Clinicopathological and therapeutic comparisons of esophageal cancer between China and the USA:a multicenter hospital-based study

Background:Esophageal cancer(EC)remains a global health challenge due to its poor prognosis.China and the United States of America(USA)represent two distinct epicenters of EC burden.Understanding the EC disparities in these two countries is vital for tailoring prevention strategies,optimizing treatment,and enhancing outcomes in both countries.Yet,there lacks a comprehensive comparison of EC characteristics between the two countries.Methods:In this multicenter,retrospective hospital-based study,we enrolled primary EC patients who received their initial treatment at one of 23 hospitals in China during 2016-2017.Using electronic medical records and cancer registration records,information on demographics,lifestyle,and clinicopathological characteristics(in-cluding tumor site,pathology,stage,metastases,differentiation,and treatment)were collected.Additionally,we compared these data with the clinicopathological information of invasive EC patients diagnosed in 2016-2017 from the Surveillance,Epidemiology,and End Results(SEER)database in the USA.Results:A total of 6,658 EC patients in China and 8,555 EC patients in the USA were included finally.85.5%(n=5,694)of EC were esophageal squamous cell carcinoma(ESCC)in China,while esophageal adenocarcinoma(EAC)was prominent in the USA(58.9%,n=5,041).Among EC patients with known staging,the proportion of early stage was higher in China compared to the USA(48.3%vs.30.5%).Among ESCC patients,early-stage cases were higher in China than in the USA(49.8%vs.31.8%),while among EAC patients,late-stage cases were higher in China than in the USA(77.3%vs.68.5%)(all P<0.001).In China,EC mainly occurred in the middle third(60.2%)of the esophagus,whereas in the USA,it was more common in the lower third(59.9%)of the organ.Compared with EC patients with known metastatic status in the USA,China had fewer cases of lymph node metastases(51.4%vs.57.7%)and distant metastases(7.9%vs.33.8%).Regarding treatment,China had more surgical therapy(53.7%vs.22.6%),less radiotherapy(35.6%vs.53.3%),and less chemotherapy(46.7%vs.59.7%)compared to the USA.Conclusions:This study reveals notable disparities in EC between China and the USA,encompassing epidemi-ological,clinicopathological,and treatment dimensions.These findings provide insight for tailored strategies addressing regional variations in clinicopathological and therapeutic characteristics.

Identification of plasma proteomic signatures associated with the progression of cardia gastric cancer and precancerous lesions

Objective:Considering that there are no effective biomarkers for the screening of cardia gastric cancer(CGC),we developed a noninvasive diagnostic approach,employing data-independent acquisition(DIA)proteomics to identify candidate protein markers.Methods:Plasma samples were obtained from 40 subjects,10 each for CGC,cardia high-grade dysplasia(CHGD),cardia low-grade dysplasia(CLGD),and healthy controls.Proteomic profiles were obtained through liquid chromatography-mass spectrometry(LC-MS/MS-based DIA proteomics.Candidate plasma proteins were identified by weighted gene co-expression network analysis(WGCNA)combined with machine learning and further validated by the Human Protein Atlas(HPA)database.The area under the receiver operating characteristic curve(AUC)was used to evaluate the performance of the biomarker panel.Results:There was a clear distinction in proteomic features among CGC,CHGD,CLGD,and the healthy controls.According to the WGCNA,we found 42 positively associated and 164 inversely associated proteins related to CGC progression and demonstrated several canonical cancer-associated pathways.Combined with the results from random forests,LASSO regression,and immunohistochemical results from the HPA database,we identified three candidate proteins(GSTP1,CSRP1,and LY6G6F)that could together distinguish CLGD(AUC=0.91),CHGD(AUC=0.99)and CGC(AUC=0.98)from healthy controls with excellent accuracy.Conclusions:The panel of protein biomarkers showed promising diagnostic potential for CGC and precancerous lesions.Further validation and a larger-scale study are warranted to assess its potential clinical applications,suggesting a potential avenue for CGC prevention in the future.