河北省食管癌和胃癌高发区居民胃癌发生部位的变化及趋势分析

Analysis of the changing trends of frequency and localization of gastric cancers arising from different sites of the stomach in population of the high incidence area of esophageal and gastric cancers in Hebei province

目的探讨河北省食管癌和胃癌高发区居民胃癌发生部位的变化。方法回顾性分析1993-2006年河北省食管癌高发区磁县和胃癌高发区赞皇县全部首诊为胃癌的4334例患者的临床资料，比较不同地区、不同年份、不同性别和不同年龄患者贲门、胃体和胃窦部位胃癌的构成比，分析当地胃癌发生部位的变化及趋势。结果两地全部首诊胃癌患者中，贲门癌占68．0％，明显高于胃体癌（24．2％）和胃窦癌（7．9％；χ^2=124．396，P〈0．0001）。1993-2006年间，贲门癌在胃癌中所占的比例呈逐渐增高的趋势。磁县患者中，贲门癌所占的比例为71．2％，明显高于赞皇县（51．2％；χ^2=109．648，P〈0．0001）。磁县贲门癌比例逐渐增多的同时，胃体癌比例呈逐渐减少的趋势；而赞皇县胃癌构成比的变化主要体现在胃窦癌逐渐减少。性别对胃癌发生部位的变化无明显影响；但不同部位胃癌患者的年龄构成比存在着差异（χ^2=58．380，P〈0．0001），其中〈50岁组胃体癌所占的比例在所有年龄组中最高，为34．2％，而贲门癌在61～70岁组中所占的比例最高，为71．6％。结论贲门是河北省胃癌高发区磁县和食管癌高发区赞皇县居民胃癌发生的主要部位。在流行病学因素不变的条件下，磁县胃癌患者中，贲门癌的构成比将继续上升，胃体癌的构成比将继续下降；而赞皇县患者中，胃窦癌的构成比将继续下降。

Objective To analyze the changing trends of frequency and localization of gastric cancers arising from the gastric eardia, corpus and antrum during the past 14 years in population of the high incidence area of esophageal and gastric carcinoma in Hebei province, China. Methods The clinicopathological data of 4334 cases of gastric carcinomas among the local residents of Cixian and Zanhuang counties, initially diagnosed in our department from 1993 to 2006, were retrospectively analyzed. The proportion of gastric carcinomas arising from the gastric cardia, corpus and antrum in different years and in patients with different sex and ages were analyzed and compared, and the changing trends of the frequency of gastric carcinoma arising from different sites of the stomach were statistically analyzed. Results Among all the 4334 gastric carcinomas, gastric cardia carcinoma accounted for 68.0%, significantly higher than that of corpus （24.2%） and antrum （7.9%; χ^2 = 124. 396 ,P 〈0. 0001 ）. An increasing tendency in the proportion of gastric cardia carcinoma from 1993 to 2006 was seen. The percentage of cardiac carcinoma in the high incidence area of esophageal carcinoma （ Cixian county） was higher than that in the high incidence area of gastric cancer （Zanhuang county） （71.2% vs. 51.2% ; χ^2= 109. 648 ,P 〈0. 0001 ）. The increase in the incidence of cardiac carcinoma in Cixian county was mainly due to the increase of cardiac carcinoma from 1993 to 2006, while the contributing factor for the increase in the proportion of cardiac carcinomas was resulted from the decrease of incidence of antrum carcinoma in Zanhuang county during the same period. The occurring site of gastric carcinoma was related with age of paitents （χ^2= 58. 380, P 〈 0. 0001 ）. The percentage of carcinoma of the gastric body was highest in 〈 50 year age group, while that in the gastric cardia was highest in 61-70 year age group （71.6%）. Conclusion The major occurring site of gastric carcinoma is the gastric cardia among the local residents in population of the high incidence areas of esophageal and gastric carcinomas during the past 14 years in Hebei province, China. The increasing trend of cardiac carcinoma and decreasing trend of corpus carcinoma in Cixian county and antrum carcinoma in Zanhuang county will be maintained in the coming years if the epidemiological conditions will not be changed.