Changes of Esophagogastric Junctional Adenocarcinoma and Gastroesophageal Reflux Disease Among Surgical Patients During 1988–2012

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.

The thinking to the huge disease burden of gastric cancer in China and the increasing tendency of esophagogastric junctional adenocarcinoma

“…And in our study, the positive correlations with change in GERD for type II and type III tumors have not been observed (12). On the other hand, some study considered that the similarities in change over time in the rate of detection of EGJA and reflux esophagitis could not easily account for causal relationship (18).…”

“…The incidence of EGJA has been increasing in the ensuing years since there has been a proximal migration of carcinoma in the world, especially in Central Asia; while the incidence of non-EGJA decreased annually (2). The increasing tendency of EGJA is also found in China (12). The reasons for these changing trends are not very clear, but may reflect the change of risk factors.…”

“…In some Asian regions, the prevalence of GERD has been reported up to 48% (12). The statistical data showed that the increased trend of GERD in Asian population might be accompanied with the increased prevalence of esophageal adenocarcinoma in Eastern countries (12). Also, the annual incidence of type I EGJA seemed to be positively associated with reflux esophagitis in time trend (17,18).…”

“…Also, the annual incidence of type I EGJA seemed to be positively associated with reflux esophagitis in time trend (17,18). Recently, out team retrospectively analyzed the changes of EGJA and GERD among 5,053 surgical patients from 1988 to 2012 in a Chinese highvolume hospital (12). We found the increasing trends of EGJA, as well as the prevalence of GERD.…”

“…The prevalence of GERD in Asia has been detected to be increasing year by year, although it is still lower than that of Western countries. In some Asian regions, the prevalence of GERD has been reported up to 48% (12). The statistical data showed that the increased trend of GERD in Asian population might be accompanied with the increased prevalence of esophageal adenocarcinoma in Eastern countries (12).…”