Esophagogastric junction tumors increasing in China too

Last Updated: 2015-02-11

By Megan Brooks

NEW YORK (Reuters Health) - Mirroring trends in the Western world, China is seeing an increase in cases of esophagogastric junctional adenocarcinoma (EGJA) and gastroesophageal reflux disease (GERD), a new study shows.

"Most probably GERD plays a role in development of EGJA, but the definite causality and mechanism between GERD and EGJA still needs to be researched further," Dr. Jian-Kun Hu, from the gastrointestinal surgery department at West China Hospital, Sichuan University in Chengdu, China, told Reuters Health by email.

Dr. Hu and colleagues assessed changes in EGJA and GERD among 5053 patients who had surgery for gastric and distal esophageal adenocarcinoma at their high-volume center from 1988 to 2012. The sample included 1723 patients with EGJA.

They found that the proportion of EGJA rose significantly (p<0.001) from 22.3% in period one (1988-1992) to 35.7% in period five (2008-2012).

By Siewert classification, the proportion of type I tumors (adenocarcinoma of the distal esophagus) and type III tumors (representing subcardial gastric carcinoma) rose significantly from period one to period five, while the proportion of type II tumors (representing true carcinoma of the cardia) declined.

The increase in EGJA in recent years might be related to changes in risk factors, Dr. Hu noted in an email to Reuters Health. Case-control studies of patients with esophageal or gastric cardia adenocarcinoma have suggested cigarette smoking and possibly heavy alcohol consumption as risk factors. And the prevalence of cigarette smoking and alcohol consumption in China rose dramatically in recent years, Dr. Hu explained.

Also, obesity has emerged as a major risk factor for these tumors. "The percentage of adults in the population who are overweight increased considerably. The diet habit also has been changing to the unhealthy foods. There is some evidence that dietary factors also may be involved, including low intake of fruits and vegetables, and high intake of red meat, fat, and calories," Dr. Hu noted.

The reported increases in EGJA are also a reflection of increasing endoscopy usage, Dr. Hu said. "The healthy consciousness of Chinese people has greatly shifted during the past two decades. The upper gastrointestinal endoscopic examination is becoming more and more acceptable in our country. The widespread application of upper gastrointestinal endoscopy in hospitals of China has made the detection rate of gastric and esophageal cancer increasing," Dr. Hu explained.

The study also showed that the prevalence of GERD increased gradually from 6.5% in period one to 10.9%, which could also be explained by a number of factors.

"Epidemiological studies have consistently suggested that symptom of GERD is the main risk factor for Barrett esophagus and esophageal adenocarcinoma. It has been reported that the increasing prevalence of GERD among populations of Asia might be closely associated with the increasing trend of EGJA in Eastern countries. And our results also demonstrated that there was a tendency between the proportion of EGJA and the prevalence of GERD for all the patients with EGJA," Dr. Hu said.

The study also suggests that total gastrectomy is becoming the preferred procedure for EGJA, the researchers say.

The study had no commercial funding and the authors have declared no conflicts of interest.

SOURCE: http://bit.ly/1DXhnnq

Ann Surg 2015.