Background:Diets rich in red or processed meat have been linked to an increased risk of cancers within the digestive system.It has been suggested that a plant-based diet may have protective effects against digestive s...Background:Diets rich in red or processed meat have been linked to an increased risk of cancers within the digestive system.It has been suggested that a plant-based diet may have protective effects against digestive system cancers.This study aimed to determine the association between plant-based diets and upper gastrointestinal tract cancers(UGTC).Methods:We conducted a systematic review and meta-analysis of observational studies.We searched the PubMed,Medline,Embase,and Web of Science databases for articles published up to September 30,2023.We pooled the risk ratios(RR)with the corresponding 95%confi-dence intervals(CI)using fixed or random-effects models.Results:Our meta-analysis included 16 studies(30 results).The data revealed a strong inverse association between a high intake of plant-based diets and UGTC(RR=0.60,95%CI=0.49-0.72),specifically gastric cancer(GC,RR=0.53,95%CI=0.42-0.67)and esophageal can-cer(EC,RR=0.63,95%CI=0.42-0.96).This relationship was not significant for gastric cardia cancer(GCA)or esophagogastric junctional cancer(EGJC,RR=0.76,95%CI=0.47-1.22).A subgroup analysis showed the association was significant in studies from Asia and Europe,as well as in studies utilizing indices such as a vegetarian diet,Mediterranean diet,the plant-based diet index,and principal component analy-sis(PCA)dietary patterns.There was no indication of publication bias among the analyzed studies.Conclusions:This meta-analysis highlights the potential health benefits of plant-based diets in preventing UGTC,particularly regarding esophageal squamous cell carcinoma(ESCC)and GC.Nevertheless,additional research is required to validate these results and explore the un-derlying mechanisms.展开更多
AIM:To clarify the similarities and differences in gastric cancer epidemiology between Japan and China.METHODS:A comprehensive literature search of the PubMed database was performed.The relevant literature published i...AIM:To clarify the similarities and differences in gastric cancer epidemiology between Japan and China.METHODS:A comprehensive literature search of the PubMed database was performed.The relevant literature published in China was also been cited.Data on incidence and mortality rates in 2008 were obtained from the Cancer Mondial database,published by International Agency for Research on Cancer at http://www-dep.iarc.fr/.RESULTS:Gastric cancer remains a significant publichealth burden in both Japan and China.The prevalence of Helicobacter pylori(H.pylori)colonization is high in the adult populations of both countries.Accumulating evidence from intervention studies in both countries has shown the effectiveness of H.pylori eradication in reduc-ing gastric cancer incidence.There are differences,however,in many aspects of gastric cancer,including patterns of incidence and mortality,trends in the prevalence of H.pylori infection,H.pylori strains,the magnitude of risk of gastric cancer related to H.pylori infection,and associations with dietary habits.Compared with China,Japan has seen a more rapid decline in H.pylori infection among adolescents.While Japanese cohort studies have dominated the literature concerning the associations between gastric cancer and dietary habits,numerous case-control studies in China suggest a positive association between a high intake of preserved fish and vegetables and gastric cancer risk.There is a need for a multidisciplinary research approach to understand the interactions between various strains of H.pylori,host factors,and other lifestyle and environmental factors in gastric carcinogenesis in both countries.CONCLUSION:The shared high incidence of gastric cancer and high prevalence of H.pylori,as well as differences in many aspects of gastric cancer,provide an excellent opportunity to establish Sino-Japanese collaborations.展开更多
AIM:To estimate the cost-benefit of endoscopic screening strategies of esophageal cancer(EC)in high-risk areas of China. METHODS:Markov model-based analyses were conducted to compare the net present values(NPVs)and th...AIM:To estimate the cost-benefit of endoscopic screening strategies of esophageal cancer(EC)in high-risk areas of China. METHODS:Markov model-based analyses were conducted to compare the net present values(NPVs)and the benefit-cost ratios(BCRs)of 12 EC endoscopic screening strategies.Strategies varied according to the targeted screening age,screening frequencies,and follow-up intervals.Model parameters were collected from population-based studies in China,published literatures,and surveillance data. RESULTS:Compared with non-screening outcomes,all strategies with hypothetical 100 000 subjects saved life years.Among five dominant strategies determined by the incremental cost-effectiveness analysis,screening once at age 50 years incurred the lowest NPV(international dollar-I$55 million)and BCR(2.52).Screening six times between 40-70 years at a 5-year interval[i.e., six times(40)f-strategy]yielded the highest NPV(I$99 million)and BCR(3.06).Compared with six times(40)fstrategy,screening thrice between 40-70 years at a 10-year interval resulted in relatively lower NPV,but the same BCR. CONCLUSION:EC endoscopic screening is cost-beneficial in high-risk areas of China.Policy-makers should consider the cost-benefit,population acceptance,and local economic status when choosing suitable screening strategies.展开更多
In 2005, a program named "Early Detection and Early Treatment of Esophageal and Cardiac Cancer" (EDETEC) was initiated in China. A total of 8279 residents aged 40-69 years old were recruited into the EDETEC ...In 2005, a program named "Early Detection and Early Treatment of Esophageal and Cardiac Cancer" (EDETEC) was initiated in China. A total of 8279 residents aged 40-69 years old were recruited into the EDETEC program in Linzhou of Henan Province between 2005 and 2008. Howerer, the cost-benefit of the EDETEC program is not very clear yet. We conducted herein a cost-benefit analysis of screening for esophageal and cardiac cancer. The assessed costs of the EDETEC program included screening costs for each subject, as well as direct and indirect treatment costs for esophageal and cardiac severe dysplasia and cancer detected by screening. The assessed benefits of this program included the saved treatment costs, both direct and indirect, on esophageal and cardiac cancer, as well as the value of prolonged life due to screening, as determined by the human capital approach. The results showed the screening cost of finding esophageal and cardiac severe dysplasia or cancer ranged from $2707 to $4512, and the total cost on screening and treatment was $13 115-$14 920. The cost benefit was $58 944-$155 110 (the saved treatment cost, $17 730, plus the value of prolonged life, $41 214-$137 380). The ratio of benefit-to-cost (BCR) was 3.95-11.83. Our results suggest that EDETEC has a high benefit-to-cost ratio in China and could be instituted into high risk areas of China.展开更多
Objective：To provide an evidence-based and consistent assessment of the burden of cancer attributable to inadequate fruit and vegetable intake in China in 2005.Methods：The proportions of cancers attributable to low ...Objective：To provide an evidence-based and consistent assessment of the burden of cancer attributable to inadequate fruit and vegetable intake in China in 2005.Methods：The proportions of cancers attributable to low consumption of vegetable and fruit were calculated separately to estimate the burden of related cancers for the year 2005 in China.Data on the prevalence of exposure were derived from a Chinese nutrition and health survey.Data on relative risks were mainly derived from meta-analysis.Attributable fractions were calculated based on the counterfactual scenario which was a shift in the exposure distribution.Results：The total cancer burden attributable to inadequate consumption of fruit was up to 233,000 deaths （13.0% of all cancers） and 300,000 cases （11.6% of all cancers） in 2005.Increasing consumption of vegetable to the highest quintile could avoid total cancer deaths and cases by 3.6% （64,000 persons） and 3.4% （88,000 persons）.The contributions to cancer burden were higher in rural areas than in urban areas.They have greater influence on men than on women.The largest proportions of cancer burden attributable to low fruit and vegetable intake were for oral and pharyngeal cancers.Conclusion：This study showed that inadequate intake of fruit and vegetable makes a significant contribution to the cancer burden.Increasing consumption of fruit and vegetable could prevent many cancer deaths and save many lives.Promoting the consumption of fruit and vegetable is an important component in diet-based strategies for preventing cancer.展开更多
AIM:To explore whether routine biopsies at the high incidence spot of esophagogastric junction(EGJ)cancer are justified in endoscopic screening.METHODS:This was a multicenter population-based study conducted in eight ...AIM:To explore whether routine biopsies at the high incidence spot of esophagogastric junction(EGJ)cancer are justified in endoscopic screening.METHODS:This was a multicenter population-based study conducted in eight high-risk areas in China.A total of 37396 participants underwent endoscopic examination.Biopsies were obtained from visible mucosal abnormalities or from normal-appearing mucosa at the high incidence spot of esophagogastric junction cancer when no abnormality was detected.Specimens showing high-grade intraepithelial neoplasia(HIN)or higher grade lesions were deemed as pathologically"positive".The ratios of positive pathologic diagnosis between participants with abnormal and normal-appearing mucosa were compared using the Pearsonχ2 test.Odds ratios and 95%confidence intervals,adjusted for potential confounders,were calculated using logistic regression.RESULTS:A total of 37520 individuals participated in this study and 37396(99.7%)participants had full information and were suitable for analysis.During endoscopic examinations,9.11%(3405/37396)participants were found to have visible mucosal lesions.Of the participants who had normal-appearing mucosa at the EGJ,only 0.28%(94/33991)were diagnosed with HIN or higher grade lesions,whereas 6.05%(206/3405)of participants with abnormalities at the EGJ had a positive pathologic result.After controlling for other variables,visible abnormal mucosa detected under endoscopy strongly predicted a positive pathologic result(OR=32.51,95%CI:23.96-44.09).The proportion of participants with"positive"pathologic diagnoses increased as the total number of endoscopic examinations performed by the doctors increased(<5000 cases vs5000-10000 cases vs>10000 cases,Z=-2.7207,P=0.0065,Cochran Armiger trend test).The same trend was found between the proportion of participants with positive pathologic diagnoses and the total number of years the doctors performed endoscopy(<5 years vs5-10 years vs>10 years,Z=-10.3222,P<0.001,Cochran Armiger trend test).CONCLUSION:Additional routine biopsies from the high incidence spot of EGJ cancer are of limited value and are unjustified.展开更多
基金funded by the Fundamental Research Funds for the Central Universities(No.3332023139)the CAMS Innovation Fund for Medical Sciences(No.2021-I2M-1-010)
文摘Background:Diets rich in red or processed meat have been linked to an increased risk of cancers within the digestive system.It has been suggested that a plant-based diet may have protective effects against digestive system cancers.This study aimed to determine the association between plant-based diets and upper gastrointestinal tract cancers(UGTC).Methods:We conducted a systematic review and meta-analysis of observational studies.We searched the PubMed,Medline,Embase,and Web of Science databases for articles published up to September 30,2023.We pooled the risk ratios(RR)with the corresponding 95%confi-dence intervals(CI)using fixed or random-effects models.Results:Our meta-analysis included 16 studies(30 results).The data revealed a strong inverse association between a high intake of plant-based diets and UGTC(RR=0.60,95%CI=0.49-0.72),specifically gastric cancer(GC,RR=0.53,95%CI=0.42-0.67)and esophageal can-cer(EC,RR=0.63,95%CI=0.42-0.96).This relationship was not significant for gastric cardia cancer(GCA)or esophagogastric junctional cancer(EGJC,RR=0.76,95%CI=0.47-1.22).A subgroup analysis showed the association was significant in studies from Asia and Europe,as well as in studies utilizing indices such as a vegetarian diet,Mediterranean diet,the plant-based diet index,and principal component analy-sis(PCA)dietary patterns.There was no indication of publication bias among the analyzed studies.Conclusions:This meta-analysis highlights the potential health benefits of plant-based diets in preventing UGTC,particularly regarding esophageal squamous cell carcinoma(ESCC)and GC.Nevertheless,additional research is required to validate these results and explore the un-derlying mechanisms.
基金Supported by Grant-in-Aid from the Third Term Comprehensive Control Research for Cancer,the Ministry of Health,La-bour and Welfare,Japan
文摘AIM:To clarify the similarities and differences in gastric cancer epidemiology between Japan and China.METHODS:A comprehensive literature search of the PubMed database was performed.The relevant literature published in China was also been cited.Data on incidence and mortality rates in 2008 were obtained from the Cancer Mondial database,published by International Agency for Research on Cancer at http://www-dep.iarc.fr/.RESULTS:Gastric cancer remains a significant publichealth burden in both Japan and China.The prevalence of Helicobacter pylori(H.pylori)colonization is high in the adult populations of both countries.Accumulating evidence from intervention studies in both countries has shown the effectiveness of H.pylori eradication in reduc-ing gastric cancer incidence.There are differences,however,in many aspects of gastric cancer,including patterns of incidence and mortality,trends in the prevalence of H.pylori infection,H.pylori strains,the magnitude of risk of gastric cancer related to H.pylori infection,and associations with dietary habits.Compared with China,Japan has seen a more rapid decline in H.pylori infection among adolescents.While Japanese cohort studies have dominated the literature concerning the associations between gastric cancer and dietary habits,numerous case-control studies in China suggest a positive association between a high intake of preserved fish and vegetables and gastric cancer risk.There is a need for a multidisciplinary research approach to understand the interactions between various strains of H.pylori,host factors,and other lifestyle and environmental factors in gastric carcinogenesis in both countries.CONCLUSION:The shared high incidence of gastric cancer and high prevalence of H.pylori,as well as differences in many aspects of gastric cancer,provide an excellent opportunity to establish Sino-Japanese collaborations.
基金Supported by The National Science and Technology Pillar Program of the 11th National Five-Year Plan of China,No. 2006BAI02A15
文摘AIM:To estimate the cost-benefit of endoscopic screening strategies of esophageal cancer(EC)in high-risk areas of China. METHODS:Markov model-based analyses were conducted to compare the net present values(NPVs)and the benefit-cost ratios(BCRs)of 12 EC endoscopic screening strategies.Strategies varied according to the targeted screening age,screening frequencies,and follow-up intervals.Model parameters were collected from population-based studies in China,published literatures,and surveillance data. RESULTS:Compared with non-screening outcomes,all strategies with hypothetical 100 000 subjects saved life years.Among five dominant strategies determined by the incremental cost-effectiveness analysis,screening once at age 50 years incurred the lowest NPV(international dollar-I$55 million)and BCR(2.52).Screening six times between 40-70 years at a 5-year interval[i.e., six times(40)f-strategy]yielded the highest NPV(I$99 million)and BCR(3.06).Compared with six times(40)fstrategy,screening thrice between 40-70 years at a 10-year interval resulted in relatively lower NPV,but the same BCR. CONCLUSION:EC endoscopic screening is cost-beneficial in high-risk areas of China.Policy-makers should consider the cost-benefit,population acceptance,and local economic status when choosing suitable screening strategies.
基金supported by Key Projects in the National Science & Technology Pillar Program (No.2006BAI02 A15)
文摘In 2005, a program named "Early Detection and Early Treatment of Esophageal and Cardiac Cancer" (EDETEC) was initiated in China. A total of 8279 residents aged 40-69 years old were recruited into the EDETEC program in Linzhou of Henan Province between 2005 and 2008. Howerer, the cost-benefit of the EDETEC program is not very clear yet. We conducted herein a cost-benefit analysis of screening for esophageal and cardiac cancer. The assessed costs of the EDETEC program included screening costs for each subject, as well as direct and indirect treatment costs for esophageal and cardiac severe dysplasia and cancer detected by screening. The assessed benefits of this program included the saved treatment costs, both direct and indirect, on esophageal and cardiac cancer, as well as the value of prolonged life due to screening, as determined by the human capital approach. The results showed the screening cost of finding esophageal and cardiac severe dysplasia or cancer ranged from $2707 to $4512, and the total cost on screening and treatment was $13 115-$14 920. The cost benefit was $58 944-$155 110 (the saved treatment cost, $17 730, plus the value of prolonged life, $41 214-$137 380). The ratio of benefit-to-cost (BCR) was 3.95-11.83. Our results suggest that EDETEC has a high benefit-to-cost ratio in China and could be instituted into high risk areas of China.
基金supported by International Agency for Research on Cancer (Lyon, France) grant CRA No GEE/08/19
文摘Objective：To provide an evidence-based and consistent assessment of the burden of cancer attributable to inadequate fruit and vegetable intake in China in 2005.Methods：The proportions of cancers attributable to low consumption of vegetable and fruit were calculated separately to estimate the burden of related cancers for the year 2005 in China.Data on the prevalence of exposure were derived from a Chinese nutrition and health survey.Data on relative risks were mainly derived from meta-analysis.Attributable fractions were calculated based on the counterfactual scenario which was a shift in the exposure distribution.Results：The total cancer burden attributable to inadequate consumption of fruit was up to 233,000 deaths （13.0% of all cancers） and 300,000 cases （11.6% of all cancers） in 2005.Increasing consumption of vegetable to the highest quintile could avoid total cancer deaths and cases by 3.6% （64,000 persons） and 3.4% （88,000 persons）.The contributions to cancer burden were higher in rural areas than in urban areas.They have greater influence on men than on women.The largest proportions of cancer burden attributable to low fruit and vegetable intake were for oral and pharyngeal cancers.Conclusion：This study showed that inadequate intake of fruit and vegetable makes a significant contribution to the cancer burden.Increasing consumption of fruit and vegetable could prevent many cancer deaths and save many lives.Promoting the consumption of fruit and vegetable is an important component in diet-based strategies for preventing cancer.
基金Supported by National Natural Science Foundation of China,No.81241091
文摘AIM:To explore whether routine biopsies at the high incidence spot of esophagogastric junction(EGJ)cancer are justified in endoscopic screening.METHODS:This was a multicenter population-based study conducted in eight high-risk areas in China.A total of 37396 participants underwent endoscopic examination.Biopsies were obtained from visible mucosal abnormalities or from normal-appearing mucosa at the high incidence spot of esophagogastric junction cancer when no abnormality was detected.Specimens showing high-grade intraepithelial neoplasia(HIN)or higher grade lesions were deemed as pathologically"positive".The ratios of positive pathologic diagnosis between participants with abnormal and normal-appearing mucosa were compared using the Pearsonχ2 test.Odds ratios and 95%confidence intervals,adjusted for potential confounders,were calculated using logistic regression.RESULTS:A total of 37520 individuals participated in this study and 37396(99.7%)participants had full information and were suitable for analysis.During endoscopic examinations,9.11%(3405/37396)participants were found to have visible mucosal lesions.Of the participants who had normal-appearing mucosa at the EGJ,only 0.28%(94/33991)were diagnosed with HIN or higher grade lesions,whereas 6.05%(206/3405)of participants with abnormalities at the EGJ had a positive pathologic result.After controlling for other variables,visible abnormal mucosa detected under endoscopy strongly predicted a positive pathologic result(OR=32.51,95%CI:23.96-44.09).The proportion of participants with"positive"pathologic diagnoses increased as the total number of endoscopic examinations performed by the doctors increased(<5000 cases vs5000-10000 cases vs>10000 cases,Z=-2.7207,P=0.0065,Cochran Armiger trend test).The same trend was found between the proportion of participants with positive pathologic diagnoses and the total number of years the doctors performed endoscopy(<5 years vs5-10 years vs>10 years,Z=-10.3222,P<0.001,Cochran Armiger trend test).CONCLUSION:Additional routine biopsies from the high incidence spot of EGJ cancer are of limited value and are unjustified.
