Song Minkyo, Rabkin Charles S, Camargo M Constanza
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr., BG 9609/6E338, Rockville, MD, 20852, USA.
Curr Treat Options Gastroenterol. 2018 Dec;16(4):561-569. doi: 10.1007/s11938-018-0203-1.
Prevalence of Helicobacter pylori, the primary risk factor for gastric cancer, is declining globally. Paralleling this trend, gastric cancer incidence is also decreasing. Historically, the populations most affected by this neoplasia have been males, Asians, and groups with low socioeconomic status. This review provides an update on recently published literature regarding changes in gastric cancer epidemiology.
Gastric cancer incidence trends vary by age, sex, race/ethnicity, and tumor anatomical location. Overall incidence appears to be leveling off among young birth cohorts in Western populations, where H. pylori has declined considerably. The changes are more prominent for females and for tumors arising beyond the esophageal-gastric junction. The classical incidence pattern of gastric cancer is evolving. While uncertain, several hypotheses may explain the changing burden of disease. The mix of gastric cancer risk factors appears to be shifting, with H. pylori no longer the sole etiological driver. These changes may eliminate the previous predilection of males and lead to increases in overall gastric cancer rates. Analytical studies addressing known and novel factors related to major societal transitions may provide clues to understanding re-emergence of this serious public health problem.
幽门螺杆菌是胃癌的主要危险因素，其在全球的流行率正在下降。与此趋势并行的是，胃癌发病率也在下降。历史上，受这种肿瘤影响最严重的人群是男性、亚洲人以及社会经济地位较低的群体。本综述提供了关于胃癌流行病学变化的最新文献。
胃癌发病率趋势因年龄、性别、种族/民族和肿瘤解剖位置而异。在西方人群中，幽门螺杆菌感染率大幅下降，年轻出生队列的总体发病率似乎趋于平稳。这些变化在女性以及食管胃交界处以外发生的肿瘤中更为突出。胃癌的经典发病模式正在演变。虽然尚不确定，但有几种假说可以解释疾病负担的变化。胃癌危险因素的组合似乎正在转变，幽门螺杆菌不再是唯一的病因驱动因素。这些变化可能消除以前男性的偏好，并导致总体胃癌发病率上升。针对与主要社会转型相关的已知和新因素的分析研究可能为理解这一严重公共卫生问题的再次出现提供线索。
