Burden of esophageal cancer and its attributable risk factors in 204 countries and territories from 1990 to 2019

Global epidemiology of early-onset upper gastrointestinal cancer: trend from the Global Burden of Disease Study 2019

BACKGROUND AND AIM

In recent years, there has been a growing incidence of gastrointestinal cancer in young individuals. Despite its significant morbidity and mortality, research on upper gastrointestinal (UGI) cancer in young populations has been relatively limited. Therefore, studies on the epidemiological changes of this cancer are needed.

METHODS

Using data from the Global Burden of Disease Study 2019, we examined the incidence, death, and disability-adjusted life years (DALYs) from UGI cancers in the young, namely, early-onset esophageal cancer (EOEC) and early-onset gastric cancer (EOGC). These results were stratified by sex, geographical region, country, and sociodemographic index.

RESULTS

There was a total of 185 140 cases, 120 289 deaths, and 5.70 million DALYs attributable to early-onset UGI cancers globally. From 2010 to 2019, the global incidence, death, and DALYs rates of early-onset UGI cancers decreased. In contrast, the incidence rates increased in both EOEC (+1.15%) and EOGC (+0.21%) in the Eastern Mediterranean region.

CONCLUSIONS

Over the past decade, the burden of UGI cancer in the young has decreased. However, it has increased in the Eastern Mediterranean region. Further research to elucidate the attributable risk factors in this population is warranted.

Contribution of High Body Mass Index to the Global Burden of Esophageal Cancer: A Population-Based Study from 1990 to 2019

BACKGROUND

The changing patterns of obesity have had a significant impact on the epidemiology of esophageal cancer (EC).

AIMS

This study aimed to investigate the specific burden of EC associated with high body mass index (BMI) across different geographical and Sociodemographic Index (SDI) regions, using data from the Global Burden of Disease Study 2019.

METHODS

Mortality, age-standardized death rates (ASDR), and disability-adjusted life-years (DALYs) from 1990 to 2019 were analyzed for 204 countries and territories. Decomposition analysis, frontier and health inequality analyses, and age-period-cohort models were employed to examine the factors driving disease burden and to predict future trends.

RESULTS

High BMI contributed to 89,903.9 [95% uncertainty interval (UI): 27,878.9-171,254.6] EC-related deaths, an ASDR of 1.1 (95% UI 0.3-2.1) per 100,000 population, and 2,202,314.1 (681,901.4-4,173,080.3) DALYs in 2019. There was an increasing trend in these figures over the 29-year period. The middle SDI region (31,023.8, 95% UI 9,180.4-62,631.5) and East Asia (36,939.9, 95% UI 9,620.5-81,495) carried the highest burden of EC-related deaths. Disease burden increased across all age groups and genders globally. Population growth was a major factor driving EC deaths across all SDI quintiles. Disparities in disease burden were observed across countries at all development levels. Predictive models indicated a continued increase in EC-related deaths in the next decade.

CONCLUSIONS

The study provided a comprehensive understanding of the global burden of EC associated with high BMI over the past decades. Opportunities exist to reduce this burden at all SDI levels through targeted interventions and policies.

Hypoxia-induced SHMT2 protein lactylation facilitates glycolysis and stemness of esophageal cancer cells

Esophageal cancer (EC) is a familiar digestive tract tumor with highly lethal. The hypoxic environment has been demonstrated to be a significant factor in modulating malignant tumor progression and is strongly associated with the abnormal energy metabolism of tumor cells. Serine hydroxymethyl transferase 2 (SHMT2) is one of the most frequently expressed metabolic enzymes in human malignancies. The study was designed to investigate the biological functions and regulation mechanisms of SHMT2 in EC under hypoxia. We conducted RT-qPCR to assess SHMT2 levels in EC tissues and cells (TE-1 and EC109). EC cells were incubated under normoxia and hypoxia, respectively, and altered SHMT2 expression was evaluated through RT-qPCR, western blot, and immunofluorescence. The biological functions of SHMT2 on EC cells were monitored by performing CCK-8, EdU, transwell, sphere formation, glucose uptake, and lactate production assays. The SHMT2 protein lactylation was measured by immunoprecipitation and western blot. In addition, SHMT2-interacting proteins were analyzed by bioinformatics and validated by rescue experiments. SHMT2 was notably upregulated in EC tissues and cells. Hypoxia elevated SHMT2 protein expression, augmenting EC cell proliferation, migration, invasion, stemness, and glycolysis. In addition, hypoxia triggered lactylation of the SHMT2 protein and enhanced its stability. SHMT2 knockdown impeded the malignant phenotype of EC cells. Further mechanistic studies disclosed that SHMT2 is involved in EC progression by interacting with MTHFD1L. Hypoxia-induced SHMT2 protein lactylation and upregulated its protein level, which in turn enhanced MTHFD1L expression and accelerated the malignant progression of EC cells.

Spatiotemporal Patterns of Esophageal Cancer Burden Attributable to Behavioral, Metabolic, and Dietary Risk Factors From 1990 to 2019: Longitudinal Observational Study

BACKGROUND

Esophageal cancer (EC) is the sixth leading cause of cancer-related burden with distinct regional variations globally. Although the burden of EC has decreased, the specific reasons for this decline are still unclear.

OBJECTIVE

This study aims to uncover the spatiotemporal patterns of EC risk-attributable burden in 204 countries and territories from 1990 to 2019 so that prevention and control strategies of EC can be prioritized worldwide.

METHODS

We extracted EC risk-attributable deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMRs), and age-standardized DALY rates (ASDRs) from the global burden of disease (GBD) study from 1990 to 2019, in terms of behavioral, metabolic, and dietary factors by age, sex, and geographical location. Average annual percentage change (AAPC) was used to assess the long-term trends in the ASMRs and ASDRs of EC due to specific risk factors.

RESULTS

Between 1990 and 2019, the greatest decrease in EC burden was attributed to low intake of fruits and vegetables. An AAPC of -2.96 (95% CI -3.28 to -2.63) and -3.12 (95% CI -3.44 to -2.79) in ASMR and ASDR was attributable to a low-fruit diet, while an AAPC of -3.60 (95% CI -3.84 to -3.36) and -3.64 (95% CI -3.92 to -3.35) in ASMR and ASDR was attributed to a low-vegetable diet. However, the trends in ASMRs and ASDRs due to high BMI showed significant increases with an AAPC of 0.52 (95% CI 0.29-0.75) in ASMR and 0.42 (95% CI 0.18-0.66) in ASDR from 1990 to 2019 compared to significant decreases in other attributable risks with AAPC<0 (P<.05). East Asia had the largest decrease in EC burden due to low-vegetable diets, with an AAPC of -11.00 (95% CI -11.32 to -10.67) in ASMR and -11.81 (95% CI -12.21 to -11.41) in ASDR, followed by Central Asia, whereas Western Sub-Saharan Africa had the largest increase in ASMR and ASDR due to high BMI, with an AAPC of 3.28 (95% CI 3.14-3.42) and 3.09 (95% CI 2.96-3.22), respectively. China had the highest EC burden attributed to smoking, alcohol use, high BMI, and low-fruit diets. Between 1990 and 2019, there was a significant decrease in EC burden attributable to smoking, alcohol use, chewing tobacco, low-fruit diets, and low-vegetable diets in most countries, wherein a significant increase in the EC burden was due to high BMI.

CONCLUSIONS

Our study shows that smoking and alcohol consumption are still the leading risk factors of EC burden and that EC burden attributable to low intake of fruits and vegetables has shown the largest decline recently. The risks of ASMRs and ASDRs of EC showed distinct spatiotemporal patterns, and future studies should focus on the upward trend in the EC burden attributed to high BMI.

Burden of esophageal cancer between 2010 and 2019 in Asian countries by geographical region and sociodemographic index: A comparison with global data

BACKGROUND

The aim of this study was to describe the trends in incidence, mortality, and burden of esophageal cancer (EC) in Asia from 2010 through 2019 and compare with other global continental data.

METHODS

We collected EC data from the 2019 Global Burden of Disease study from 2010 to 2019 in 49 countries and territories in Asia based on the sociodemographic index (SDI). For all locations, annual case data and age-standardized rates (ASRs) were extracted to investigate the EC incidence, prevalence, mortality, and disability-adjusted life-years (DALYs). The ASR relative difference (%) between years and the male/female (M/F) ratio were calculated. Data are reported in values and 95% uncertainty interval (UI).

RESULTS

In 2019, more than 70% of EC new cases, deaths, prevalence, and DALYs occurred in Asian countries. From 2010 to 2019, incidences, deaths, prevalence cases, and DALY number of EC increased over 1.10-, 1.07-, 1.14-, and 1.03-fold, in Asia. During this period, the age-standardized incidence rate (ASIR), age-standardized death rate (ASDR), age-standardized prevalence rate (ASPR), and age-standardized DALYs rate (DALYs ASR) of EC decreased by 18, 21, 14, and 22%, respectively. The rate of decline in Asia is higher than in the world and other continents. In 2019, age-specific incidence, death, prevalence, and DALY cases of EC cancer peaked at 65-74, 70-74, 65-69, and 65-69 years, respectively. In 2019, the highest ASIR, ASDR, ASPR, and DALYs ASR of EC were observed in East Asian countries, while having the highest decreasing trend. In 2019, among high SDI Asian countries, Taiwan had the highest ASIR, ASPR, and DALYs ASR, and the United Arab Emirates had the highest ASDR. Among high-middle SDIs, Kazakhstan had the highest ASIR, ASPR, ASDR, and DALYs ASR; among middle SDIs, China had the highest ASIR, ASDR, and ASPR, and Viet Nam had the highest DALYs ASR; among low-middle SDIs, Mongolia had the highest ASIR, ASDR, ASPR, and DALY ASR of EC cancer. Among low SDI Asian countries, Pakistan had the highest ASIR and ASPR, and DALY ASR for EC cancer. For four indicators, in most countries, the ratio of men was higher than women, and in some countries, this ratio reached more than 10 times.

CONCLUSION

Although the rate of decline in incidence, death, prevalence and burden of EC in Asia was higher than in other areas in the last 10 years, more than 70% of these amounts occur in Asia. Therefore, it appears that adopting appropriate strategies in the field of identifying and controlling modifiable risk factors for EC, implementing screening programs, and timely diagnosis and treatment will help in reducing the burden of this disease in Asian countries.

Global incidence, mortality, and burden of esophageal cancer, and its correlation with SDI, metabolic risks, fasting plasma glucose, LDL cholesterol, and body mass index: An ecological study

Background and Aims

Esophageal cancer (EC) is one of the most common gastrointestinal malignancies. The geographical variation shows the influence of genetic factors, ethnicity, and distribution of various risk factors. Accurate knowledge of EC epidemiology at the global level will help to develop management strategies. Therefore, the present study was conducted to investigate the global and regional disease burden of EC, including the incidence, mortality, and burden of this cancer in 2019.

Methods

Incidence, mortality, disability-adjusted life years (DALYs), and age-standardized rates (ASRs) associated with EC in 204 countries in different classifications were extracted from the global burden of disease study. After collecting information on metabolic risks, fasting plasma glucose (FPG), low-density lipoprotein (LDL) cholesterol, and body mass index (body mass index), the relationship between age-standardized incidence rate (ASIR), mortality rate, and DALYs with these variables was determined.

Results

In 2019, 534,563 new cases of EC were reported worldwide. The highest ASIR is related to regions with medium sociodemographic index (SDI), and high middle income according to the World Bank, the Asian continent, and the western Pacific region. In 2019, a total of 498,067 deaths from EC were recorded. The highest mortality rate due to ASR is in countries with medium SDI and countries with upper middle income of the World Bank. In 2019, 1,166,017 DALYs were reported due to EC. The ASIR, ASDR, and DALYS ASR of EC showed a significant negative linear correlation with SDI, metabolic risks, high FPG, high LDL cholesterol, and high BMI (p < 0.05).

Conclusions

The results of this study showed significant gender and geographic variation in the incidence, mortality, and burden of EC. It is recommended to design and implement preventive approaches based on known risk factors and improve quality and access to efficient and appropriate treatments.

Analysis of living habit risk factors for esophageal cancer in central China: A bi-center case-control study

Background

Esophageal cancer remains a public health problem in many countries, especially developing countries. The early lifestyle preventive measures mentioned in the treatment guidelines for esophageal cancer are very limited. We aimed to evaluate the risk factors for esophageal cancer in a high-incidence area in China and to provide evidence for clinical intervention in esophageal cancer prevention.

Methods

Symptom and lifestyle/habit questionnaires including 19 items were designed. The correlation between the occurrence of esophageal cancer and living habits was analyzed retrospectively through questionnaire survey. A total of 708 subjects (365 esophageal cancer, 343 non-esophageal cancer) enrolled from two hospitals in central China (Linzhou Esophageal Cancer Hospital and The Third Xiangya Hospital of Central South University) completed symptom and lifestyle/habit questionnaires. We used conditional logistic regression to estimate the odds ratio (OR) with consideration of 95% confidence interval (CI).

Results

The composition ratio analysis showed that the top five lifestyle factors related to esophageal cancer were eating too fast, drinking, hot drinks, smoking and overeating. Univariate analysis showed that 15 factors, including male sex, smoking, drinking, eating too fast, overeating, hot drinks, greasy food, acidic food, hard food, strong tea, coffee, bedtime immediately after meals, eating food before bedtime, difficult defecation, and an overtight belt, were associated with esophageal cancer (all P <0.05). Logistic multivariate regression analysis showed, drinking (OR 3.609, 95%CI 2.223-5.859; P=0.000); hot drinks (OR 2.672, 95%CI 1.786-3.997; P=0.000); overeating (OR 2.110, 95%CI 1.411-3.154; P=0.000); eating too fast (OR 1.879, 95%CI 1.274-2.772; P=0.001); strong tea (OR 1.882, 95%CI 1.171~3.023; P=0.009); hard food (OR 1.723, 95%CI 1.113-2.667; P=0.015); smoking (OR 1.686, 95%CI 1.045-2.720; P=0.032), which were significantly associated with the development of esophageal cancer.

Conclusion

The unhealthy lifestyles of patients in high-incidence areas of esophageal cancer in central China are significantly associated with the incidence of esophageal cancer. Lifestyle changes that address these factors, especially overeating and eating too fast, which are rarely studied or discussed despite being common, may improve esophageal cancer management and treatment outcomes. The present results may be used as a reference for preventive education and treatment.

Efficacy of modified thoraco-laparoscopic Ivor-Lewis versus traditional thoraco-laparoscopic Ivor-Lewis for esophageal cancer: Propensity score-matched analysis

Objective

To compare the clinical results of the modified Ivor-Lewis procedure, which preserves the azygous vein, thoracic duct and surrounding tissues, with the traditional Ivor-Lewis procedure, which removes these tissues, for treating esophageal squamous cell carcinoma, and evaluating whether the azygous vein, thoracic duct and surrounding tissues are required to be removed for the surgery of esophageal cancer.

Methods

To retrospectively analyze the clinical data of patients suffering from esophageal cancer treated by thoracic-laparoscopic Ivor-Lewis procedure admitted to the Department of Thoracic Surgery of Gansu Provincial People's Hospital from September 2017 to September 2019. According to the surgical method, they were divided into the modified thoracolaparoscopic Ivor-Lewis (modified group) and the traditional thoracolaparoscopic Ivor-Lewis (traditional group). Propensity score matching analysis (PSM) was applied to reduce the selection bias of confounding factors.

Results

A total of 245 patients who suffered from esophageal cancer and underwent thoracic-laparoscopic Ivor-Lewis were enrolled in the study. There were 124 cases in the modified group and 121 cases in the traditional group. The discrepancies in the age and T-stage among patients in the traditional and modified groups were statistically significant. After PSM, the above-mentioned factors became statistically insignificant. There were 86 patients in each group after PSM. Compared with the traditional group, the modified group has shorter operative time (p=0.007), less intraoperative bleeding (p=0.003) and less postoperative 3 days chest drainage(p=0.001), with a statistically significant difference. No significant difference in local recurrence (p=0.721) and distant metastasis (p=0.742) after surgery were found in the two groups, and the difference was not statistically significant. There was also no statistically significant difference in the 3-year postoperative survival rate (44.2% vs. 41.9%, p=0.605) between the modified and traditional groups.

Conclusion

The modified Ivor-Lewis procedure, which preserves the azygous vein, thoracic duct, and surrounding tissue, reduces surgical trauma in esophageal cancer, has not increased postoperative recurrent metastases, while achieved the same long-term outcomes as expanded surgery.