Changes of Esophagogastric Junctional Adenocarcinoma and Gastroesophageal Reflux Disease Among Surgical Patients During 1988-2012: A Single-institution, High-volume Experience in China

Kai Liu, Kun Yang, Weihan Zhang, Xiaolong Chen, Xinzu Chen, Bo Zhang, Zhixin Chen, Jiaping Chen, Yongfan Zhao, Zongguang Zhou, Longqi Chen, Jiankun Hu, Kai Liu, Kun Yang, Weihan Zhang, Xiaolong Chen, Xinzu Chen, Bo Zhang, Zhixin Chen, Jiaping Chen, Yongfan Zhao, Zongguang Zhou, Longqi Chen, Jiankun Hu

Abstract

Objective: To evaluate the changes of esophagogastric junctional adenocarcinoma (EGJA) and gastroesophageal reflux disease (GERD) among surgical patients from 1988 to 2012 in a Chinese high-volume hospital.

Background: The incidence of EGJA in Western countries has rapidly increased in recent decades. However, recent data from China remain sparse.

Methods: A retrospective analysis was performed on the basis of 5053 patients who underwent surgery for gastric and distal esophageal adenocarcinoma. Total of 1723 patients with EGJA who underwent surgery were included. Changes of the prevalence of GERD and the clinicopathological features and surgical treatment of EGJA were longitudinally analyzed by a 5-year interval.

Results: The proportion of EGJA was increased from 22.3% in period 1 (1988-1992) to 35.7% in period 5 (2008-2012) (P < 0.001). The proportion of Siewert type III (35.9% vs 47.0%) (P < 0.001) and type I (8.7% vs 15.8%) (P = 0.002) tumors of EGJA was also increased during the past 25 years. The prevalence of GERD had increased gradually from 6.5% in period 1 to 10.9% in period 5 for the 3 subgroups without significant difference (P = 0.459). There was an upward tendency with significant difference between the proportion of EGJA and the prevalence of GERD (r = 0.946, P = 0.000). Instead of type II and type III tumors, there was a positive correlation with change in GERD for type I tumors (r = 0.438, P = 0.029). Total gastrectomy was more preferred among patients with EGJA in period 5 than in period 1 (42.0% vs 19.6%) (P < 0.001).

Conclusions: An increasing trend of EGJA is observed during the past 25 years in West China Hospital. The prevalence of GERD among EGJA had showed a gradually increased trend. However, the causality between GERD and EGJA still needs to be researched further. Total gastrectomy is becoming more preferred procedure in patients with EGJA.

Figures

FIGURE 1
FIGURE 1
Time trends of gastric adenocarcinoma at different anatomical locations over the 25-year period from 1988 to 2012.
FIGURE 2
FIGURE 2
Trend in subtype of esophagogastric junctional adenocarcinoma according to Siewert's classification.
FIGURE 3
FIGURE 3
Time trend of GERD among esophagogastric junctional adenocarcinoma (EGJA) and the proportion trend of GERD among subtype of EGJA according to Siewert's classification. GERD indicates gastroesophageal reflux disease.
FIGURE 4
FIGURE 4
Time trends of esophagogastric junctional adenocarcinoma in distribution of TNM stage during the past 25 years in West China Hospital. TNM stage is based on the Japanese classification of gastric carcinoma: 3rd English edition.

References

    1. Jemal A, Bray F, Melissa M, et al. Global cancer statistics 2011. CA Cancer J Clin 2011; 61:69–90.
    1. Hasegawa S, Yoshikawa T. Adenocarcinoma of the esophagogastric junction: incidence, characteristics, and treatment strategies. Gastric Cancer 2010; 13:63–73.
    1. Katrina FT, Susan AS, Sherri LS. Trends in esophageal cancer incidence by histology, United States, 1998-2003. Int J Cancer 2008; 123:1422–1428.
    1. Blot WJ, Devesa SS, Kneller RW, et al. Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 1991; 265:1287–1289.
    1. Kusano C, Gotoda T, Khor CJ, et al. Changing trends in the proportion of adenocarcinoma of the esophagogastric junction in a large tertiary referral center in Japan. J Gastroenterol Hepatol 2008; 23:1662–1665.
    1. Blaser MJ, Saito D. Trends in reported adenocarcinomas of the oesophagus and gastric cardia in Japan. Eur J Gastroenterol Hepatol 2002; 14:107–113.
    1. Ahn HS, Lee HJ, Yoo MW, et al. Changes in clinicopathological features and survival after gastrectomy for gastric cancer over a 20-year period. Br J Surg 2011; 98:255–260.
    1. Park MW, Bae JM, Kim SW, et al. Annual change of clinicopathologic characteristics after radical gastrectomy due to gastric cancer. J Kor Surg Soc 2009; 77:88–95.
    1. Zagari RM, Fuccio L, Wallander MA, et al. Gastro-oesophageal reflux symptoms, oesophagitis and Barrett's oesophagus in the general population: the Loiano-Monghidoro study. Gut 2008; 57:1354–1359.
    1. Ness-Jensen E, Lindam A, Lagergren J, et al. Changes in prevalence, incidence and spontaneous loss of gastro-oesophageal reflux symptoms: a prospective population-based cohort study, the HUNT study. Gut 2012; 61:1390–1397.
    1. Nouraie M, Radmard AR, Zaer-Rezaii H, et al. Hygiene could affect GERD prevalence independently: a population-based study in Tehran. Am J Gastroenterol 2007; 102:1353–1360.
    1. Bor S, Mandiracioglu A, Kitapcioglu G, et al. Gastroesophageal reflux disease in a low-income region in Turkey. Am J Gastroenterol 2005; 100:759–765.
    1. Cho YS, Choi MG, Jeong JJ, et al. Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Asan-si, Korea. Am J Gastroenterol 2005; 100:747–753.
    1. Zhou Y, Zhang Z, Zhang Z, et al. A rising trend of gastric cardia cancer in Gansu Province of China. Cancer Lett 2008; 269:18–25.
    1. Stein HJ, Feith M, Siewert JR. Cancer of the esophagogastric junction. Surg Oncol 2000; 9:35–41.
    1. Siewert JR, Stein HJ. Classification of adenocarcinoma of the esophagogastric junction. Br J Surg 1998; 85:1457–1459.
    1. Kenneth RD, Donald OC. Update guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol 2005; 100:190–200.
    1. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 2011; 14:101–112.
    1. Edge SB, Byrd DR, Compton CC, et al. AJCC Cancer Staging Handbook. Springer-Verlag, 7th ed.New York, NY:2010.
    1. Johnson ML, Gordon HS, Petersen NJ, et al. Effect of definition of mortality on hospital profiles. Med Care 2002; 40:7–16.
    1. Park CH, Song KY, Kim SN. Treatment results for gastric cancer surgery: 12 years’ experience at a single institute in Korea. Eur J Surg Oncol 2008; 34:36–41.
    1. Sasako M, Sano T, Yamamoto S, et al. Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia: a randomised controlled trial. Lancet Oncol 2006; 7:644–645.
    1. Devesa SS, Blot WJ, Fraumeni JF. Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer 1998; 83:2049–2053.
    1. Park SM, Lim MK, Shin SA, et al. Impact of pre-diagnosis smoking, alcohol, obesity, and insulin resistance on survival in male cancer patients: National Health Insurance Corporation Study. J Clin Oncol 2006; 24:5017–5024.
    1. Dent J, El-Serag HB, Wallander MA, et al. Epidemiology of gastro-esophageal reflux disease: a systematic review. Gut 2005; 54:710–717.
    1. Fock KM, Talley N, Hunt R, et al. Report of the Asia-Pacific consensus on the management of gastroesophageal reflux disease. J Gastroenterol Hepatol 2004; 19:357–367.
    1. Fujiwara Y, Higuchi K, Watanabe Y, et al. Prevalence of gastroesophageal reflux disease and gastroesophageal reflux disease symptoms in Japan. J Gastroenterol Hepatol 2005; 20:26–29.
    1. Thrift AP, Kramer JR, Qureshi Z, et al. Age at onset of GERD symptoms predicts risk of Barrett's esophagus. Am J Gastroenterol 2013; 108:915–922.
    1. Chak A, Falk G, Grady WM. Assessment of familiarity, obesity, and other risk factors for early age of cancer diagnosis in adenocarcinomas of the esophagus and gastroesophageal junction. Am J Gastroenterol 2009; 104:1913–1921.
    1. Merry AH, Schouten LJ, Goldbohm RA. Body mass index, height and risk of adenocarcinoma of the oesophagus and gastric cardia: a prospective cohort study. Gut 2007; 56:1503–1511.
    1. Ho KY, Cheung TK, Wong BC. Gastroesophageal reflux disease in Asian countries: disorder of nature or nurture? J Gastroenterol Hepatol 2006; 21:1362–1365.
    1. Shaheen N, Ransohoff DF. Gastroesophageal reflux, Barrett esophagus and esophageal cancer: scientific review. JAMA 2002; 287:1972–1981.
    1. Lagergren J, Bergström R, Lindgren A, et al. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 1999; 340:825–831.
    1. Wang K, Yang CQ, Duan LP, et al. Changing pattern of adenocarcinoma of the esophagogastric junction in recent 10 years: experience at a large tertiary medical center in China. Tumori 2012; 98:568–574.
    1. Siewert JR, Feith M, Werner M. Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical(topographic classification in 1002 consecutive patients. Ann Surg 2000; 232:353–361.
    1. De Manzoni G, Pedrazzani C, Pasini F, et al. Results of surgical treatment of adenocarcinoma of the gastric cardia. Ann Thorac Surg 2002; 73:1035–1040.
    1. Siewert JR, Feith M, Stein HJ. Biologic and clinical variations of adenocarcinoma at the esophago-gastric junction: relevance of a topographic-anatomic subclassification. J Surg Oncol 2005; 90:139–146.
    1. Hasegawa S, Yoshikawa T, Cho H, et al. Is adenocarcinoma of the esophagogastric junction difference between Japan and Western countries? The incidence and clinicopathological features at a Japanese high-volume cancer center. World J Surg 2009; 33:95–103.
    1. Bai JG, Lv Y, Dang CX. Adenocarcinoma of the esophagogastric junction in China according to Siewert's classification. Jpn J Clin Oncol 2006; 36:364–367.
    1. Chung JW, Lee GH, Choi KS, et al. Unchanging trend of esophagogastric junctional adenocarcinoma in Korea: experience at a single institution based on Siewert's classification. Dis Esophagus 2009; 22:676–681.
    1. Harrison LE, Karpeh MS, Brennan MF. Total gastrectomy is not necessary for proximal gastric cancer. Surgery 1998; 123:127–130.
    1. Kitamura K, Yamaguchi T, Okamoto K, et al. Total gastrectomy for early gastric cancer. J Surg Oncol 1995; 60:83–88.
    1. Yoo CH, Sohn BH, Han WK, et al. Proximal gastrectomy reconstructed by jejunal pouch interposition for upper third gastric cancer: prospective randomized study. World J Surg 2005; 29:1592–1599.
    1. An JY, Youn HG, Choi MG, et al. The difficult choice between total and proximal gastrectomy in proximal early gastric cancer. Am J Surg 2008; 196:587–591.
    1. Wu CW, Chang IS, Lo SS, et al. Complications following D3 gastrectomy: post hoc analysis of a randomised trial. World J Surg 2006; 30:12–16.
    1. Bozzetti F, Gianotti L, Braga M, et al. Postoperative complications in gastrointestinal cancer patients: the joint role of the nutritional status and the nutritional support. Clin Nutr 2007; 26:698–709.

Source: PubMed

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