Zhu Juan, Du Lingbin, Li Huizhang, Ran Xianhui, Zeng Hongmei, Wei Wenqiang
Department of Cancer Prevention, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China.
Office of National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Natl Cancer Cent. 2024 Apr 20;4(4):318-325. doi: 10.1016/j.jncc.2024.04.001. eCollection 2024 Dec.
Esophageal cancer (EC) remains a global health challenge due to its poor prognosis. China and the United States of America (USA) represent two distinct epicenters of EC burden. Understanding the EC disparities in these two countries is vital for tailoring prevention strategies, optimizing treatment, and enhancing outcomes in both countries. Yet, there lacks a comprehensive comparison of EC characteristics between the two countries.
In this multicenter, retrospective hospital-based study, we enrolled primary EC patients who received their initial treatment at one of 23 hospitals in China during 2016-2017. Using electronic medical records and cancer registration records, information on demographics, lifestyle, and clinicopathological characteristics (including tumor site, pathology, stage, metastases, differentiation, and treatment) were collected. Additionally, we compared these data with the clinicopathological information of invasive EC patients diagnosed in 2016-2017 from the Surveillance, Epidemiology, and End Results (SEER) database in the USA.
A total of 6,658 EC patients in China and 8,555 EC patients in the USA were included finally. 85.5% ( = 5,694) of EC were esophageal squamous cell carcinoma (ESCC) in China, while esophageal adenocarcinoma (EAC) was prominent in the USA (58.9%, = 5,041). Among EC patients with known staging, the proportion of early stage was higher in China compared to the USA (48.3% vs. 30.5%). Among ESCC patients, early-stage cases were higher in China than in the USA (49.8% vs. 31.8%), while among EAC patients, late-stage cases were higher in China than in the USA (77.3% vs. 68.5%) (all < 0.001). In China, EC mainly occurred in the middle third (60.2%) of the esophagus, whereas in the USA, it was more common in the lower third (59.9%) of the organ. Compared with EC patients with known metastatic status in the USA, China had fewer cases of lymph node metastases (51.4% vs. 57.7%) and distant metastases (7.9% vs. 33.8%). Regarding treatment, China had more surgical therapy (53.7% vs. 22.6%), less radiotherapy (35.6% vs. 53.3%), and less chemotherapy (46.7% vs. 59.7%) compared to the USA.
This study reveals notable disparities in EC between China and the USA, encompassing epidemiological, clinicopathological, and treatment dimensions. These findings provide insight for tailored strategies addressing regional variations in clinicopathological and therapeutic characteristics.
食管癌（EC）因其预后较差，仍然是一项全球性的健康挑战。中国和美国是食管癌负担的两个不同中心。了解这两个国家食管癌的差异对于制定预防策略、优化治疗方案以及改善两国的治疗效果至关重要。然而，两国之间缺乏对食管癌特征的全面比较。
在这项基于医院的多中心回顾性研究中，我们纳入了2016 - 2017年期间在中国23家医院之一接受初始治疗的原发性食管癌患者。利用电子病历和癌症登记记录，收集了人口统计学、生活方式以及临床病理特征（包括肿瘤部位、病理、分期、转移、分化程度和治疗情况）等信息。此外，我们将这些数据与美国监测、流行病学和最终结果（SEER）数据库中2016 - 2017年诊断的浸润性食管癌患者的临床病理信息进行了比较。
最终纳入中国的6658例食管癌患者和美国的8555例食管癌患者。中国85.5%（n = 5694）的食管癌为食管鳞状细胞癌（ESCC），而在美国食管腺癌（EAC）占主导地位（58.9%，n = 5041）。在已知分期的食管癌患者中，中国早期病例的比例高于美国（48.3%对30.5%）。在ESCC患者中，中国早期病例高于美国（49.8%对31.8%），而在EAC患者中，中国晚期病例高于美国（77.3%对68.5%）（均P < 0.001）。在中国，食管癌主要发生在食管中段（60.2%），而在美国，食管癌更常见于食管下段（59.9%）。与美国已知转移状态的食管癌患者相比，中国淋巴结转移（51.4%对57.7%）和远处转移（7.9%对33.8%）的病例较少。在治疗方面，与美国相比，中国接受手术治疗的比例更高（53.7%对22.6%），接受放疗的比例更低（35.6%对53.3%），接受化疗的比例更低（46.7%对59.7%）。
本研究揭示了中国和美国在食管癌方面存在显著差异，包括流行病学、临床病理和治疗等方面。这些发现为针对临床病理和治疗特征的区域差异制定个性化策略提供了见解。
