The global, regional, and national burden of oesophageal cancer and its attributable risk factors in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Abstract

Background Oesophageal cancer is a common and often fatal cancer that has two main histological subtypes: oesophageal squamous cell carcinoma and oesophageal adenocarcinoma. Updated statistics on the incidence and mortality of oesophageal cancer, and on the disability-adjusted life-years (DALYs) caused by the disease, can assist policy makers in allocating resources for prevention, treatment, and care of oesophageal cancer. We report the latest estimates of these statistics for 195 countries and territories between 1990 and 2017, by age, sex, and Socio-demographic Index (SDI), using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD). MethodsWe used data from vital registration systems, vital registration-samples, verbal autopsy records, and cancer registries, combined with relevant modelling, to estimate the mortality, incidence, and burden of oesophageal cancer from 1990 to 2017. Mortality-to-incidence ratios (MIRs) were estimated and fed into a Cause of Death Ensemble model (CODEm) including risk factors. MIRs were used for mortality and non-fatal modelling. Estimates of DALYs attributable to the main risk factors of oesophageal cancer available in GBD were also calculated. The proportion of oesophageal squamous cell carcinoma to all oesophageal cancers was extracted by use of publicly available data, and its variation was examined against SDI, the Healthcare Access and Quality (HAQ) Index, and available risk factors in GBD that are specific for oesophageal squamous cell carcinoma (eg, unimproved water source and indoor air pollution) and for oesophageal adenocarcinoma (gastro-oesophageal reflux disease).Findings There were 473 000 (95% uncertainty interval [95% UI] 459 000-485 000) new cases of oesophageal cancer and 436 000 (425 000-448 000) deaths due to oesophageal cancer in 2017. Age-standardised incidence was 5•9 (5•7-6•1) per 100 000 population and age-standardised mortality was 5•5 (5•3-5•6) per 100 000. Oesophageal cancer caused 9•78 million (9•53-10•03) DALYs, with an age-standardised rate of 120 (117-123) per 100 000 population. Between 1990 and 2017, age-standardised incidence decreased by 22•0% (18•6-25•2), mortality decreased by 29•0% (25•8-32•0), and DALYs decreased by 33•4% (30•4-36•1) globally. However, as a result of population growth and ageing, the total number of new cases increased by 52•3% (45•9-58•9), from 310 000 (300 000-322 000) to 473 000 (459 000-485 000); the number of deaths increased by 40•0% (34•1-46•3), from 311 000 (301 000-323 000) to 436 000 (425 000-448 000); and total DALYs increased by 27•4% (22•1-33•1), from 7•68 million (7•42-7•97) to 9•78 million (9•53-10•03). At the national level, China had the highest number of incident cases (235 000 [223 000-246 000]), deaths (213 000 [203 000-223 000]), and DALYs (4•46 million [4•25-4•69]) in 2017. The highest national-level agestandardised incidence rates in 2017 were observed in Malawi (23•0 [19•4-26•5] per 100 000 population) and Mongolia (18•5 [16•4-20•8] per 100 000). In 2017, age-standardis...

Global Burden, Risk Factors, and Trends of Esophageal Cancer: An Analysis of Cancer Registries from 48 Countries

“…Our results showed the highest disease burden of esophageal cancer in Eastern Asia, Eastern Africa, South Africa, and Northern Europe, and lower burden in Central America, Western Africa, Northern Africa, and Western Asia. These findings are generally consistent with those of a GBD study for esophageal cancer in 2017, although there was a slight difference in the order (Eastern Asia, South Africa, and Eastern Africa) [ 18 ]. This may be caused by the different time frames, data sources, and methods of modelling used for the estimation.…”

“…We previously found that there was an inverse association between the incidence of SCC and level of GDP and HDI at the country level [ 5 ]. The substantial reduction in the incidence of SCC in many less developed regions might be attributed to the decreased prevalence of risk factors associated with improving socioeconomic status [ 5 , 18 ]. Although the prognosis of esophageal cancer remains poor, the general decrease in mortality may, at least to some extent, be explained by the advancement of diagnostic technology and treatment, such as detection and treatment for early-stage esophageal cancer by upper endoscopy, neoadjuvant chemotherapy, and minimally invasive esophagectomy [ 7 ].…”

“…The previous analysis estimated the incidence by histological subtypes without trend analysis [ 13 , 14 , 15 ], or evaluated the epidemiological trend using cancer registry data up to 2007 only [ 5 , 16 , 17 ]. The Global Burden of Disease (GBD) Study [ 18 ] evaluated the pattern of esophageal disease based on modeling. Furthermore, none of these studies investigated the country-level association between the AC/SCC incidence ratio and lifestyle and metabolic risk factors for esophageal cancer.…”

Public Preferences and Predicted Uptake for Esophageal Cancer Screening Strategies: A Labeled Discrete Choice Experiment

“…The ongoing increasing incidence of esophageal adenocarcinoma (EAC) and its still dismal prognosis in most patients has stimulated interest in its early detection ( 1 ). Although Barrett's esophagus (BE) is a known precursor of EAC, only a minority of patients with EAC are known with a previous diagnosis of BE ( 2 ).…”

A New Risk Score Model Based on Lactate Dehydrogenase Predicting Prognosis in Esophageal Squamous Cell Carcinoma Treated With Chemoradiotherapy

“…1,2 More than 85% of all EC cases were diagnosed with esophageal squamous cell carcinoma (ESCC) . 3 Despite advancement in therapeutic strategies have improved the prognosis of ESCC patients, the long-term survival still remains dismal. 4 As we all know, TNM staging system has been correlated with survival in predicting prognosis for ESCC.…”