食管-胃交界腺癌地域发病特点与思考

Incidence and Geographic Characteristics of Esophagus-gastric Junction Adenocarcinoma

我国食管癌高发区主要分布在华北太行山、陕豫秦岭、鄂豫皖大别山、川北、闽粤、苏北为主的六大地理区域。同时西北部的新疆、甘肃也存在着食管癌的高发区域。2000年WHO将责门癌称为:食管-胃交界腺癌。近年来高发区流行病学调查看到贲门癌发病迅速上升。本文从地域角度分析发病死亡登记资料和临床诊断数据,以期了解贲门癌发病趋势和原因。在华北太行山脉,川北和苏北三个地域。10个食管癌高发区中有六个地区男性胃癌的发病为第一位的,在闽粤、陕豫秦岭、西北部地域也有同样的流行趋势。甘肃西北部以1977～1988年和1989～2000年两个时间段的内镜诊断做了比较,贲门胃底癌检出率上升了29.9%,其中武威市贲门癌占胃癌的45.8%。分析新疆维吾尔族胃癌的发病部位,贲门癌占43.9%～45.3%。根据目前地域流行病学资料,我国传统食管癌高发区普遍还存在着贲门癌的高发。这种现象在山区,交通闭塞区域更为突出。分析高发的原因主要有两个:一是根据ICD-8编码要求,贲门癌归入胃癌统计,改变了我国传统将贲门癌归入食管癌的登记方法,二是内镜广泛的应用,提高了食管癌和贲门癌的鉴别诊断。未来的病因研究单纯从吸烟饮酒思维模式似不能完全解释。地域性贲门癌的发病与遗传因素有更密切的关系。

High-risk areas of esophageal cancer in China are mainly distributed in six geographic regions. They are the Taihang Moutains in Northern China; the Qinling Mountains in Shannxi and Henan provinces; the Dabie Moutains in Hubei, He＇nan and Anhui provinces; the North of Sichuan; the Fujian and Guangdong provinces and the North of Jiangsu prov- ince. At the same time, there are also high-risk areas of esophageal cancer in the Xinjiang and Gansu in the Northwest of China. In 2000, WHO renamed cancer of the gastric cardia as esophageal gastric junction adenocarcinoma. Over the past few years, epidemiological studies showed that in the major geographic areas listed the incidence of gastric cardia cancer is increasing. Death registration and clinical diagnosis data from the different regions were analyzed in this paper in order to understand the trends and causes of gastric cardia cancer. In the Taihang Mountains of North China and in the northern parts of Sichuan and Jiangsu provinces, the incidence of gastric cancer in male patients ranked first in 6 of the 10 high-risk regions. The same trend appeared in Fujian and Guangdong, the Qingling Mountains in Shannxi and He＇nan, and the north- western regions of China. In northwestern regions of Gansu province, results of endoscopic diagnosis during two time peri- ods （1977-1988 and 1989-2000） were compared. The detection rate of cardiac carcinoma of the gastric fundus increased by 29.9% in these regions. Cardiac carcinoma accounted for 45.8% in the detection rate of gastric cancer in Wuwei city. Analysis of the affected regions in Uygur gastric cancer patients revealed that cardiac carcinoma amounted for 43.9% 45.3% of all cases with gastric cancer. Based on the current geographical epidemiological data, there is still a high risk of carcinoma of gastric cardia in China＇s traditional high-risk area of esophageal cancer. The phenomenon is more conspicu- ous in the mountain areas and the regions with blocked traffic. There are 2 main explanations behind the increased detec- tion： One is that gastric cardia is to be classified statistically as gastric carcinoma based on the ICD-8 coding, thus chang- ing the traditional registration method in China that classifies cardiac carcinoma as esophageal cancer. Another is the com- prehensive application of endoscopy to improve the differential diagnosis of esophageal cancer from gastric cardia cancers. Smoking and drinking alcohol surely contribute to the occurence of gastric cardia cancer. But hereditary factors may play a major role in causing regional gastric cardia cancer.