背景:当前上消化道(UGI)癌症筛查策略主要针对癌症特异性风险,以食管腺癌(EAC)为重点。然而,所有UGI癌症均可通过上内镜检查进行筛查和早期发现.这项研究评估并探讨了累积UGI癌症的基于发病率的死亡率(IBM)。旨在识别基于种族或性别的差异。
方法:我们使用了监测,流行病学,和最终结果研究数据分析诊断为EAC的患者,食管鳞状细胞癌,贲门胃癌(CGC),非贲门胃癌(NCGC),或结直肠腺癌从2000年到2019年。年龄调整后的IBM以每100,000人口的比率计算,并按性别和种族/种族分层。我们还将UGI癌症IBM与结直肠癌进行了比较,已建立的全人群内镜筛查指南的癌症.
结果:UGI癌症的累积IBM为8.40(95%CI8.34-8.46)。最高的癌症特异性IBM率是EAC(2.26,95%CI2.23-2.29),其次是NCGC(2.07,95%CI2.04-2.10),CGC(1.60,95%CI1.57-1.62),ESCC(1.21,95%CI1.19-1.23),和杂项UGI癌(1.27,95%CI1.13-1.40)。UGI癌症IBM在黑人男性中最高(16.43,95%CI15.97-16.89),美洲印第安人/阿拉斯加土著男性(15.23,95%CI13.75-16.82),和西班牙裔男性(13.76,95%CI13.42-14.11)。这些比率明显高于白人男性(12.81,95%CI12.68-12.95)。
结论:UGI癌症对目前没有任何系统筛查方法的非白人人群亚组造成了显著更高的死亡负担。
BACKGROUND: Current strategies for upper gastrointestinal (UGI) cancer screening primarily target cancer-specific risk, with the strongest focus on esophageal adenocarcinoma (EAC). However, all UGI cancers are amendable to screening and early detection with an upper endoscopic examination. This study assesses and explores incidence-based mortality (IBM) for cumulative UGI cancers, aiming to identify race-based or sex-based disparities.
METHODS: We used Surveillance, Epidemiology, and End Results Research data to analyze patients diagnosed with EAC, esophageal squamous cell carcinoma,
cardia gastric cancer, noncardia gastric cancer, or colorectal adenocarcinoma from 2000 to 2019. Age-adjusted IBM was calculated as a rate per 100,000 population and stratified by sex and race/ethnicity. We also compared UGI cancer IBM with that of colorectal cancer, a cancer with established population-wide endoscopic screening guidelines.
RESULTS: Cumulative IBM for UGI cancers was 8.40 (95% confidence interval [CI] 8.34-8.46). The highest cancer-specific IBM rates were for EAC (2.26, 95% CI 2.23-2.29), followed by noncardia gastric cancer (2.07, 95% CI 2.04-2.10),
cardia gastric cancer (1.60, 95% CI 1.57-1.62), esophageal squamous cell carcinoma (1.21, 95% CI 1.19-1.23), and miscellaneous UGI cancer (1.27, 95% CI 1.13-1.40). UGI cancer IBM was highest among Black men (16.43, 95% CI 15.97-16.89), American Indian/Alaska Native men (15.23, 95% CI 13.75-16.82), and Hispanic men (13.76, 95% CI 13.42-14.11). These rates are significantly greater than among White men (12.81, 95% CI 12.68-12.95).
CONCLUSIONS: UGI cancers impose a significantly higher mortality burden on non-White population subgroups that are not currently targeted by any systematic screening approach.