Sunnybrook Health Sciences Centre, 2075 Bayview Ave Rm HG40, Toronto, ON, M4N 3M5, Canada.
J Gastrointest Surg. 2011 May;15(5):782-90. doi: 10.1007/s11605-011-1450-9. Epub 2011 Mar 16.
In Western countries, the incidence of esophageal adenocarcinoma (EA) and gastric cardia adenocarcinoma (GCA) is increasing. This population-based study describes the incidence of, associated patient risk factors for, and regional variation in EA/GCA in Ontario, Canada.
All adults with a new diagnosis of EA or GCA between 1972 and 2005 in Ontario were identified. Adjusted annual incidence rates were calculated, and multivariate models were used to identify patient risk factors. Maps were created to explore regional variation.
Over the study period, 8,245 persons were diagnosed with EA/CGA; incidence increased from 1.01 to 3.9 per 100,000. Age (>65 vs. <50 years; rate ratio (RR), 3.4; 95% confidence interval (CI), 2.8-4.1) and comorbidity (highest vs. lowest, RR, 3.5; 95% CI, 2.9-4.2) were most strongly associated with the development of EA/GCA. We found considerable regional variation in the rates of EA/GCA (North West vs. Central region, RR, 6.5; 95% CI, 4.4-9.6). Maps suggested ethnicity may explain some regional variation, and that the current allocation of designated surgical treatment centers for EA/CGA may be suboptimal.
The incidence of EA/GCA is rising dramatically in Ontario. Further investigation of observed regional variation is warranted, particularly for the allocation of cancer health resources.
在西方国家，食管腺癌（EA）和胃贲门腺癌（GCA）的发病率正在上升。本项基于人群的研究描述了加拿大安大略省 EA/GCA 的发病率、相关患者危险因素和区域性差异。
确定了在 1972 年至 2005 年间在安大略省被诊断患有新的 EA 或 GCA 的所有成年人。计算了调整后的年发病率，并使用多变量模型来确定患者的危险因素。绘制了地图以探索区域差异。
在研究期间，有 8245 人被诊断患有 EA/CGA；发病率从每 10 万人 1.01 例增加到 3.9 例。年龄（>65 岁与<50 岁；率比（RR），3.4；95%置信区间（CI），2.8-4.1）和合并症（最高与最低；RR，3.5；95%CI，2.9-4.2）与 EA/GCA 的发生最密切相关。我们发现 EA/GCA 的发病率存在相当大的区域差异（西北地区与中地区域；RR，6.5；95%CI，4.4-9.6）。地图表明，种族可能解释了一些区域差异，并且目前为 EA/CGA 指定的手术治疗中心的分配可能不理想。
在安大略省，EA/GCA 的发病率正在急剧上升。需要进一步调查观察到的区域差异，特别是癌症卫生资源的分配。
