The Distribution And Risk Estimate Of Esophagogastric Junction Adenocarcinoma And Precursors Lesions In Linzhou: A Prospective Cohort Study

Shanrui MA, Cancer Institute / Hospital, Chinese Academy of Medical Sciences, China
HAO C. 2 , WANG M. 1 , MA Q. 1 , WEI W. 1

1 Department of Cancer Epidemiology, Cancer Institute / Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
2 Department of Endoscopy, Linzhou Institute / hospital, Linzhou 456550, China

Background:The incidence of esophagogastric junction adenocarcinoma (EGJA) has shown a significantly upward trend in China, especially in traditional high-risk areas of esophageal cancer. However, the literature on incidence and mortality of EGJA is limited.
Purpose:To understand the epidemic state of EGJA and precursor lesions in high-risk areas of China.
Methods:Endoscopy with Lugol's iodine staining was performed on 10328 local residents aged 40 to 69 years old in Linzhou of Henan province from 2005–2009 and followed up until 31 March 2014. We estimated the relative risk of developing EGJA for each of the initial histological diagnoses.
Results:A total of 9941 subjects were enrolled in this study, about 144 incident cases and 32 death case of GCA were identified between 2005-2014. The incidence rate of non-atrophic gastritis(NAG), atrophic gastritis(AG), mild dysplasia(mD), severe dysplasia(SD), EGJA were 0.29% (9/3 108), 0.93% (9/965), 1.17% (10/858), 11.38% (19/167), 81.05% (77/95). And relative risks (95% confidence intervals) for incidence of EGJA, by initial histological diagnosis, were: NOR 1.0 (reference), NAG 0.69(0.31-1.50), AG 2.21(1.03-4.76), mD 2.77(1.34-5.72), SD 27.01(17.89-40.78), and EGJA 192.42(159.82-231.67). Moreover, the mortality of NAG, AG, mD, SD, EGJA were: 0.16% (5/3 108), 0.31% (3/965), 0.35% (3/858), 2.40% (4/167), 14.74% (14/95) and the relative risks for mortality of this tumor were: NOR 1.0 (reference), NAG 2.55(0.64-10.12), AG 4.92 (1.16-20.81), mD 5.53(1.34-22.89), SD 37.91(15.30-93.92), and EGJA 233.24 (149.26-364.45).
Conclusions:Up to 20.97% residents were asymptomatic were suffered from EGJA or precursor lesions in Linzhou. And increasing grades of dysplasia were strongly associated with increasing risk.
Funding source:National Natural Science Foundation of China