Zheng T, Mayne S T, Holford T R, Boyle P, Liu W, Chen Y, Mador M, Flannery J
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut.
Cancer. 1993 Jul 15;72(2):330-40. doi: 10.1002/1097-0142(19930715)72:2<330::aid-cncr2820720205>3.0.co;2-l.
Adenocarcinoma of the gastric cardia has been be increasing in Connecticut, and the risk factors responsible for the increasing incidence are unknown. This study examined the incidence pattern of adenocarcinoma of the gastric cardia and distal stomach in Connecticut during the past decades and identified components of birth cohort, period, and age as determinants of the observed time trends by regression modeling.
This study was based on all histologically confirmed incident cases of gastric adenocarcinoma reported to the Connecticut Tumor Registry between 1955 and 1989. Stomach cancers were grouped into cancers of the gastric cardia, distal stomach, or unknown/unspecified subsite. Age-adjusted incidence rates were calculated by the direct method standardized to the 1970 United States population. A regression model was used to identify birth cohort, period, and age as determinants of the observed time trends.
The results indicated that the incidence rate of adenocarcinoma of the cardia is increasing, particularly in white males, whereas adenocarcinoma of the distal stomach is now decreasing in both sexes in Connecticut. Regression modeling suggests that the increase of adenocarcinoma of the cardia may be explained partly by a birth cohort phenomenon.
There is little information regarding the risk factors that might be responsible for the observed increasing trend for adenocarcinoma of the cardia, although smoking, alcohol intake, retinol intake, and hiatal hernia have been associated with an increased risk of adenocarcinoma of the cardia or gastric cancer. Considering the different epidemiologic features of adenocarcinoma of the cardia and distal stomach, future analytic studies should separate cancer of the gastric cardia and cancer of the distal stomach in searching for etiologic factors.
在康涅狄格州，贲门腺癌的发病率一直在上升，而导致发病率上升的风险因素尚不清楚。本研究调查了过去几十年间康涅狄格州贲门腺癌和胃远端腺癌的发病模式，并通过回归模型确定了出生队列、时期和年龄等因素是观察到的时间趋势的决定因素。
本研究基于1955年至1989年期间向康涅狄格肿瘤登记处报告的所有经组织学确诊的胃腺癌新发病例。胃癌被分为贲门癌、胃远端癌或部位不明/未指定的亚部位癌。采用直接法将年龄调整发病率标准化为1970年美国人口。使用回归模型确定出生队列、时期和年龄是观察到的时间趋势的决定因素。
结果表明，贲门腺癌的发病率正在上升，尤其是在白人男性中，而在康涅狄格州，胃远端腺癌的发病率目前在两性中均呈下降趋势。回归模型表明，贲门腺癌的增加可能部分由出生队列现象解释。
关于可能导致观察到的贲门腺癌上升趋势的风险因素的信息很少，尽管吸烟、饮酒、视黄醇摄入和食管裂孔疝与贲门腺癌或胃癌的风险增加有关。考虑到贲门腺癌和胃远端腺癌不同的流行病学特征，未来的分析研究在寻找病因时应将贲门癌和胃远端癌分开。
