Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York.
Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California; Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California.
Clin Gastroenterol Hepatol. 2023 Dec;21(13):3285-3295.e8. doi: 10.1016/j.cgh.2023.01.037. Epub 2023 Feb 14.
BACKGROUND & AIMS: Gastric cancer (GC) remains a leading cause of cancer and cancer-related mortality. Recent reports suggest noncardia GC is increasing in certain U.S.
However, whether these trends are driven by gastric adenocarcinoma (GA) or other histologies, including neuroendocrine tumors (NETs), lymphoma, or gastrointestinal stromal tumors (GISTs), is unclear.
We analyzed the Surveillance, Epidemiology and End Results-18 cancer registry (2000-2018) to determine age-standardized incidence rates (ASIR) and annual percentage change (APC) trends for histologically-confirmed GCs, stratified by anatomic location (noncardia vs cardia), age group (20-49 vs 50+ years), sex, race, and ethnicity. Joinpoint regression modeling estimated the statistical significance of trend comparisons.
Of 74,520 individuals with noncardia GC, most (66.2%) were GA, with the next largest categories being non-mucosa-associated lymphoid tissue (non-MALT) lymphomas (6.9%), GIST (6.7%), NET (6.4%), and MALT lymphoma (5.6%). Noncardia GA ASIR was significantly higher than other histologies and demonstrated the greatest differences by race and ethnicity. APCs for GA and MALT, both Helicobacter pylori-associated cancers, declined significantly over time, which was driven primarily by trends among individuals ≥50 years-old. NET and GIST APCs significantly increased irrespective of age group, with the highest APCs observed among non-Hispanic white individuals. Cardia GC was rarer than noncardia GC and comprised primarily by GA (87.9%). Cardia GC incidence fell during the study period, which was primarily driven by decline in cardia GA.
GA was the most common histology. On the basis of our findings, the rise in noncardia GC among certain U.S. populations appears predominantly driven by NET and GIST, not GA. Further studies are needed to clarify underlying etiologies for these findings.
胃癌（GC）仍然是癌症和癌症相关死亡的主要原因。最近的报告表明，在美国某些人群中，非贲门 GC 的发病率正在上升。
我们分析了监测、流行病学和最终结果-18 个癌症登记处（2000-2018 年）的数据，以确定经组织学证实的 GC 的年龄标准化发病率（ASIR）和年度百分比变化（APC）趋势，按解剖部位（非贲门与贲门）、年龄组（20-49 岁与 50 岁以上）、性别、种族和民族进行分层。Joinpoint 回归模型估计了趋势比较的统计学意义。
在 74520 名非贲门 GC 患者中，大多数（66.2%）为 GA，其次是非黏膜相关淋巴组织（non-MALT）淋巴瘤（6.9%）、GIST（6.7%）、NET（6.4%）和 MALT 淋巴瘤（5.6%）。非贲门 GA 的 ASIR 明显高于其他组织学类型，且在种族和民族方面差异最大。与 H. pylori 相关的两种癌症 GA 和 MALT 的 APC 随着时间的推移显著下降，这主要是由于≥50 岁人群的趋势所致。NET 和 GIST 的 APC 均显著增加，无论年龄组如何，非西班牙裔白人的 APC 最高。贲门 GC 比非贲门 GC 少见，主要由 GA 组成（87.9%）。在研究期间，贲门 GC 的发病率下降，主要是由于贲门 GA 的下降。
GA 是最常见的组织学类型。基于我们的发现，美国某些人群中非贲门 GC 的上升似乎主要是由 NET 和 GIST 驱动的，而不是 GA。需要进一步的研究来阐明这些发现的潜在病因。
