Mao Y S, Gao S G, Wang Q, Shi X T, Li Y, Gao W W, Guan F S, Li X F, Han Y T, Liu Y Y, Liu J F, Zhang K, Liu S Y, Fu X N, Fang W T, Chen L Q, Wu Q C, Xiao G M, Chen K N, Jiao G G, Zhang S J, Mao W M, Rong T H, Fu J H, Tan L J, Chen C, Xu S D, Guo S P, Yu Z T, Hu J, Hu Z D, Yang Y K, Ding N N, Yang D, He J
Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Zhonghua Zhong Liu Za Zhi. 2020 Mar 23;42(3):228-233. doi: 10.3760/cma.j.cn112152-20191112-00729.
To investigate the epidemiological characteristics and current status of surgical management for esophageal cancer in China. A national database was setup through a network platform. The clinical data of esophageal cancer treated by surgery was collected from 70 major hospitals in China between January 2009 and December 2014. Complete data of 8 181 cases of esophageal cancer patients who underwent surgery were recorded in the database and recruited in the analysis. Among them, 6 052 cases were male and 2 129 were female, the average age was 60.5 years.The epidemiological investigation results showed that 148 cases (1.8%) had history of psychological trauma, 7 527 cases (92.0%) were lower social economic status, 5 072 cases (62.0%) were short of fresh vegetables and fruits, 6 544 cases (80.0%) ate rough food frequently, 3 722 cases (45.5%) drank untreated water directly from lake or river or shallow well, 3 436 cases (42.0%) had a unhealthy eating habit, including habits of eating food fast (507 cases, 6.2%), eating hot food or drinking hot tea/soup (998 cases, 12.2%), eating fried food (1 939 cases, 23.7%), 4 410 cases (53.9%) had the habits of smoking cigarettes and 2 822 cases (34.5%) drank white wine frequently.The pathological results showed that 7 813 cases (95.5%) were squamous cell carcinoma, 267 cases were adenocarcinoma (3.3%), 25 cases were adenosquamous cell carcinoma (0.3%) and 50 cases were small cell carcinoma (0.6%). A total of 1 800 cases (22.0%) received preoperative neoadjuvant therapy due to locally advanced disease or difficulty of resection. The esophagectomies were performed through left thoracotomy approach in 5 870 cases (71.8%), through right chest approach in 2 215 cases (27.1%), and the remain 96 cases (1.2%) received surgery though other approaches.A total of 8 001 cases (97.8%) underwent radical resection, the other 180 cases (2.2%) received palliative resection. The 30-day postoperative mortality rate was 0.5%, the overall ≥ grade Ⅱ postoperative complication rate was 11.6% (951 cases). The 1-yr, 3-yr, and 5-yr overall actual survival rates were 82.6%, 61.6%, and 52.9%, respectively. The data analysis of the national database for esophageal cancer shows that bad eating habits or eating rough food without enough nutrients, lower social and economic status, drinking white wine and smoking cigarettes frequently may be correlated with tumorigenesis of esophageal cancer. However, strong evidences produced by prospective observation studies are needed. Overall, the long-term survival of esophageal cancer patients has been improved gradually due to the application of advanced surgical techniques and reasonable multimodality treatment.
为调查中国食管癌的流行病学特征及外科治疗现状。通过网络平台建立了一个全国性数据库。收集了2009年1月至2014年12月期间中国70家大型医院手术治疗食管癌的临床资料。数据库记录了8181例接受手术的食管癌患者的完整数据并纳入分析。其中，男性6052例，女性2129例，平均年龄60.5岁。流行病学调查结果显示，148例（1.8%）有心理创伤史，7527例（92.0%）社会经济地位较低，5072例（62.0%）缺乏新鲜蔬菜和水果，6544例（80.0%）经常食用粗糙食物，3722例（45.5%）直接饮用未经处理的湖水、河水或浅井水，3436例（42.0%）有不良饮食习惯，包括进食快（507例，6.2%）、食用热食或饮用热茶/汤（998例，12.2%）、食用油炸食品（1939例，23.7%），4410例（53.9%）有吸烟习惯，2822例（34.5%）经常饮用白酒。病理结果显示，7813例（95.5%）为鳞状细胞癌，267例为腺癌（3.3%），25例为腺鳞癌（0.3%），50例为小细胞癌（0.6%）。共有1800例（22.0%）因局部晚期疾病或切除困难接受了术前新辅助治疗。5870例（71.8%）经左胸入路行食管切除术，2215例（27.1%）经右胸入路，其余96例（1.2%）经其他入路手术。共有8001例（97.8%）行根治性切除，其余180例（2.2%）行姑息性切除。术后30天死亡率为0.5%，总体≥Ⅱ级术后并发症发生率为11.6%（951例）。1年、3年和5年总体实际生存率分别为82.6%、61.6%和52.9%。食管癌全国数据库的数据分析表明，不良饮食习惯或食用缺乏营养成分的粗糙食物、较低的社会经济地位、经常饮用白酒和吸烟可能与食管癌的发生有关。然而，需要前瞻性观察研究提供有力证据。总体而言，由于先进手术技术的应用和合理的多模式治疗，食管癌患者的长期生存已逐渐得到改善。
