Division of Gastroenterology/Hepatology, Warren Alpert Medical School of Brown University, Providence, RI 02903, United States,
Department for HIV Elimination, Fulton County Government, Atlanta, GA 30303, United States.
World J Gastroenterol. 2019 Aug 21;25(31):4512-4533. doi: 10.3748/wjg.v25.i31.4512.
Esophageal cancer (EC) is associated with a poor prognosis, particularly so in Africa where an alarmingly high mortality to incidence ratio prevails for this disease.
To provide further understanding of EC in the context of the unique cultural and genetic diversity, and socio-economic challenges faced on the African continent.
We performed a systematic review of studies from Africa to obtain data on epidemiology, risk factors, management and outcomes of EC. A non-systematic review was used to obtain incidence data from the International Agency for Research on Cancer, and the Cancer in Sub-Saharan reports. We searched EMBASE, PubMed, Web of Science, and Cochrane Central from inception to March 2019 and reviewed the list of articles retrieved. Random effects meta-analyses were used to assess heterogeneity between studies and to obtain odds ratio (OR) of the associations between EC and risk factors; and incidence rate ratios for EC between sexes with their respective 95% confidence intervals (CI).
The incidence of EC is higher in males than females, except in North Africa where it is similar for both sexes. The highest age-standardized rate is from Malawi (30.3 and 19.4 cases/year/100000 population for males and females, respectively) followed by Kenya (28.7 cases/year/100000 population for both sexes). The incidence of EC rises sharply after the age of 40 years and reaches a peak at 75 years old. Meta-analysis shows a strong association with tobacco (OR 3.15, 95%CI: 2.83-3.50). There was significant heterogeneity between studies on alcohol consumption (OR 2.28, 95%CI: 1.94-2.65) and on low socioeconomic status (OR 139, 95%CI: 1.25-1.54) as risk factors, but these could also contribute to increasing the incidence of EC. The best treatment outcomes were with esophagectomy with survival rates of 76.6% at 3 years, and chemo-radiotherapy with an overall combined survival time of 267.50 d.
Africa has high incidence and mortality rates of EC, with preventable and non-modifiable risk factors. Men in this setting are at increased risk due to their higher prevalence of tobacco and alcohol consumption. Management requires a multidisciplinary approach, and survival is significantly improved in the setting of esophagectomy and chemoradiation therapy.
食管癌（EC）预后不良，在非洲尤其如此，因为该地区的死亡率与发病率之比高得惊人。
为了更好地了解在非洲独特的文化和遗传多样性以及社会经济挑战背景下的食管癌。
我们对来自非洲的研究进行了系统综述，以获取有关食管癌流行病学、危险因素、管理和结局的数据。我们还使用非系统性综述方法从国际癌症研究机构（IARC）和撒哈拉以南癌症报告中获取发病率数据。我们检索了 EMBASE、PubMed、Web of Science 和 Cochrane Central 从开始到 2019 年 3 月的文献，并对检索到的文章进行了综述。使用随机效应荟萃分析评估研究之间的异质性，并获得食管癌与危险因素之间关联的比值比（OR）；以及男女之间食管癌的发病率比值及其各自的 95%置信区间（CI）。
男性食管癌的发病率高于女性，但在北非，男女发病率相似。男性和女性的最高年龄标准化率来自马拉维（分别为 30.3 和 19.4 例/年/100000 人），其次是肯尼亚（男女均为 28.7 例/年/100000 人）。食管癌的发病率在 40 岁后急剧上升，在 75 岁时达到峰值。荟萃分析显示与烟草有很强的关联（OR 3.15，95%CI：2.83-3.50）。关于酒精摄入（OR 2.28，95%CI：1.94-2.65）和低社会经济地位（OR 139，95%CI：1.25-1.54）作为危险因素的研究之间存在显著的异质性，但这些因素也可能导致食管癌发病率的增加。最佳治疗结果是食管癌切除术，3 年生存率为 76.6%，化疗和放疗的总联合生存时间为 267.50 天。
非洲食管癌的发病率和死亡率都很高，且存在可预防和不可改变的危险因素。由于男性更普遍吸烟和饮酒，他们的风险更高。这种情况下的管理需要多学科的方法，并且在食管癌切除术和放化疗的情况下，生存率显著提高。
