esôfago de Barrett em segmentos longos foi oito vezes maior. A prevalência global de esôfago de Barrett foi 0,7%. Em pacientes com DRGE a prevalência foi 2,7%. Segmentos longos de esôfago de Barrett representaram globalmente 0,3% e em pacientes com DRGE 1,1%.

STANDARDIZED CLINICAL PATHWAYS FOR ESOPHAGECTOMY ARE NOT A REALITY IN BRAZIL, EVEN WITH A HIGH PREVALENCE OF ESOPHAGEAL CANCER AND ACHALASIA / PROTOCOLOS CLÍNICOS PERIOPERATÓRIOS PADRONIZADOS NÃO SÃO REALIDADE NO BRASIL MESMO COM ALTA PREVALÊNCIA DE CÂNCER DE ESÔFAGO E ACALÁSIA

Background:The adoption of standardized protocols and specialized multidisciplinary teams for esophagectomy involve changes in routines with the implantation of expensive clinical practices and deviations from ingrained treatment philosophies. Aim:To evaluate the prevalence of standardized protocols and specialized multidisciplinary teams in São Paulo state, Brazil. Methods:Institutions that routinely perform esophagectomies in São Paulo were contacted and questioned about the work team involved in the procedure and the presence of standardized routines in the preoperatory care. Results: Fifteen centers answered the questionnaire: 10 (67%) public institutions and five (33%) private. There were seven (47%) medical schools, six (40%) with a residency program and two (13%) nonacademic institutions. The mean number of esophagectomies per year was 23. There was a multidisciplinary pre-operative team in nine (60%). There was a multidisciplinary postoperative team in 11 (73%). Early mobilization protocol was adopted in 12 (80%) institutions, early feeding in 13 (87%), routinely epidural in seven (47%), analgesia protocol in seven (47%), hydric restriction in six (40%), early extubation in six (40%), standardized hospitalization time in four (27%) and standardized intensive care time in two (13%). Conclusion:The prevalence of standardized protocols and specialized teams is very low in Sao Paulo state, Brazil. The presence of specialized surgeons is a reality and standardized protocols related directly to surgeons have higher frequency than those related to other professionals in the multidisciplinary team.

Racional:A adoção de protocolos padronizados por equipe multidisciplinar especializada no perioperatório de esofagectomia melhora a morbimortalidade da operação, porém envolve implantação de práticas por vezes custosas e mudanças de rotinas e filosofias arraigadas. Objetivo:Avaliar a ocorrência de protocolos padronizados e equipe multidisciplinar para esofagectomia no estado de São Paulo. Métodos:Foram contactadas instituições que realizam esofagectomias rotineiramente e questionadas a respeito da equipe envolvida no procedimento e a ocorrência de rotinas clínicas padronizadas no perioperatório dos pacientes.Resultados:Das 15 instituições respondedoras eram 10 (67%) públicas e cinco (33%) privadas; sete (47%) escolas médicas, seis (40%) com programa de residência e duas (13%) não acadêmicas. Estas realizavam em média 23 esofagectomias por ano. Nove (60%) instituiçoes possuíam equipe multidisciplinar especializada no pré-operatório e 11 (73%) no pós-operatório. Devido a existência de protocolos, foram adotados: mobilização precoce em 12 instituições (80%); alimentação precoce em 13 (87%); epidural rotineira em sete (47%), protocolo de analgesia em sete (47%), restrição hídrica em seis (40%), extubação precoce em seis (40%), tempo de hospitalização padrão em quatro (%) e tempo de UTI padrão em duas (13%) instituições. Conclusão:É baixa a ocorrência de protocolos padronizados e equipes multidisciplinares especializadas para esofagectomia no estado de São Paulo. Observa-se elevada prevalência de cirurgiões especializados e maior frequência de protocolos relacionados diretamente aos cirurgiões, em detrimento aos outros profissionais da equipe multidisciplinar.

Esófago de Barrett: revisión de la literatura / Barrett's esophagus: review

El Esófago de Barrett (EB) es una patología adquirida producto del reflujo gastroesofágico crónico que provoca la lesión de la mucosa esofágica normal y su reemplazo por mucosa metaplásica. La importancia clínica del EB radica en que constituye un factor de riesgo para el desarrollo de adenocarcinoma esofágico. La incidencia del adenocarcinoma esofágico se encuentra en aumento y su diagnóstico se realiza generalmente en etapas avanzadas, teniendo un pronóstico sombrío. Actualmente el objetivo es detectar el cáncer en etapas iniciales y eventualmente tratables, para lo cual se han planteado distintos protocolos de vigilancia y numerosas alternativas de tratamiento del epitelio metaplásico del esófago de Barrett. En el siguiente artículo se revisan los conceptos más recientes de manejo.

Barrett's esophagus is an acquired disease caused by chronic gastroesophageal reflux causing the injury of normal esophageal mucosa and its replacement by metaplastic mucosa. The clinical significance of Barrett's esophagus is that it constitutes a risk factor for the development of esophageal adenocarcinoma. The incidence of esophageal adenocarcinoma is increasing and its diagnosis is usually done in advanced stages, with grim prognosis. Currently the goal is to detect cancer in early, treatable stages. Different protocols have been proposed, numerous alternatives for monitoring and treating metaplastic epithelium of Barrett's esophagus. In the following article the latest management concepts are reviewed.

Caracterización epidemiológica de cáncer de esófago en Hospital Base Valdivia, período 2002-2011 / Epidemiologic characterization of esophagus neoplasm, Valdivia Hospital, 2002-2011

INTRODUCCIÓN: El cáncer de esófago posee para el 2007 una tasa de incidencia estimada en Chile de 5,7x100.000 habitantes. Los tipos histológicos más frecuentes son carcinoma de células escamosas y adenocarcinoma, esta última ha experimentado un aumento de su incidencia. OBJETIVOS: Caracterizar población de pacientes diagnosticados con cáncer de esófago, entre los años 2002 y 2011, del Hospital Base de Valdivia (HBV). METODOLOGÍA: Estudio descriptivo retrospectivo, cuyos datos se obtuvieron por revisión de libros de biopsias del Servicio de Anatomía Patológica de Hospital Base Valdivia entre los años 2002-2011 registrando datos sobre sexo, edad y tipo histológico. Los datos fueron tabulados y graficados en programa Excel 2010. RESULTADOS: Se analizaron 151 biopsias, con promedio de edad 70 años. La incidencia promedio fue de 4,14/100.000 habitantes con una relación 5:3 para sexo masculino y femenino respectivamente. La incidencia anual para hombres fue de 1,7 en 2002 y 7,2 en 2011. La incidencia anual promedio para carcinoma escamoso fue de 3,4/100.000 habitantes, para adenocarcinoma 0,58/100.000 habitantes, y otros tipos histológicos 0,2/100.000 habitantes. DISCUSIÓN: La incidencia por género fue más baja para varones que las cifras nacionales, pero con tendencia al alza. El tipo histológico más frecuente fue carcinoma escamoso. A diferencia de lo esperado el adenocarcinoma no tiene tendencia al alza.

INTRODUCTION: The year 2007 the esophageal neoplasms has an estimated incidence in Chile of 5,7/100.000. The most frequently histologic kinds are the Squamous Cell Carcinoma and the Adenocarcinona, the last one has shown an incidence rise. OBJECTIVES: Epidemiologic characterization of esophagus neoplasm cases for the 2002-2011 period. METODOLOGY: Retrospective descriptive study, where the data was obtained by biopsy books revision from the anatomy department at Valdivia hospital. Tabulation and analysis performed whit excel 2010. RESULTS: 151 cases were analyzed, average age were 70 years. The average incidence for men cases: 1,7/100.000 in 2002 and 7,2/100.000 in 2011. The Squamous Cell Carcinoma average incidence: 3,4/100.000 and for the adenocarcinoma: 0,58/100.000. DISCUSSION: The average incidence was lower for men than the national rates, but it's increasing. The mostcommon histologic kind is the quamous Cell Carcinoma. The adenocarcinoma isn't increasing as was expected.

Epidemiological features of esophageal cancer. Squamous cell carcinoma versus adenocarcinoma

PURPOSE: To analyze the epidemiological features of patients with esophageal cancer according to the histopathological types: squamous cell carcinoma or adenocarcinoma. METHODS: A total of 100 patients with esophageal cancer, being 50 squamous cell carcinomas and 50 adenocarcinomas were analyzed for demographics, nutritional factors, lifestyle habits, benign pathological conditions associated, like Barrett's esophagus and megaesophagus, tumor stage and survival rates. The nutritional factors evaluated included body mass index, percent weight loss, hemoglobin and albumin serum levels. RESULTS: Esophageal cancer occurred more often in men over 50 years-old in both histological groups. No significant differences on age and gender were found between the histological groups. Squamous cell carcinoma was significantly more frequent in blacks than adenocarcinoma. Alcohol consumption and smoking were significantly associated with squamous cell carcinoma. Higher values of body mass index were seen in patients with adenocarcinoma. Barrett's esophagus was found in nine patients (18%) with adenocarcinoma, and megaesophagus in two patients (4%) with squamous cell carcinoma. The majority of patients were on stages III and IV in both histological groups. The mean survival rates were 7.7 ± 9.5 months for patients with squamous cell carcinoma and 8.0 ± 10.9 months for patients with adenocarcinoma. No significant differences on tumor stage and survival rates were detected between the histological groups. CONCLUSION: Epidemiological features are distinct for the histopathological types of esophageal cancer. Squamous cell carcinoma is associated with black race, alcohol and smoking, while adenocarcinoma is related to higher body mass index, white race and Barrett's esophagus. .

Obtaining informed consent in an illiterate population

Esophageal cancer is highly prevalent among the Turkman people in Northeastern Iran. In order to evaluate its etiology, there is an on-going prospective cohort study in this area involving approximately 50000 subjects over the age of 40 years. The majority of these subjects are illiterate, thus obtaining informed consent is very important and difficult. Initially, we explained the aim and study method to religious leaders and health-sanitary officials. One week prior to obtaining informed consent, potential participants were given adequate information about the research process by trained health personnel at their own home. Thus, participants had sufficient time to consider the research and consult with local health personnel, religious authorities, family, neighbors, friends and those who previously participated in the study. Potential participants could observe the research process directly and then be included in the study if they agreed. A total of 50045 individuals agreed to participate in the study, of which 70% were illiterate. There were no refusals due to the medical ethical aspects of this study. The method of awareness in this study can be a useful pattern for research on elderly and illiterate individuals who are participants in research studies in Iran and other countries