| PurposesTo evaluate the distribution, the progress rate and the incidence and mortality of esophageal squamous cell cancer and precursor lesions in high-risk areas of China, and to provide evidence for determining the reference ranges of detection rates and the following up intervals of different stages of esophageal precancerous lesions in high-risk areas.Materials and MethodsEndoscopy with Lugol’s iodine staining was performed on local residents aged 40 to 69 years in Linzhou, Cixian and Feicheng from 2005-2009. Compliance was calculated by the percentage of the people who had endoscopic screening among the target population. Chi-square test and trend chi-square test were used to compare the distribution differences in age, gender and areas of esophageal squamous cell cancer and precancer.95%CI of the detection rates was then employed to represent the reference ranges of esophageal squamous cell cancer and precursor lesions.Following up procedure was performed as Technical Program for the Early Treatment and Early Detection for Esophageal Cancer. Subjects who had endoscopic screening for the first time during 2005-2009, with a clear pathological diagnosis and without treatment were enrolled in the second part of the study. Chi-square test was used to test the compliance of the following up. The number of the progress cases and progress rate was calculated after comparing the two pathological results. Gender and age specific progress rate were compared to verify the high risk population.Subjects who had endoscopic screening during 2005-2009 with a clear pathologic result (esophageal cancer excluded)and without treatment were enrolled in the third part. Incidence and mortality were based on the Cancer Registration datas. Trend Chi-square test was applied to compare the incidence and mortality of different grades of lesions. Chi-square test was used to compare the gender and age specific incidence and mortality. For mild dysplasia cases 3-year accumulative incidence rate was compared with other years and for moderate dysplasia.1-year accumulative rate was compared with other years.Results1.99060 local people were covered and the target population aged 40-69 years were 46568, among which 21955 took part in the endoscopic screening. The compliance rate of screening endoscopy of this study was 47.15% of all. and female’s compliance (50.91%,11739/23058) was much higher than that of male(43.45%,10216/23510) (X2=47.15, P<0.001).191 cases were excluded since no clear pathologic results and 21764 participants were enrolled in the first part of the study. The detection rate for precancerous lesion 24.65%(5365/21764),with 1729 basal cell hyperplasia cases(7.94%,95% CI 7.59%-8.30%),3163 low-grade intraepithelial neoplasia cases(14.53%,95%CI: 14.06%-15.00%).335 high-grade intraepithelial neoplasia cases(1.54%,95%CI: 1.38%～1.70%) and 138 esophageal squamous cell cancer cases (0.63%,95%CI: 0.53%～0.74%)The detection rates of male were significantly higher than that of female in all grades of precancerous lesion. The detection rates of basal cell hyperplasia, low grade intraepithelial neoplasia, high grade intraepithelial neoplasia and esophageal squamous cell cancer of males and females were respectively 9.05% and 6.98%(x2=19.438, P<0.001),15.85% and 13.38%(x2=26.661, P<0.001),1.74% and 1.37%(x2=4.865. P=0.027),0.85% and 0.45%(x2=13.829, P<0.001).The detection rates of all grades of precursor lesions increased with age rising(P values were all<0.001). among which the detection rates of the mentioned four lesions for 40-44 years old and 65-69 years old were 7.61%(425/5585),6.70%(374/5585). 0.34% (19/5585),0.18%(10/5585) and 8.14%(84/1093),21.87%(239/1093). 3.84% (42/1093),1.92%(21/1093).The detection rates of the four lesions of Linzhou Cixian and Feicheng were different apparently. The highest detection rate of BCH was in Cixian(18.57%,1136/6116), while highest rates of LGIN and HGIN occurs in Linzhou(17.40%,1787/10269 and 1.80%, 185/10269). The rate of ESCC was of no difference in three areas.2.Among the 21955 subject who had endoscopic screening during 2005-2009,2389 of them accepted the second endoscopic screening. The compliance was 10.88%(11.26%for male and 10.55% for female. x2=0.096, P=0.099). The compliance were all low in three areas with the highest 15.81% in Linzhou and the lowest 4.5% in Cixian.In the first 7 years of following up, the progress rate of MD was higher than that of mD. but the trend changed after 7 years. For mD cases, the progress rates were low and rose little from 2 years to 4 years(0.18%-1.07%), but increased faster from 5 years. For MD cases, the same situation happened.The progress rate of MD for male was higher than that of md from 2 to 9 years(5.29%-10.58% for MD and 0.18%-7.18% for md).As for female the same trend took place before 5 years. In each age group, the progress rate of MD was high than mD at the beginning of the following up. but the gap got smaller with time going.3.The incidence and mortality of every stage of precancerous lesions went up significantly in high risk areas of China. In every year (following up interval) the incidence or mortality ranks as MD>mD>BCH>normal. The incidence or mortality for male was higher than female in any of stage of precancerous lesions. The incidence and mortality increased with age rising.For mD. the 3-year accumulative incidence was used to compare with other years, but significant difference appeared only from 7 years(x2=5.286, P=0.021). Similarly, for MD the 1-year accumulative incidence was used to compare with other years, but significant difference emerged only from 5 years(x2= 11.465, P=0.001).ConclusionsUp to 24.65% residents that were asymptomatic were suffered from esophageal squamous cancer or precursor lesions in high-risk areas in China. The distribution of esophageal squamous cell cancer and precursor lesions was closely related to the gender and the age. which suggested that males were supposed to be paid more attention to.The following up intervals for ESCC screening were supposed to be adjusted. According to the progress rate and the incidence/mortality regularity, we suggested that the following up intervals could be adjusted to 5-6 years 1 time for mD, and 3-4 years for MD. Compliance of the following up were to be enhanced to provide more precise evidence. |
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