| Background and Objective:Esophageal carcinomas is one of the most common malignant tumors in China,Cixian,Shexian and Wuan of Hebei Province located in the southern foot of Taihang Mountains,where have the high incidence of primary esophageal cancer.In recent years,we have found that the incidence of gastric cardia carcinomas in this region were at a high level,there was a common phenomenon of high incidence of esophageal and gastric cardia. And there was a common phenomenon that primary concurrent carcinomas of the esophagus and gastric cardia from the same patient.However, there is little known about its pathogenesis.This study try to characterize the detection rate, demographic characteristics,endoscopic features and histologic characteristics of synchronous multiple primary early esophageal and gastric cardia carcinomas and precancerous lesions(SMPECs) by endoscopic screened in a high-risk area of China, so as to contribute to the early diagnosis and treatment of SMPECs.Methods:From2005to2010,endoscopic screening was performed among villagers asymptomatic population40-69years old in high risk areas.After informed consent had been obtained,epidemiologist interviewed the individual to be examined to fill out a baseline questionnaire form.23561cases were examined from esophagus to duodenum by using Digestive endoscopy with mucosal iodine staining.The results were recorded in detail,Biopsy in cardia were performed with the exact clock number recorded.Biopsy specimens were taken from all focal lesions and un-stained or lightly-stained places in the esophagus.All the histological diagnoses were double-blindly made. Results:1Demographic characteristics1.1The detection of esophageal and gastric cardia carcinomas and precancerous lesionsIn total,23561participants accepted the initial endoscopy screening. The detection rate of esophageal mild dysplasia(mD), moderate dysplasia(MD), severe dysplasia/carcinoma in situ(SD/CIS),early carcinoma (intramucosal carcinoma,IMC and submucosal carcinoma,SMC) and Invasive cancer was7.47%(1760/23561),1.63%(385/23561),0.63%(149/23561),0.18%(42/23561) and0.30%(70/23561) respectively,the detection rate of early esophageal carcinomas and precancerous lesions was9.91%(2336/23561). Gastric cardia low-grade intraepithelial neoplasia(LIN), high-grade intraepithelial neoplasia(HIN)early carcinoma and Invasive cancer was2.95%(694/23561),0.61%(144/23561),0.15%(36/23561) and0.41%(97/23561) respectively, the detection rate of early gastric cardia carcinomas and precancerous lesions was3.71%(874/23561).1.2The detection of synchronous multiple primary esophageal and gastric cardia carcinomas and precancerous lesionsOf the23561cases asymptomatic population with endoscopy screening,3012cases early esophageal and gastric cardia carcinomas and precancerous lesions were detected, including2139cases esophageal early carcinomas only(EECO) and685cases gastric cardia early carcinomas only (GECO),the detection rate of SMPECs was6.24%(188/3012).167cases esophageal and gastric cardia invasive cancer were detected, the detection rate of SMPCs was2.40%(4/167).1.3The detected trend of SMPECsThe detection rate of SMPECs was compared between different years. Sixty-two SMPECs were detected during2005-2007, a hundred and twenty-six SMPECs were detected during2008-2010.the detection rate of SMPECs was7.02%in2008-2010, which was significantly higher than that in2005-2007(5.09%)(χ2=4.10,P<0.05). 1.4Age and gender of SMPECsThe detection rate of SMPECs on male and female was1.00%(115/11471) and0.60%(73/12090) respectively,the difference have statistical significance (χ2=11.63,P=0.00). The detection of esophageal cancer was11.45%(1313/11471) and6.83%(826/12090) respectively,the difference have statistical significance(χ2=126.47,P=0.00), he detection of esophageal cancer was4.02%(461/11471) and1.85%(224/12090) respectively,the difference have statistical significance (χ2=92.27,P=0.00).The detection rates of SMPECs and early cancer only in esophageal/gastric cardia were higher in male,there are no significance difference (χ2=0.21,P>0.05).The detection rates of SMPEC in different age groups had significant difference between them (χ2=148.96,P=0.00).,the detection rates of EECO in different age groups had significant difference between them (χ2=719.22,P=0.00),the detection rates of GECO in different age groups had significant difference between them (χ2=532.59,P=0.00).The detection rate of SMPECs of under55and above55was0.40%(61/15393) and1.55%(127/8168) respectively,the difference have statistical significance(x2=88.75,P=0.00), With age increasing, the detection rates of SMPECs, EECO and GECO group became gradually higher respectively.There was an association of ascensus trend between the detection rates and Age(P<0.05).The detection rate of EECO of under55and above55was5.28%(813/15393) and16.23%(1326/8168) respectively, the difference have statistical significance (χ2=630.21,P=0.00),t he detection rate of GECO of under55and above55was1.74%(268/15393) and5.11%(417/8168) respectively, the difference have statistical significance (χ2=200.50,P=0.00).1.5The family history of SMPECs112cases with SMPECs had family history of upper digestive tract cancer, the positive rate was52.99%(112/188),which was significantly higher than EECO(31.4%) and GECO(25.78).Risk of the with the family history to SMPECs group was obviously higher than that of the without family history group with OR=3.84,(P5%C/:2.41-5.01,P=0.00),AR=71.25%. Risk of the with the family history to EECO group was obviously higher than that of the without family history group with OR=1.46,(95%CI:1.29-1.65,P=0.00), AR=31.48%.2Endoscopic characteristics2.1Endoscopic featuresThe endoscopic appearance of early esophageal and gastric cardia carcinomas and precancerous lesions were different,Many kinds of appearances coexist There were no difference in the lesions morphology distribution of SMPECs and early carcinomas in esophageal and gastric cardia only.The appearance of early esophageal carcinomas and precancerous lesions was like mucosal congestion and roughness61.06%,red areas43.79%, superficial erosion and ulcer25.92%,flat protrusion,plaque12.71%,and uneven tubercle5.79%.The appearance of early gastric cardia carcinomas and precancerous lesions was like mucosal congestion and edema71.70%, mucosal erosion and ulcer37.39%,mucosal crimple and hollow30.23%, granular flat protrusion21.59%,node6.93%.2.2Site characteristicsIn the middle esophagus, both SMPECs and EECO were the most common, accounted for64.89%and65.78%,in contrast with low incidence at upper esophagus (7.98%,11.33%) and lower esophagus (27.13%and22.89%), The detection rates of early cancer in SMPECs and EECO were higher in the middle esophagus, there are no significance difference (χ2=3.28,P>0.05).The detection rate of early cancer where located root of the mucosal fold in cardia(12to3clock bit) was85.64%(161/188) in SMPECs, t he detection rate of early cancer where located root of the mucosal fold in cardia(12to3clock bit) was87.57%in GECO.The detection rates of early cancer in SMPECs and GECO were higher in the12to3clock bit of cardia,there are no significance difference(χ2=1.00,P>0.05).3Histologic characteristicsOf the188cases SMPECs,the cases of esophageal mD,MD,SD/Cis and early carcinoma was126,52,7and3respectively,the detection rate of mD and MD was94.68%,the cases of gastric cardia LIN, HIN and early carcinoma was137,42and9,the detection rate of HIN was72.87%,the difference have statistical significance (χ2=32.89,P=0.00).Conclusions:1The screening with endoscopic staining examination could detect the synchronous multiple primary early esophageal and gastric cardia carcinomas and precancerous lesions efficaciously in high risk areas.2Male, above55and a positive family history of upper gastrointestinal carcinomas does seem to increase the risk of synchronous multiple primary early esophageal and gastric cardia carcinomas and precancerous lesions.3Special attention should be paid to the endoscopic appearance of synchronous multiple primary early esophageal and gastric cardia carcinomas and precancerous lesions by endoscopic screening in high risk areas. Enhancing the cognition about SMPECs could helpful to improve its detection.4There was significant difference about detection rates of early esophageal and gastric cardia carcinomas and precancerous lesions between at middle esophagus and12to3clock bits in gastric cardia than other sites. It hinted that we could raise the detection of early carcinomas and precancerous lesions lesion by observing and biopsy in these sites.5It has been more common for low-grade dysplasia in esophagus than in gastric cardia of synchronous multiple primary early esophageal and gastric cardia carcinomas and precancerous lesions. |
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