Sierra Monica S, Cueva Patricia, Bravo Luis Eduardo, Forman David
International Agency for Research on Cancer, Section of Cancer Surveillance, Lyon, France.
Registro Nacional de Tumores de Quito, Hospital Solón Espinosa Ayala SOLCA Núcleo de Quito, Ecuador.
Cancer Epidemiol. 2016 Sep;44 Suppl 1:S62-S73. doi: 10.1016/j.canep.2016.03.008.
Stomach cancer mortality rates in Central and South America (CSA) are among the highest in the world. We describe the current burden of stomach cancer in CSA.
We obtained regional and national-level cancer incidence data from 48 population-based registries (13 countries) and nation-wide cancer deaths from WHO's mortality database (18 countries). We estimated world population age-standardized incidence (ASR) and mortality (ASMR) rates per 100,000 and estimated annual percent change to describe time trends.
Stomach cancer was among the 5 most frequently diagnosed cancers and a leading cause of cancer mortality. Between CSA countries, incidence varied by 6-fold and mortality by 5-6-fold. Males had up to 3-times higher rates than females. From 2003 to 2007, the highest ASRs were in Chile, Costa Rica, Colombia, Ecuador, Brazil and Peru (males: 19.2-29.1, females: 9.7-15.1). The highest ASMRs were in Chilean, Costa Rican, Colombian and Guatemalan males (17.4-24.6) and in Guatemalan, Ecuadorian and Peruvian females (10.5-17.1). From 1997 to 2008, incidence declined by 4% per year in Brazil, Chile and Costa Rica; mortality declined by 3-4% in Costa Rica and Chile. 60-96% of all the cancer cases were unspecified in relation to gastric sub-site but, among those specified, non-cardia cancers occurred 2-13-times more frequently than cardia cancers.
The variation in rates may reflect differences in the prevalence of Helicobacter pylori infection and other risk factors. High mortality may additionally reflect deficiencies in healthcare access. The high proportion of unspecified cases calls for improving cancer registration processes.
中美洲和南美洲（CSA）的胃癌死亡率位居世界前列。我们描述了CSA地区当前的胃癌负担情况。
我们从48个基于人群的登记处（13个国家）获取了地区和国家层面的癌症发病率数据，并从世界卫生组织的死亡率数据库（18个国家）获取了全国范围的癌症死亡数据。我们估计了每10万人的世界人口年龄标准化发病率（ASR）和死亡率（ASMR），并估计了年度百分比变化以描述时间趋势。
胃癌是最常被诊断出的5种癌症之一，也是癌症死亡的主要原因。在CSA国家之间，发病率相差6倍，死亡率相差5至6倍。男性发病率比女性高至多3倍。2003年至2007年期间，最高的年龄标准化发病率出现在智利、哥斯达黎加、哥伦比亚、厄瓜多尔、巴西和秘鲁（男性：19.2 - 29.1，女性：9.7 - 15.1）。最高的年龄标准化死亡率出现在智利、哥斯达黎加、哥伦比亚和危地马拉的男性中（17.4 - 24.6）以及危地马拉、厄瓜多尔和秘鲁的女性中（10.5 - 17.1）。1997年至2008年期间，巴西、智利和哥斯达黎加的发病率每年下降4%；哥斯达黎加和智利的死亡率下降了3%至4%。所有癌症病例中有60% - 96%未明确胃亚部位，但在明确的病例中，非贲门癌的发生频率比贲门癌高2至13倍。
发病率的差异可能反映了幽门螺杆菌感染及其他风险因素流行率的不同。高死亡率可能还反映了医疗服务可及性的不足。未明确病例的高比例要求改进癌症登记流程。
