甘肃省河西走廊地区33年胃镜检出胃癌临床流行病学研究
摘要
目的：通过对甘肃省胃癌高发区(河西地区)36所二级以上医院33年经内镜检出胃癌患者资料进行统计,分析我省胃癌高发区河西五地市胃癌的检出率、患者性别、年龄、发病部位、病理组织学类型及区域分布等流行病学特点,探讨我省胃癌高发区胃癌的流行趋势及影响因素,为该疾病的预防和控制提供科学的依据。方法：选择自1977年1月至2009年12月甘肃省河西五地市36所医院胃镜检查并经病理确实的胃癌患者的病例资料,应用描述流行病学方法,逐年统计各医院的胃镜检查人数、胃镜检出胃癌人数、病理确诊人数,分别对性别、年龄、发病部位、病理诊断、患者来源区域、检查时间等进行统计学分析。结果：33年来甘肃省胃癌高发区(河西地区)胃癌总检出率为5.57%,呈逐年下降趋势。胃癌高发于50～69岁,男性多见,好发于贲门、胃体及胃窦部,且以腺癌为主,其中低分化腺癌所占比例较高(35.04%),检出率武威地区最高(6.39%)。其中早期胃癌有206例,占胃癌总数的1.17%。结论：甘肃省胃癌高发区(河西地区)胃癌检出率呈逐年下降趋势,男性显著高于女性,发病年龄高峰集中于50-69岁,发病部位中胃体癌所占比例最高,且以低分化腺癌为主,早期胃癌检出率低,在当地开展胃癌早期防治意义重大。
Objective:To investigate the clinical epidemiological characteristics of gastric carninoma and its trend during the past 33 years in Hexi Corridol,Gansu province.Method:Patients with gastric carcinoma,detected by endoscopy and pathologically diagnosed from 1977.1 to 2009.12 were selected.The main clinical data, epidemiologyical, endoscopic manifestation and the pathological characteristics were studied. Results:The overall diagnosis rate of gratric carcinoma was 5.57% in the past 33 years. The predominant age rangde from 50 to 69 years old, with the majority being the men, and the gastric carcinoma mainly occurred in the cardia,body and sinus.The adenocarcinoma taked large part and the percentage of low adenocarcinoma is high about 38.88%. The hightest rate of detection was Wuwei(6.39%). Conclusions:The diagnosis rate of gratric carcinoma in Hosi Corridol during the past 33 years had the significant falling trend. The men patients was apparently much more than women, the predominant age rangde from 50 to 69 years old, the gastric carcrnoma occurred most freaquently in the gastric body, and the low adenocarcinoma took high proportion. The diagnosis rate of early gratric carcinoma was very low, therefore,early prevention and control work for this diease has great significance.
Objective:To investigate the clinical epidemiological characteristics of gastric carninoma and its trend during the past 33 years in Hexi Corridol,Gansu province.Method:Patients with gastric carcinoma,detected by endoscopy and pathologically diagnosed from 1977.1 to 2009.12 were selected.The main clinical data, epidemiologyical, endoscopic manifestation and the pathological characteristics were studied. Results:The overall diagnosis rate of gratric carcinoma was 5.57% in the past 33 years. The predominant age rangde from 50 to 69 years old, with the majority being the men, and the gastric carcinoma mainly occurred in the cardia,body and sinus.The adenocarcinoma taked large part and the percentage of low adenocarcinoma is high about 38.88%. The hightest rate of detection was Wuwei(6.39%). Conclusions:The diagnosis rate of gratric carcinoma in Hosi Corridol during the past 33 years had the significant falling trend. The men patients was apparently much more than women, the predominant age rangde from 50 to 69 years old, the gastric carcrnoma occurred most freaquently in the gastric body, and the low adenocarcinoma took high proportion. The diagnosis rate of early gratric carcinoma was very low, therefore,early prevention and control work for this diease has great significance.
引文
[1]2008年世界卫生组织调查报告.
[2]2008年第三次全国死因调查报告.
[3]徐飚,王建明.胃癌流行病学研究[J].中华肿瘤防治杂志,2006,13：1—7.
[4]Miki K, Morita M, Sasajima M, et al. Usefulness of gastric cancer screening using the serum pepsinogen test method. Am J Gastroenterol,2003,98:735-739.
[5]Farly D.R. Donohue JH.Early gastric cancer[J].Gastric sury,1992,72:401-421.
[6]Ryu Ishihara MD, Hideo Tanaka MD, Hiroyasu Iishi MD, et al. Long-term outcome of esophageal mucosal squamous cell carcinoma without lymphovascular involvement after endoscopic resection.Cancer,2008,112:2166-2172.
[7]范钟磷,田春铎,王秀娟.青海地区十年间胃癌胃镜检出率分析.青海医学院学报,1994,15：20-21.
[8]丁士刚,周丽雅,林三仁等.25年来经胃镜检出胃癌的临床与病理特点.中国微创外科杂志,2001,1：117—119.
[9]赵丽珍,张军,高君等.西安地区12年间胃癌检出上消化道癌症分析[J].西安交通大学学报(医学版),2005,26：498—501.
[10]李建成,杨莉芬.甘肃省恶性肿瘤死亡率变化趋势[J].中国肿瘤,2000,9：170.
[11]任登先.纤维胃镜检查101251例临床分析[J].甘肃科学学报,1990,2：75—78.
[12]南寿山,黄晓俊,郝晓雯.甘肃省30年胃镜检出胃癌临床流行病学分析.中华消化内镜杂志,2008,29(11)：1163-1164.
[13]罗好曾,程继志.武威市移民及萎缩性胃炎人群胃癌流行病学调查研究[J].肿瘤防治研究,1994,21(4)：260-261.
[14]李玉民,石斌,柴琛等.甘肃省河西地区胃癌发病状况的调查[J].中华普通外科杂志,2004,19：183—184.
[15]Hermann Brenner,Dietrich Rothenbacher,and Volker Arndt.Epidemiology of stomach cancer[J].Cancer Epidemiology,2009,472:467-477.
[16]孙秀娣,牧人,周有尚等.中国胃癌死亡率20年变化情况分析及其发展趋势预测[J].中华肿瘤杂志,2004,26(1)：4-9.
[17]Peggy Hsieh,and Kazuhiko Yamane.DNA mismatch repair:Molecular mechanism,cancer,and ageing.Mechanisms of Ageing and Development,2008,129:391-407.
[18]常虹,赵越,丁士刚,等.胃癌患者年龄分布与临床病理特点关系的研究[J].临床荟萃,2003,18：841-843.
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[2]Parkin DM, Bray FI, Devesa SS. Corrigendum to "Cancer burden in the year 2000. The global picture" [European Journal of Cancer,37(Suppl.8) (2001) S4-S66][J].Eur J Cancer, 2003,39:848.
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[5]郭军巧,肖万安,袁媛.幽门螺杆菌与胃癌关系的Meta分析[J].中国卫生统计,2004,21(1)：24-27.
[6]Hohenberger P, Gretschel S. Gastric cancer[J]. Lancet,2003,362(9380):305-15.
[7]王凯娟,王润田.中国幽门螺杆菌感染流行病学Meta分析[J].中华流行病学杂志,2003,24(6)：6443-446
[8]孙坚萍.EB病毒相关胃癌研究进展[J].国外医学病毒学分册,2004,11(2)：56-59.
[9]Fisher SG, Davis F, Nelson R, et al. A cohort study of stomach cancer risk in men after gastric surgery for benign disease[J]. J Natl Cancer Inst,1993,85(16):1303-10.
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[13]陈焕朝,李茂生,王明荣,等.扬中县居民血硒状态与癌症死亡率相关性研究[J].中华肿瘤杂志,1990,12(6)：480.
[14]郭春华,王明荣,刘圣贤,等.加硒食盐对疾病的干预效果观察[J].微量元素与健康研究,1996,3(1)：42-43
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[17]朱晓东,林庚金,许祖德,等.高盐饲料配合甲基硝基亚硝基胍诱发大鼠胃癌[J].上海实验动物科学,2003,23(2)：85-88.
[18]Setiawan VW, Zhang ZF, Yu GP, et al.Protective effect of green tea on the risks of chronic gastritis and stomach cancer[J].Int J Cancer,2001,92(4):600-4.
[19]Yatsuya H, Toyoshima H, Mizoue T,et al. Family history and the risk of stomach cancer death in Japan:differences by age and gender[J].Int J Cancer,2002,97(5):688-94.
[20]Machado JC, Pharoah P, Sousa S, Carvalho R, et al. Interleukin 1B and interleukin 1RN polymorphisms are associated with increased risk of gastric carcinoma[J]. Gastroenterology,2001,121(4):823-9.
[21]Boissy R, Watson M, Umbach D, et al. A pilot study investigating the role of NAT1 and NAT2 polymorphisms in gastric adenocarcinoma[J]. Int J cancer,2000,87(4):507.
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[24]Tanikawa C,Furukawa Y,Yoshida N,et al. XEDAR as a putative colorectal tumor suppressor that mediates p53-regulated anoikis pathway[J]. Oncogene,2009,28(34):3081-3092.
[25]Liu Y, Kaneko S, Sobue T. Trends in reported incidences of gastric cancer by tumour location, from 1975 to 1989 in Japan. Int J Epidemiol 2004; 33:808-815
[26]McMichael AJ, McCall MG, Hartshorne JM, Woodings TL. Patterns of gastro-intestinal cancer in European migrants to Australia:the role of dietary change. Int J Cancer 1980; 25: 431-437
[27]El-Serag HB, Mason AC, Petersen N, Key CR. Epidemiological differences between adenocarcinoma of the oesophagus and adenocarcinoma of the gastric cardia in the USA. Gut 2002; 50:368-372
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[30]Webb PM, Knight T, Greaves S, Wilson A, Newell DG, Elder J, Forman D. Relation between infection with Helicobacter pylori and living conditions in childhood:evidence for person to person transmission in early life. BMJ 1994; 308:750-753
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[32]Olmos JA, Rios H, Higa R. Prevalence of Helicobacter pylori infection in Argentina:results of a nationwide epidemiologic study. Argentinean Hp Epidemiologic Study Group. J Clin Gastroenterol 2000; 31:33-37
[33]Goodman KJ, Correa P. Transmission of Helicobacter pylori among siblings. Lancet 2000; 355:358-362
[34]Parsonnet J, Friedman GD, Vandersteen DP, Chang Y, Vogelman JH, Orentreich N, Sibley RK. Helicobacter pylori infection and the risk of gastric carcinoma.N Engl J Med 1991; 325:1127-1131
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[2]2008年第三次全国死因调查报告.
[3]徐飚,王建明.胃癌流行病学研究[J].中华肿瘤防治杂志,2006,13：1—7.
[4]Miki K, Morita M, Sasajima M, et al. Usefulness of gastric cancer screening using the serum pepsinogen test method. Am J Gastroenterol,2003,98:735-739.
[5]Farly D.R. Donohue JH.Early gastric cancer[J].Gastric sury,1992,72:401-421.
[6]Ryu Ishihara MD, Hideo Tanaka MD, Hiroyasu Iishi MD, et al. Long-term outcome of esophageal mucosal squamous cell carcinoma without lymphovascular involvement after endoscopic resection.Cancer,2008,112:2166-2172.
[7]范钟磷,田春铎,王秀娟.青海地区十年间胃癌胃镜检出率分析.青海医学院学报,1994,15：20-21.
[8]丁士刚,周丽雅,林三仁等.25年来经胃镜检出胃癌的临床与病理特点.中国微创外科杂志,2001,1：117—119.
[9]赵丽珍,张军,高君等.西安地区12年间胃癌检出上消化道癌症分析[J].西安交通大学学报(医学版),2005,26：498—501.
[10]李建成,杨莉芬.甘肃省恶性肿瘤死亡率变化趋势[J].中国肿瘤,2000,9：170.
[11]任登先.纤维胃镜检查101251例临床分析[J].甘肃科学学报,1990,2：75—78.
[12]南寿山,黄晓俊,郝晓雯.甘肃省30年胃镜检出胃癌临床流行病学分析.中华消化内镜杂志,2008,29(11)：1163-1164.
[13]罗好曾,程继志.武威市移民及萎缩性胃炎人群胃癌流行病学调查研究[J].肿瘤防治研究,1994,21(4)：260-261.
[14]李玉民,石斌,柴琛等.甘肃省河西地区胃癌发病状况的调查[J].中华普通外科杂志,2004,19：183—184.
[15]Hermann Brenner,Dietrich Rothenbacher,and Volker Arndt.Epidemiology of stomach cancer[J].Cancer Epidemiology,2009,472:467-477.
[16]孙秀娣,牧人,周有尚等.中国胃癌死亡率20年变化情况分析及其发展趋势预测[J].中华肿瘤杂志,2004,26(1)：4-9.
[17]Peggy Hsieh,and Kazuhiko Yamane.DNA mismatch repair:Molecular mechanism,cancer,and ageing.Mechanisms of Ageing and Development,2008,129:391-407.
[18]常虹,赵越,丁士刚,等.胃癌患者年龄分布与临床病理特点关系的研究[J].临床荟萃,2003,18：841-843.
[1]Kelley JR, Duggan JM. Gastric cancer epidemiology and risk factors[J].J Clin Epidemiol,2003,56(1):1-9.
[2]Parkin DM, Bray FI, Devesa SS. Corrigendum to "Cancer burden in the year 2000. The global picture" [European Journal of Cancer,37(Suppl.8) (2001) S4-S66][J].Eur J Cancer, 2003,39:848.
[3]张文范,张荫昌,陈峻青.胃癌[M].第2版.上海：上海科学技术出版社,2001.17.
[4]李立明.流行病学[M].第5版.北京：人民卫生出版社,2003.39-40.
[5]郭军巧,肖万安,袁媛.幽门螺杆菌与胃癌关系的Meta分析[J].中国卫生统计,2004,21(1)：24-27.
[6]Hohenberger P, Gretschel S. Gastric cancer[J]. Lancet,2003,362(9380):305-15.
[7]王凯娟,王润田.中国幽门螺杆菌感染流行病学Meta分析[J].中华流行病学杂志,2003,24(6)：6443-446
[8]孙坚萍.EB病毒相关胃癌研究进展[J].国外医学病毒学分册,2004,11(2)：56-59.
[9]Fisher SG, Davis F, Nelson R, et al. A cohort study of stomach cancer risk in men after gastric surgery for benign disease[J]. J Natl Cancer Inst,1993,85(16):1303-10.
[10]戴涤新,陆建邦,等.林州居民胃部疾病与胃癌关系的病例对照研究[J].中国肿瘤,1999，8(6)：255-256.
[11]施一江,黎钧耀,李茂生,等.空腹胃液中挥发性亚硝胺含量与胃癌和萎缩性胃炎关系的研究[J].中国癌症杂志,1999,9(1)：1-3.
[12]Sauvaget C, Lagarde F, Nagano J.Lifestyle factors, radiation and gastric cancer in atomic-bomb survivors (Japan)[J]. Cancer Causes Control,2005,16(7):773-80.
[13]陈焕朝,李茂生,王明荣,等.扬中县居民血硒状态与癌症死亡率相关性研究[J].中华肿瘤杂志,1990,12(6)：480.
[14]郭春华,王明荣,刘圣贤,等.加硒食盐对疾病的干预效果观察[J].微量元素与健康研究,1996,3(1)：42-43
[15]Nardone G, Morgner A. Helicobacter pylori and gastric malignancies[J]. Helicobacter,2003,8 Suppl 1:44-52.
[16]Kobayashi M, Tsubono Y, Sasazuki S, et al. Vegetables, fruit and risk of gastric cancer in Japan:a 10-year follow-up of the JPHC Study Cohort Ⅰ[J]. Int J Cancer,2002,102(1):39-44.
[17]朱晓东,林庚金,许祖德,等.高盐饲料配合甲基硝基亚硝基胍诱发大鼠胃癌[J].上海实验动物科学,2003,23(2)：85-88.
[18]Setiawan VW, Zhang ZF, Yu GP, et al.Protective effect of green tea on the risks of chronic gastritis and stomach cancer[J].Int J Cancer,2001,92(4):600-4.
[19]Yatsuya H, Toyoshima H, Mizoue T,et al. Family history and the risk of stomach cancer death in Japan:differences by age and gender[J].Int J Cancer,2002,97(5):688-94.
[20]Machado JC, Pharoah P, Sousa S, Carvalho R, et al. Interleukin 1B and interleukin 1RN polymorphisms are associated with increased risk of gastric carcinoma[J]. Gastroenterology,2001,121(4):823-9.
[21]Boissy R, Watson M, Umbach D, et al. A pilot study investigating the role of NAT1 and NAT2 polymorphisms in gastric adenocarcinoma[J]. Int J cancer,2000,87(4):507.
[22]Robertson KD. DNA methylation, methyltransferases, and can- cer. Oncogene 2001; 20: 3139-3155.
[23]Sinha SK,Chaudhary PM. Induction of apoptosis by X-linked ectodermal dysplasia receptor via a caspase 8-dependent mechanism[J]. J Biol Chem.2004,279(40):41873-41881.
[24]Tanikawa C,Furukawa Y,Yoshida N,et al. XEDAR as a putative colorectal tumor suppressor that mediates p53-regulated anoikis pathway[J]. Oncogene,2009,28(34):3081-3092.
[25]Liu Y, Kaneko S, Sobue T. Trends in reported incidences of gastric cancer by tumour location, from 1975 to 1989 in Japan. Int J Epidemiol 2004; 33:808-815
[26]McMichael AJ, McCall MG, Hartshorne JM, Woodings TL. Patterns of gastro-intestinal cancer in European migrants to Australia:the role of dietary change. Int J Cancer 1980; 25: 431-437
[27]El-Serag HB, Mason AC, Petersen N, Key CR. Epidemiological differences between adenocarcinoma of the oesophagus and adenocarcinoma of the gastric cardia in the USA. Gut 2002; 50:368-372
[28]Feldman RA. Epidemiologic observations and open questions about disease and infection caused by Helicobacter pylori. In:Achtman M, Serbaum S. Helicobacter pylori:Molecular and Cellular Biology. Wymondham:Horizon Scientific,2001:29-51
[29]Buckley MJ, O'Shea J, Grace A, English L, Keane C, HourihanD, O'Morain CA. A community-based study of the epidemiology of Helicobacter pylori infection and associated asymptomatic gastroduodenal pathology. Eur J Gastroenterol Hepatol 1998; 10:375-379
[30]Webb PM, Knight T, Greaves S, Wilson A, Newell DG, Elder J, Forman D. Relation between infection with Helicobacter pylori and living conditions in childhood:evidence for person to person transmission in early life. BMJ 1994; 308:750-753
[31]Kurosawa M, Kikuchi S, Inaba Y, Ishibashi T, Kobayashi F. Helicobacter pylori infection among Japanese children. J Gastroenterol Hepatol 2000; 15:1382-1385
[32]Olmos JA, Rios H, Higa R. Prevalence of Helicobacter pylori infection in Argentina:results of a nationwide epidemiologic study. Argentinean Hp Epidemiologic Study Group. J Clin Gastroenterol 2000; 31:33-37
[33]Goodman KJ, Correa P. Transmission of Helicobacter pylori among siblings. Lancet 2000; 355:358-362
[34]Parsonnet J, Friedman GD, Vandersteen DP, Chang Y, Vogelman JH, Orentreich N, Sibley RK. Helicobacter pylori infection and the risk of gastric carcinoma.N Engl J Med 1991; 325:1127-1131
[35]Vakil N, Hahn B, McSorley D. Recurrent symptoms and gastro-oesophageal refux disease in patients with duodenal ulcer treated for Helicobacter pylori infection. Aliment Pharmacol Ther 2000; 14:45-51
[36]McColl KE, Dickson A, El-Nujumi A, El-Omar E, Kelman A. Symptomatic benefit 1-3 years after H pylori eradication in ulcer patients:impact of gastroesophageal refux disease. Am J Gastroenterol 2000; 95:101-105
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