Incidence and prognosis of esophageal adenocarcinoma, Siewert type Ⅰ adenocarcinoma of esophagogastric junction and Barrett esophagus in Henan province from 2010 to 2015 / 中华消化杂志

ABSTRACT

Objective To explore the incidence and prognosis of esophageal adenocarcinoma (EAC),Siewert type Ⅰ adenocarcinoma of esophagogastric junction (AEG) and Barrett esophagus (BE) in Henan province,an area of high incidence of esophageal cancer.Methods From January 2010 to January 2015,the clinical data of 152 patients with EAC,70 patients with Siewert type Ⅰ AEG and 149 patients with BE were collected,and the clinicopathological features and treatment methods of all the patients were retrospectively analyzed.Patients with EAC and Siewert type Ⅰ AEG were followed up by telephone,while the patients with BE were followed up by telephone and endoscopy examination.The follow-up was ended in January 1st 2016 and the total follow-up period was 12 to 72 months.Chi square test,t test and one way analysis of variance were performed for comparison of pathological characteristics among groups;linear regression method was used to detect changing trends in the rates over time and Kaplan-Meier method was for survival analysis.Results The annual detection rates in five years of EAC were 0.7‰,0.9‰,0.8‰,1.1‰ and 1.1‰,respectively,suggesting an increasing trend (F=10.714,P＜0.05).The proportion of EAC to esophageal squamous carcinoma (ESC) were 2.9％,3.2％,3.1％,3.4％ and 3.8％,respectively with an increasing trend (F=17.647,P＜0.05).The one,three-and five-year overall survival rates of EAC were 57.7％,30.6％ and 15.3 ％.Among 152 patients with EAC,51 received operation and 101 patients did not.The median survival time was 14 months,and the median survival time of operation group and non-operation group was 60 months and 10 months,respectively.Survival curve layered by treatment methods indicated that the three-year survival rates of operation combined with chemotherapy group,operation group,radiotherapy or chemotherapy group and notreatment group were 82.3％,50.0％,11.2％ and 0.The three-year survival rates in operation combined with chemotherapy group,operation group,radiotherapy or chemotherapy group and no-treatment group were significantly different (x2 =1.099,2.236 and 11.431,all P＜0.01).The annual detection rates in five years of Siewert type Ⅰ AEG were 0.2‰,0.3‰,0.4‰,0.4‰,0.7‰,respectively,with an increasing trend (F=19.105,P＜0.05).The one-,three-and five-year overall survival rate of Siewert type Ⅰ AEG was 59.8％,30.5 ％ and 15.3 ％,respectively.Among 70 patients with Siewert type Ⅰ AEG,16 cases received operation,while 54 cases without operation.The median survival time of Siewert type Ⅰ AEG was 16 months,and the median survival time of operation group and non-operation group was 50 months and 13 months.The one-,three-and five-year survival rates of operation group were 87.5％,62.6％ and 43.0％ respectively,and the one-,threeand five-year survival rates of non-operation group were 50.2 ％,19.6 ％ and 0,respectively,and the difference in cumulative survival rate between the two groups was statistically significant (x2 =12.289,P＜ 0.05).The annual detection rates of BE in five years were 0.6‰,0.5‰,0.9‰,0.9‰ and 1.1‰,respectively,with an increasing trend (F=13.364,P＜0.05).Among 149 patients with BE,there were 24 cases with specialized intestinal metaplasia and six cases with dysplasia,but none of them developed into adenocarcinoma during the follow-up period.Conclusions In Henan province,an area with high incidence of esophageal cancer,there is an increasing trend in the annual detection rates in five years of EAC,Siewert type Ⅰ AEG and BE.Although the incidence of EAC and Siewert type Ⅰ AEG is not high,the prognosis is poor with low survival rate.The prognosis of non-operation group is obviously worse than that of operation group.Specialized intestinal metaplasia and dysplasia in patiens with BE are rare and have a low probability of developing into adenocarcinoma.