Research Progress of Etiology, Screening and Early Diagnosis of Esophageal Cancer in China
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摘要:
食管癌是全球最致命的癌症之一，CLOBOCAN 2020显示，全球约有60万食管癌新发病例，死亡约54万例，而全球近一半的食管癌发病和死亡病例发生在我国。过去二十年中我国食管癌的发病与死亡呈下降趋势，然而，食管癌早期症状不明显，确诊时大多已处于晚期，导致其5年生存率较低。因此，明确其病因与危险因素，采取预防以及早期诊断措施，可有效降低食管癌疾病负担。本研究回顾了我国食管癌的流行病学、危险因素、筛查与早期诊断研究，为食管癌防治问题的决策者提供系统参考。
Abstract:Esophageal cancer (EC) is one of the most fatal cancers worldwide. According to GLOBOCAN 2020, it was estimated that there were 600, 000 new EC cases and 540 000 EC deaths, while nearly half of all newly diagnosed cases of EC and associated deaths worldwide occurred in China. The annual incidence and mortality of EC have been reduced in the last 20 years in China. However, the early symptoms and signs of EC are not easily distinguished and the disease tends to be within the middle and late stage of pathogenesis when identified, leading to its low 5-year survival rate. Therefore, it could help effectively reduce the burden of EC by clarifying its etiology and risk factors, as well as taking preventive and early diagnosis measures. This article reviews the epidemiology, etiology, screening and early diagnosis of EC in China, to provide systematic references for EC prevention and control.
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Key words:
- Esophageal cancer /
- Epidemiology /
- Risk factors /
- Screening /
- Early diagnosis
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Competing interests: The authors declare that they have no competing interests.作者贡献：杨欢：提纲设计、论文撰写孙宛怡：引文资料查询、论文修改王建炳：论文修改王晓坤、张锦雨：数据信息核对范金虎：论文审阅乔友林：论文复审
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图 1 2006—2016年我国肿瘤登记地区不同性别人群食管癌发病率(A)及死亡率(B) (/10万)
Figure 1 Esophageal cancer incidence(A) and mortality(B) rates by gender in China registry regions, 2006-2016 (/100 000)
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图 2 2006—2016年我国肿瘤登记地区城市和农村人群食管癌发病率(A)及死亡率(B) (/10万)
Figure 2 Esophageal cancer incidence(A) and mortality(B) rates by urban and rural areas in China registry regions, 2006-2016 (/100 000)
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[1] Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249. doi: 10.3322/caac.21660
[2] Liang H, Fan JH, Qiao YL. Epidemiology, etiology, and prevention of esophageal squamous cell carcinoma in China[J]. Cancer Bio Med, 2017, 14(1): 33-41. doi: 10.20892/j.issn.2095-3941.2016.0093
[3] 魏文强. 我国食管癌防控的现状与挑战[J]. 中华预防医学杂志, 2019, 53(11): 1081-1083. Wei WQ. Current status and challenges of prevention and control of esophageal cancer in China[J]. Zhonghua Yu Fang Yi Xue Za Zhi, 2019, 53(11): 1081-1083.
[4] Zhang S, Sun K, Zheng R, et al. Cancer incidence and mortality in China, 2015[J]. J Natl Cancer Center, 2021, 1(1): 2-11. doi: 10.1016/j.jncc.2020.12.001
[5] International Agency for Research on Cancer. List of Classifications by Cancer Sites with Sufficient or Limited Evidence in Humans[Z]. 2021. https://monographs.iarc.who.int/wp-content/uploads/2019/07/classifications_by_cancer_site.pdf
[6] Yokoyama A, Kakiuchi N, Yoshizato T, et al. Age-related remodelling of oesophageal epithelia by mutated cancer drivers[J]. Nature, 2019, 565(7739): 312-317. doi: 10.1038/s41586-018-0811-x
[7] Yershova K, Yuan JM, Wang R, et al. Tobacco-specific N-nitrosamines and polycyclic aromatic hydrocarbons in cigarettes smoked by the participants of the Shanghai Cohort Study[J]. Int J Cancer, 2016, 139(6): 1261-1269. doi: 10.1002/ijc.30178
[8] Chang J, Tan W, Ling Z, et al. Genomic analysis of oesophageal squamous-cell carcinoma identifies alcohol drinking-related mutation signature and genomic alterations[J]. Nat Commun, 2017, 8: 15290. doi: 10.1038/ncomms15290
[9] Abnet CC, Arnold M, Wei WQ. Epidemiology of Esophageal Squamous Cell Carcinoma[J]. Gastroenterology, 2018, 154(2): 360-373. doi: 10.1053/j.gastro.2017.08.023
[10] Prabhu A, Obi KO, Rubenstein JH. Systematic review with meta-analysis: race-specific effects of alcohol and tobacco on the risk of oesophageal squamous cell carcinoma[J]. Aliment Pharmacol Ther, 2013, 38(10): 1145-1155. doi: 10.1111/apt.12514
[11] World Cancer Research Fund/American Institute for Cancer R. Continuous Update Project Expert Report, Diet, Nutrition Physical Activity and Pancreatic[Z]. https://www.wcrf.org/dietandcancer/oesophageal-cancer/
[12] 梁赫, 王少明, 杨召, 等. 新鲜水果可能降低男性吸烟人群中食管癌的长期死亡风险: 林县营养干预试验30年随访研究[J]. 中国肿瘤, 2017, 26(12): 953-959. doi: 10.11735/j.issn.1004-0242.2017.12.A006 Liang H, Wang SM, Yang Z, et al. Fresh Fruit Intake and Long-term Risk of Esophageal Cancer Among Male Smokers: Finding from the Linxian Nutrition Intervention Trials After 30 Years of Follow Up[J]. Zhongguo Zhong Liu, 2017, 26(12): 953-959. doi: 10.11735/j.issn.1004-0242.2017.12.A006
[13] 黄桁, 王喻, 姜凯元, 等. 食管癌高发区农村居民饮食状况调查及防治分析[J]. 现代肿瘤医学, 2018, 26(22): 3667-3670. doi: 10.3969/j.issn.1672-4992.2018.22.036 Huang H, Wang Y, Jiang KY, et al. Survey on dietary of residents in high-incidence area of esophageal cancer and recommendations for prevention and treatment of esophageal cancer[J]. Xian Dai Zhong Liu Yi Xue, 2018, 26(22): 3667-3670. doi: 10.3969/j.issn.1672-4992.2018.22.036
[14] 张粟, 杨欢, 王国清, 等. 河南省林州市食管鳞癌及癌前病变的影响因素研究[J]. 中国肿瘤, 2020, 29(5): 327-333. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHLU202005002.htm Zhang S, Yang H, Wang GQ, et al. Risk Factors of Esophageal Squamous Cell Carcinoma and Precancerous Lesions in Linzhou, Henan[J]. Zhongguo Zhong Liu, 2020, 29(5): 327-333. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHLU202005002.htm
[15] Tian D, Mo SJ, Han LK, et al. Investigation of Dietary Factors and Esophageal Cancer Knowledge: Comparison of Rural Residents in High- and Low-incidence Areas[J]. Sci Rep, 2018, 8(1): 4914. doi: 10.1038/s41598-018-23251-3
[16] 陈艳, 尹钰, 吐尔逊江·买买提明, 等. 新疆哈萨克族食管癌高发区居民膳食状况及一碳单位代谢相关营养素水平调查[J]. 中国公共卫生, 2017, 33(5): 780-782. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGW201705025.htm Chen Y, Yin Y, Maimaitiming T, et al. Dietary nutrition and nutrients associated with one carbon unit metabolism among Kazakh people in areas with high esophageal cancer incidence in Xinjiang[J]. Zhongguo Gong Gong Wei Sheng, 2017, 33(5): 780-782. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGW201705025.htm
[17] Yu E, Malik VS, Hu FB. Cardiovascular Disease Prevention by Diet Modification: JACC Health Promotion Series[J]. J Am Coll Cardiol, 2018, 72(8): 914-926. doi: 10.1016/j.jacc.2018.02.085
[18] 赵静颖, 纪爱芳, 程亚平. 食管癌的病因学研究进展[J]. 世界最新医学信息文摘, 2021, 21(15): 87-88, 91. doi: 10.3969/j.issn.1671-3141.2021.15.032 Zhao JY, Ji AF, Cheng YP. Advances in Etiology of Esophageal Cancer[J]. Shi Jie Zui Xin Yi Xue Xin Xi Wen Zhai, 2021, 21(15): 87-88, 91. doi: 10.3969/j.issn.1671-3141.2021.15.032
[19] Wang SM, Taylor PR, Fan JH, et al. Effects of Nutrition Intervention on Total and Cancer Mortality: 25-Year Post-trial Follow-up of the 5.25-Year Linxian Nutrition Intervention Trial[J]. J Natl Cancer Inst, 2018, 110(11): 1229-1238. doi: 10.1093/jnci/djy043
[20] 罗贤懋, 林培中, 刘雨菁, 等. 核黄素预防恶性肿瘤的研究进展[J]. 癌症进展, 2020, 18(4): 325-330. https://www.cnki.com.cn/Article/CJFDTOTAL-AZJZ202004001.htm Luo XM, Lin PZ, Liu YJ, et al. Research progress of riboflavin in cancer prevention[J]. Ai Zheng Jin Zhan, 2020, 18(4): 325-330. https://www.cnki.com.cn/Article/CJFDTOTAL-AZJZ202004001.htm
[21] 刘轲, 崔露琼, 蒋盼盼, 等. 感染与食管癌的研究进展[J]. 食管疾病, 2020, 2(3): 161-164, 205. https://www.cnki.com.cn/Article/CJFDTOTAL-LYYZ202003001.htm Liu K, Cui LQ, Jiang PP, et al. Research Progress in Infection and Esophageal Cancer[J]. Shi Guan Ji Bing, 2020, 2(3): 161-164, 205. https://www.cnki.com.cn/Article/CJFDTOTAL-LYYZ202003001.htm
[22] Cao W, Lee H, Wu W, et al. Multi-faceted epigenetic dysregulation of gene expression promotes esophageal squamous cell carcinoma[J]. Nat Commun, 2020, 11(1): 3675. doi: 10.1038/s41467-020-17227-z
[23] Teng G, Dai Y, Chu Y, et al Helicobacter pylori induces caudal-type homeobox protein 2 and cyclooxygenase 2 expression by modulating microRNAs in esophageal epithelial cells[J]. Cancer Sci, 2018, 109(2): 297-307. doi: 10.1111/cas.13462
[24] Gao H, Li L, Zhang C, et al. Systematic Review with Meta-analysis: Association of Helicobacter pylori Infection with Esophageal Cancer[J]. Gastroenterol Res Pract, 2019, 2019: 1953497.
[25] Wang J, Zhao L, Yan H, et al. A Meta-Analysis and Systematic Review on the Association between Human Papillomavirus (Types 16 and 18) Infection and Esophageal Cancer Worldwide[J]. PLoS One, 2016, 11(7): e0159140. doi: 10.1371/journal.pone.0159140
[26] Koshiol J, Wei WQ, Kreimer AR, et al. No role for human papillomavirus in esophageal squamous cell carcinoma in China[J]. Intl J Cancer, 2010, 127(1): 93-100. doi: 10.1002/ijc.25023
[27] 陈甜甜. 泰兴地区食管癌发病趋势及家族聚集性研究[D]. 山东: 山东大学, 2013. Chen TT. Research of the Incidence Trend and familial aggregation of esophageal cancer in Taixing city[D]. Shandong: Shandong Da Xue, 2013.
[28] Yang H, Wang JB, Zhang JY, et al. Family History and Risk of Upper Gastrointestinal Cancer in the Linxian General Population[J]. Front Oncol, 2021, 11: 605106. doi: 10.3389/fonc.2021.605106
[29] He Z, Liu Z, Liu M, et al. Efficacy of endoscopic screening for esophageal cancer in China (ESECC): design and preliminary results of a population-based randomised controlled trial[J]. Gut, 2019, 68(2): 198-206. doi: 10.1136/gutjnl-2017-315520
[30] 林东昕, 谭文, 陆士新, 等. 中国食管癌分子流行病学研究[J]. 中华流行病学杂志, 2003, 24(10): 939-943. doi: 10.3760/j.issn:0254-6450.2003.10.023 Lin DX, Tan W, Lu SX, et al. Molecular Epidemiology Studies of Esophageal Cancer in China[J]. Zhonghua Liu Xing Bing Xue Za Zhi, 2003, 24(10): 939-943. doi: 10.3760/j.issn:0254-6450.2003.10.023
[31] Wang AH, Liu Y, Wang B, et al. Epidemiological studies of esophageal cancer in the era of genome-wide association studies[J]. World J Gastrointest Pathophysiol, 2014, 5(3): 335-343. doi: 10.4291/wjgp.v5.i3.335
[32] Lin DC, Wang MR, Koeffler HP. Genomic and Epigenomic Aberrations in Esophageal Squamous Cell Carcinoma and Implications for Patients[J]. Gastroenterology, 2018, 154(2): 374-389. doi: 10.1053/j.gastro.2017.06.066
[33] Jiang JH, Pi J, Jin H, et al. Oridonin-induced mitochondria-dependent apoptosis in esophageal cancer cells by inhibiting PI3K/AKT/mTOR and Ras/Raf pathways[J]. J Cell Biochem, 2019, 120(3): 3736-3746. doi: 10.1002/jcb.27654
[34] Li W, Zhang L, Guo B, et al. Exosomal FMR1-AS1 facilitates maintaining cancer stem-like cell dynamic equilibrium via TLR7/NFκB/c-Myc signaling in female esophageal carcinoma[J]. Mol Cancer, 2019, 18(1): 22. doi: 10.1186/s12943-019-0949-7
[35] Pühringer-Oppermann F, Stahl M, Keller G, et al. Lack of prognostic impact of p53 gene mutation and p53 phosphorylation at serine 15 in multimodally treated adenocarcinomas of the gastroesophageal junction[J]. J Cancer Res Clin Oncol, 2006, 132(7): 433-438. doi: 10.1007/s00432-006-0085-9
[36] Song Y, Li L, Ou Y, et al. Identification of genomic alterations in oesophageal squamous cell cancer[J]. Nature, 2014, 509(7498): 91-95. doi: 10.1038/nature13176
[37] Deng J, Chen H, Zhou D, et al. Comparative genomic analysis of esophageal squamous cell carcinoma between Asian and Caucasian patient populations[J]. Nat Commun, 2017, 8(1): 1533. doi: 10.1038/s41467-017-01730-x
[38] Fan YJ, Song X, Li JL, et al. Esophageal and gastric cardia cancers on 4238 Chinese patients residing in municipal and rural regions: a histopathological comparison during 24-year period[J]. World J Surg, 2008, 32(9): 1980-1988. doi: 10.1007/s00268-008-9674-x
[39] Lee CH, Lee KW, Fang FM, et al. The neoplastic impact of tobacco-free betel-quid on the histological type and the anatomical site of aerodigestive tract cancers[J]. Int J Cancer, 2012, 131(5): E733-E743. doi: 10.1002/ijc.27401
[40] Chen ZH, Shao JL, Lin JR, et al. Reproductive factors and oesophageal cancer in Chinese women: a case-control study[J]. BMC Gastroenterol, 2011, 11: 49. doi: 10.1186/1471-230X-11-49
[41] Ekheden I, Yang X, Chen H, et al. Associations Between Gastric Atrophy and Its Interaction With Poor Oral Health and the Risk for Esophageal Squamous Cell Carcinoma in a High-Risk Region of China: A Population-Based Case-Control Study[J]. Am J Epidemiol, 2020, 189(9): 931-941. doi: 10.1093/aje/kwz283
[42] Yang H, Zhang S, Wang J, et al. Oral leukoplakia and the long-term risk of upper gastrointestinal cancer deaths in the Linxian dysplasia population[J]. Thorac Cancer, 2020, 11(10): 2804-2811. doi: 10.1111/1759-7714.13595
[43] 国家消化内镜专业质控中心, 国家消化系疾病临床医学研究中心(上海), 国家消化道早癌防治中心联盟, 等. 中国早期食管癌及癌前病变筛查专家共识意见(2019年, 新乡)[J]. 中华消化内镜杂志, 2019, 36(11): 793-801. doi: 10.3760/cma.j.issn.1007-5232.2019.11.001 National Quality Control Center of Digestive Endoscopy, National Clinical Research Center for Digestive Diseases (Shanghai), National Early Gastrointestinal-Cancer Prevention & Treatment Center Alliance(GECA), et al. China experts consensus on the protocal of early esophageal cancer and pre-cancerous lesion screening (2019, Xinxiang)[J]. Zhonghua Xiao Hua Nei Jing Za Zhi, 2019, 36(11): 793-801. doi: 10.3760/cma.j.issn.1007-5232.2019.11.001
[44] 刘璇, 张一方, 湛永乐, 等. 食管癌筛查队列操作流程与建设标准方案探讨[J]. 中华流行病学杂志, 2021, 42(8): 1504-1508. doi: 10.3760/cma.j.cn112338-20200930-01215 Liu X, Zhang YF, Zhan YL, et al. Study on the operation process and construction standard of an esophageal cancer screening cohort study[J]. Zhonghua Liu Xing Bing Xue Za Zhi, 2021, 42(8): 1504-1508. doi: 10.3760/cma.j.cn112338-20200930-01215
[45] 王贵齐, 魏文强. 上消化道癌筛查和早诊早治项目的新转变: 机会性筛查[J]. 中华预防医学杂志, 2019, 53(11): 1084-1087. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYD201502012.htm Wang GQ, Wei WQ. A new transition of the screening, early diagnosis and early treatment project of the upper gastrointestinal cancer: opportunistic screening[J]. Zhonghua Yu Fang Yi Xue Za Zhi, 2019, 53(11): 1084-1087. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYD201502012.htm
[46] Chen R, Liu Y, Song G, et al. Effectiveness of one-time endoscopic screening programme in prevention of upper gastrointestinal cancer in China: a multicentre population-based cohort study[J]. Gut, 2021, 70(2): 251-260.
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