Endoscopy screening effect on stage distributions of esophageal cancer: A cluster randomized cohort study in China

Abstract

Efficacy of endoscopic screening for esophageal cancer is not sufficiently definitive and lacks randomized controlled trial evidence. The present study proved short‐term screening efficacy through describing and comparing disease stage distributions of intervention and control populations. Villages from Linzhou and Cixian were cluster randomly allocated to the intervention or to the control group and the target population of 52 729 and 43 068 individuals was 40‐69 years old, respectively, and the actual enrolled numbers were 18 316 and 21 178, respectively. TNM stage information and study‐defined stage information of esophageal cases from 2012 to 2016 were collected. Stage distributions were compared between the intervention and control groups in the total target population, as well as in the subgroup populations in terms of enrolment and before or after intervention. There were a total of 199 and 141 esophageal cancer cases in the intervention and control groups, respectively. For the target population, distributions of TNM stage were borderline significant between the two groups after intervention (P = .093). However, subgroup analysis of the enrolled population during the after‐intervention period had statistical significance for both TNM and study‐defined stage. Natural TNM stage distributions were approximately 32%, 41%, 24% and 3% for stages I to IV vs 71%, 19%, 7% and 3% in the intervention population. The natural study‐defined stage distributions from early, middle to advanced stages were approximately 18%, 49% and 33% vs 59%, 33% and 8%. Early‐stage esophageal cancer cases accounted for a higher proportion after endoscopy screening, and the efficacy in the target population depends on the intervention compliance.

<p>Secular Trend of Cancer Death and Incidence in 29 Cancer Groups in China, 1990–2017: A Joinpoint and Age–Period–Cohort Analysis</p>

“…The decrease in liver, esophageal, and stomach cancers in our study is closely associated with the effective implementation of cancer screening, early diagnosis, and clinical treatment in China. 7 , 18 , 19 Although population-based cancer screening has been implemented for high-risk populations for major cancers (including lung, female breast, colorectal, esophageal, gastric, and liver cancers) since 2006, the population coverage of cancer screening on a nationwide level is still insufficient, and the current largest female breast screening program has a coverage reaching only about 50% of its target population, despite its implementation since 2009. 20 , 21 So, the prevention and treatment of these cancers should be continuously strengthened.…”

“…In 2017, the total number of cancer deaths in males was 1,669,303 (1,588,052-1,751,095) and in females it was 937,603 (876,-978-989,714). In males, 477,246 (448,765-503,850) deaths due to lung cancer occurred, which accounted for 28.6% (females: 22.9%) of total cancer deaths (Table S2) 19.1% of the total incidence numbers of all cancers in females. Cervical cancer also had a high incidence rate.…”

The improved cure fraction for esophageal cancer in Linzhou city

“…From 2006 to 2012, 22,869 people took part in the screening of esophageal cancer [ 19 ]. There were higher proportion of early-stage esophageal cancer cases and 5 year survival rate of esophageal cancer in endoscopy screening group in Linzhou city [ 20 , 21 ]. According to the screening procedure, local people aged 40–69 will be organized to screen with endoscope for esophageal cancer.…”

Ribophorin II promotes cell proliferation, migration, and invasion in esophageal cancer cells in vitro and in vivo

“…It is also the main malignant cancer of the upper digestive tract found in the Chinese population. Because early signs of esophageal cancer are asymptomatic, many patients are diagnosed at advanced stages, and the 5-year survival rate is only 15% [2,3]. Early diagnosis and treatment can significantly improve the survival rate [4,5].…”